Table 3.
Postnatal care validation results: Kenya, pooled data collection rounds 2009-2012
| Indicator | Total Matched N* |
Observer Report: Prevalence of Intervention (%) | Woman’s Self Report: Prevalence of Intervention (%) | Sensitivity (%) | Specificity (%) | Estimated Survey Prevalence† (%) |
IF‡ |
AUC (95% CI) | Met AUC & IF? | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Physical examination of the mother: | ||||||||||||
| Blood pressure check |
319 |
41.1 |
39.8 |
78.7 (70.6, 85.5) |
83.9 (77.9, 88.8) |
41.9 |
1.02 |
0.813 (0.769, 0.857) |
Yes |
|||
| Breast exam |
316 |
31.0 |
29.1 |
75.0 (64.9, 83.4) |
87.1 (81.9, 91.2) |
32.2 |
1.04 |
0.810 (0.761, 0.86) |
Yes |
|||
| Examine abdomen |
320 |
33.1 |
24.4 |
83.3 (73.2, 90.8) |
83.1 (77.7, 87.6) |
38.9 |
1.18 |
0.832 (0.784, 0.88) |
Yes |
|||
| Examine vagina |
309 |
20.4 |
8.1 |
56.0 (34.9, 75.6) |
82.7 (77.8, 87.0) |
25.2 |
1.23 |
0.694 (0.592, 0.795) |
No |
|||
| Screen for cervical cancer |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
|||
| Check anemia§ |
310 |
29.0 |
32.3 |
60.0 (49.7, 69.7) |
85.7 (80.2, 90.1) |
27.5 |
0.95 |
0.729 (0.675, 0.782) |
Yes |
|||
|
Advice/screening on health risks for mother: | ||||||||||||
| Ask about excessive bleeding |
316 |
40.8 |
31.3 |
83.8 (75.1, 90.5) |
78.8 (72.8, 84) |
46.8 |
1.15 |
0.813 (0.768, 0.859) |
Yes |
|||
| Discuss danger signs after birth|| |
318 |
29.2 |
37.1 |
61.0 (51.6, 69.9) |
89.5 (84.4, 93.4) |
25.3 |
0.86 |
0.753 (0.704, 0.802) |
Yes |
|||
| Discuss STIs or HIV/AIDS |
321 |
34.6 |
35.8 |
68.7 (59.4, 77) |
84.5 (78.8, 89.1) |
33.9 |
0.98 |
0.766 (0.717, 0.815) |
Yes |
|||
|
Counseling on family planning/return to fertility: | ||||||||||||
| Discuss how soon after delivery a woman can get pregnant |
535 |
25.8 |
30.5 |
48.5 (40.6, 56.4) |
84.1 (80, 87.7) |
24.3 |
0.94 |
0.663 (0.620, 0.706) |
No |
|||
| Discuss return to fertility |
543 |
22.8 |
30.8 |
48.5 (40.7, 56.3) |
88.6 (84.9, 91.6) |
19.9 |
0.87 |
0.685 (0.644, 0.727) |
No |
|||
| Discuss benefits of birth spacing |
320 |
30.3 |
44.4 |
55.6 (47.1, 64) |
89.9 (84.5, 93.9) |
23.9 |
0.79 |
0.728 (0.681, 0.774) |
Yes |
|||
| Discuss return to sexual activity |
540 |
15.9 |
17.0 |
50.0 (39.4, 60.6) |
91.1 (88.0, 93.5) |
15.5 |
0.97 |
0.705 (0.652, 0.758) |
Yes |
|||
| Discuss family planning (FP) method (incl. natural methods)¶ |
355 |
65.6 |
60.8 |
93.1 (88.8, 96.1) |
77 (69.1, 83.7) |
69.0 |
1.05 |
0.850 (0.811, 0.889) |
Yes |
|||
| Receive any modern FP method** |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
|||
| Explains advan/disad of chosen FP method |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
NA |
|||
|
Postnatal care for the newborn: | ||||||||||||
| Discuss breastfeeding/feeding for baby |
529 |
62.2 |
66.9 |
79.4 (74.8, 83.5) |
72.6 (65.3, 79.0) |
59.7 |
0.96 |
0.760 (0.72, 0.799) |
Yes |
|||
| Examine baby (undressed) |
307 |
74.6 |
60.3 |
82.7 (76.5, 87.9) |
37.7 (29.1, 46.9) |
77.5 |
1.04 |
0.602 (0.551, 0.653) |
No |
|||
| Weigh the baby |
307 |
92.2 |
85.3 |
96.6 (93.6, 98.4) |
33.3 (20.0, 49.0) |
94.2 |
1.02 |
0.649 (0.579, 0.72) |
No |
|||
| Immunize baby |
455 |
87.7 |
87.0 |
96.2 (93.8, 97.9) |
69.5 (56.1, 80.8) |
88.1 |
1.00 |
0.829 (0.769, 0.889) |
Yes |
|||
| Gave information on baby’s sickness signs†† |
355 | 61.4 | 46.2 | 81.7 (74.9, 87.3) | 56 (48.7, 63.2) |
67.1 | 1.09 |
0.689 (0.643, 0.735) |
No | |||
CI – confidence interval, AUC – area under the receiver operating curve, IF – inflation factor
NA = estimate suppressed due to low sample size (n <5 per cell of 2 by 2 table). Numbers in bold: Meets criteria for high individual level accuracy (AUC>0.70) and/or low population-level bias (0.75<IF<1.25). Numbers in italics: Meets criteria for moderate individual-level accuracy (0.60≤AUC≤0.70).
*Sample sizes vary by indicator as not all questions were asked in each survey round and due to participant non-response.
†Estimated survey prevalence calculated using equation: P × (SE + SP – 1) – (1 – SP), where P = Observed prevalence, SE = Sensitivity (proportion of true positives correctly classified by clients), SP = Specificity (proportion of true negatives correctly classified by clients).
‡Inflation Factor (IF) = Estimated survey-based prevalence / Observed prevalence.
§Anemia checked by referral for blood test or by checking woman’s pallor (examine finger nails or lower eyelid).
||Danger signs for mother include: foul smelling discharge, fever, bleeding, broken scars, painful nipples, painful breasts.
¶Natural family planning methods include abstinence and lactational amenorrhea.
**Modern methods include injectables, pill, IUD, implant, progestin-only (breastfeeding mothers), condom use and sterilization.
††Danger signs for baby include difficulties feeding, difficulties breathing, body feels hot/cold or jaundice.