Table 4.
Postnatal care validation results: Swaziland, Pooled Data Collection Rounds 2009-2012
| Indicator | Total Matched N* | Observer Report: Prevalence of Intervention (%) | Woman’s Self-Report: Prevalence of Intervention (%) | Sensitivity (%) | Specificity (%) | Est. Survey Prev.† (%) | IF‡ | AUC (95% CI) | Met AUC & IF? |
|---|---|---|---|---|---|---|---|---|---|
|
Physical examination of the mother: | |||||||||
| Blood pressure check |
114 |
74.6 |
74.6 |
83.5 (73.9, 90.7) |
51.7 (32.5, 70.6) |
74.6 |
1.00 |
0.676 (0.58, 0.78) |
No |
| Breast exam |
117 |
72.6 |
74.4 |
86.2 (77.1, 92.7) |
66.7 (47.2, 82.7) |
71.7 |
0.99 |
0.764 (0.67, 0.86) |
Yes |
| Examine abdomen |
112 |
64.3 |
75.0 |
75.0 (64.4, 83.8) |
67.9 (47.6, 84.1) |
59.7 |
0.93 |
0.714 (0.61, 0.81) |
Yes |
| Examine vagina |
112 |
71.4 |
74.1 |
83.1 (73.3, 90.5) |
62.1 (42.3, 79.3) |
70.2 |
0.98 |
0.726 (0.63, 0.82) |
Yes |
| Screen for cervical cancer |
121 |
48.8 |
17.4 |
81.0 (58.1, 94.6) |
58.0 (47.7, 67.8) |
61.0 |
1.25 |
0.695 (0.60, 0.79) |
No |
| Check anemia§ |
113 |
38.9 |
70.8 |
42.5 (31.5, 54.1) |
69.7 (51.3, 84.4) |
35.0 |
0.90 |
0.561 (0.46, 0.66) |
No |
|
Advice/screening on health risks for mother: | |||||||||
| Ask about excessive bleeding |
115 |
61.7 |
35.7 |
65.9 (49.4, 79.9) |
40.5 (29.3, 52.6) |
63.4 |
1.03 |
0.532 (0.44, 0.62) |
No |
| Discuss danger signs after birth|| |
115 |
49.6 |
52.2 |
58.3 (44.9, 70.9) |
60.0 (45.9, 73.0) |
49.1 |
0.99 |
0.592 (0.50, 0.68) |
No |
| Discuss STIs or HIV/AIDS |
113 |
63.7 |
49.6 |
64.3 (50.4, 76.6) |
36.8 (24.4, 50.7) |
63.9 |
1.00 |
0.506 (0.42, 0.60) |
No |
| Counseling on family planning/ return to fertility: | |||||||||
| Discuss how soon after delivery a woman can get pregnant |
170 |
25.9 |
50.6 |
32.6 (22.8, 43.5) |
81 (70.9, 88.7) |
22.5 |
0.87 |
0.568 (0.5, 0.63) |
No |
| Discuss return to fertility |
169 |
16.6 |
50.3 |
23.5 (15.0, 34.0) |
90.5 (82.1, 95.8) |
11.8 |
0.71 |
0.57 (0.51, 0.63) |
No |
| Discuss benefits of birth spacing |
190 |
35.3 |
66.3 |
42.1 (33.3, 51.2) |
78.1 (66, 87.5) |
29.0 |
0.82 |
0.601 (0.53, 0.67) |
No |
| Discuss return to sexual activity |
172 |
24.4 |
49.4 |
38.8 (28.4, 50.0) |
89.7 (81.3, 95.2) |
17.3 |
0.71 |
0.642 (0.58, 0.7) |
No |
| Discuss family planning (FP) method (incl. natural methods)¶ |
189 |
78.8 |
69.8 |
78.0 (70, 84.8) |
19.3 (10, 31.9) |
78.6 |
1.00 |
0.487 (0.42, 0.55) |
No |
| Receive any modern FP method** |
217 |
65.0 |
74.2 |
79.5 (72.4, 85.5) |
76.8 (63.6, 87) |
59.8 |
0.92 |
0.781 (0.72, 0.85) |
Yes |
| Explains advan/disadv of chosen FP method |
231 |
41.1 |
46.8 |
53.7 (43.8, 63.3) |
69.9 (61, 77.9) |
39.8 |
0.97 |
0.618 (0.56, 0.68) |
No |
|
Postnatal care for newborn: | |||||||||
| Discuss breastfeeding/feeding for baby |
279 |
83.9 |
95.7 |
NA |
NA |
NA |
NA |
NA |
NA |
| Examine baby (undressed) |
118 |
92.4 |
80.5 |
95.8 (89.6, 98.8) |
21.7 (7.5, 43.7) |
94.5 |
1.02 |
0.588 (0.50, 0.68) |
No |
| Weigh the baby |
117 |
96.6 |
96.6 |
NA |
NA |
NA |
NA |
NA |
NA |
| Immunize baby |
309 |
87.1 |
81.2 |
93.2 (89.4, 96.0) |
39.7 (27, 53.4) |
89.0 |
1.02 |
0.664 (0.60, 0.73) |
No |
| Gave information on baby’s sickness signs†† | 166 | 59.0 | 67.5 | 60.7 (51.0, 69.8) | 44.4 (30.9, 58.6) | 58.6 | 0.99 | 0.526 (0.44, 0.61) | No |
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.