Table 3.
Validation analyses: comparing birth observations with women’s self-reports at facility exit interviews, women’s self-reports at household follow-up interviews nine to 22 months after childbirth, and health worker documentation in maternity registers
| Birth observations (gold standard) |
Comparison data recording method*,† |
Matched pairs |
|||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
N |
Prevalence (95% CI) |
N |
Don’t know (%) |
Prevalence (95% CI) |
Matched pairs, N |
Agreement (%) |
5 counts per cell? |
Sensitivity (95% CI) |
Specificity (95% CI) |
AUC‡ (95% CI) |
IF‡ |
Criteria met‡ |
|
|
Skilled birth attendance and companionship during labor and delivery: | |||||||||||||
| Main provider – doctor, nurse, or midwife: | |||||||||||||
| 1889 |
10 (4-24) |
Exit interview, women’s self-report |
1775 |
0 |
32 (24-41) |
1775 |
72 |
Yes |
67 (60-74) |
72 (70-75) |
0.70 (0.66-0.73) |
3.04 |
AUC |
| 445 |
13 (5-27) |
Follow-up interview, women’s self-report |
426 |
0 |
48 (37-60) |
426 |
55 |
Yes |
62 (48-75) |
54 (49-59) |
0.58 (0.51-0.65) |
3.76 |
none |
| 1516 |
12 (4-31) |
Maternity register, health worker documentation |
1327 |
0 |
12 (4-29) |
1327 |
97 |
Yes |
92 (87-96) |
98 (97-99) |
0.95 (0.93-0.97) |
1.05 |
AUC, IF |
| More than one provider present at birth: | |||||||||||||
| 1869 |
57 (45-68) |
Exit interview, women’s self-report |
1774 |
0 |
58 (48-66) |
1755 |
93 |
Yes |
95 (93-96) |
90 (88-92) |
0.93 (0.91-0.94) |
1.02 |
AUC, IF |
| 444 |
55 (43-67) |
Follow-up interview, women’s self-report |
426 |
0 |
80 (67-89) |
418 |
60 |
Yes |
86 (80-90) |
26 (20-33) |
0.56 (0.52-0.60) |
1.45 |
none |
| Support person present at birth: | |||||||||||||
| 1127 |
35 (22-49) |
Exit interview, women’s self-report |
1075 |
0 |
57 (41-72) |
1067 |
75 |
Yes |
97 (94-98) |
64 (60-67) |
0.80 (0.78-0.82) |
1.65 |
AUC |
| 443 |
31 (17-50) |
Follow-up interview, women’s self-report |
426 |
0 |
82 (74-88) |
419 |
41 |
Yes |
88 (81-93) |
21 (16-26) |
0.54 (0.51-0.58) |
2.64 |
none |
|
Care for the woman: | |||||||||||||
| Maternal age at delivery (adolescent births):§ | |||||||||||||
| 1516 |
20 (17-24) |
Maternity register, Health worker documentation |
1472 |
0 |
20 (17-23) |
1463 |
98 |
Yes |
95 (92-97) |
99 (98-100) |
0.97 (0.96-0.98) |
0.98 |
AUC, IF |
| Prior parity (prior parity, 4 or more births):§ | |||||||||||||
| 1515 |
47 (42-52) |
Maternity register, health worker documentation |
1474 |
0 |
49 (43-56) |
1471 |
93 |
Yes |
95 (94-97) |
91 (88-93) |
0.93 (0.92-0.94) |
1.06 |
AUC, IF |
| Woman allowed to move and change position during labor: | |||||||||||||
| 712 |
78 (66-87) |
Exit interview, women’s self-report |
1075 |
1 |
71 (58-81) |
674 |
84 |
Yes |
92 (89-94) |
57 (49-66) |
0.75 (0.70-0.79) |
1.04 |
AUC, IF |
| Woman allowed to drink liquids and eat during labor: | |||||||||||||
| 712 |
91 (88-93) |
Exit interview, women’s self-report |
1075 |
1 |
92 (88-94) |
674 |
91 |
Yes |
98 (96-99) |
25 (14-37) |
0.61 (0.56-0.67) |
1.05 |
IF |
| Woman allowed to deliver in preferred position: | |||||||||||||
| 773 |
52 (43-61) |
Exit interview, women’s self-report |
1075 |
1 |
75 (66-83) |
691 |
81 |
Yes |
95 (92-97) |
63 (58-69) |
0.79 (0.76-0.82) |
1.29 |
AUC |
| Woman allowed to have support person at birth: | |||||||||||||
| 1885 |
63 (43-80) |
Exit interview, women’s self-report |
1773 |
1 |
59 (41-75) |
1757 |
85 |
Yes |
85 (83-87) |
85 (82-88) |
0.85 (0.83-0.87) |
0.94 |
AUC, IF |
| 443 |
60 (36-80) |
Follow-up interview, women’s self-report |
426 |
1 |
67 (56-77) |
422 |
57 |
Yes |
71 (65-76) |
36 (29-44) |
0.53 (0.49-0.58) |
1.14 |
IF |
| Birth attendant washed hands with soap before examinations: | |||||||||||||
| 1872 |
30 (21-41) |
Exit interview, women’s self-report |
1775 |
16 |
40 (31-49) |
1492 |
81 |
Yes¶ |
– |
– |
– |
– |
– |
| 444 |
19 (13-26) |
Follow-up interview, women’s self-report |
426 |
16 |
77 (65-85) |
359 |
26 |
No |
– |
– |
– |
– |
– |
| Birth attendant wore gloves during examinations: | |||||||||||||
| 1872 |
75 (66-83) |
Exit interview, women’s self-report |
1775 |
0 |
98 (98-99) |
1769 |
75 |
Yes |
98 (98-99) |
2 (1-3) |
0.50 (0.49-0.51) |
1.30 |
none |
| 444 |
90 (73-97) |
Follow-up interview, women’s self-report |
426 |
1 |
98 (94-99) |
419 |
90 |
No |
– |
– |
– |
– |
– |
| Partograph used to monitor labor and delivery: | |||||||||||||
| 1516 |
21 (14-29) |
Maternity register, health worker documentation |
1308 |
0 |
39 (29-50) |
1306 |
79 |
Yes |
95 (91-97) |
75 (72-77) |
0.84 (0.83-0.87) |
1.92 |
AUC |
| Blood pressure taken – initial client assessment: | |||||||||||||
| 1515 |
31 (21-44) |
Exit interview, women’s self-report |
1435 |
0 |
34 (23-47) |
1429 |
92 |
Yes |
91 (88-94) |
92 (90-93) |
0.91 (0.90-0.93) |
1.10 |
AUC, IF |
| 444 |
22 (10-43) |
Follow-up interview, women’s self-report |
426 |
2 |
58 (48-67) |
417 |
56 |
Yes |
82 (73-89) |
48 (43-54) |
0.65 (0.60-0.70) |
2.62 |
none |
| Episiotomy performed: | |||||||||||||
| 1504 |
1 (1-2) |
Exit interview, women’s self-report |
1435 |
0 |
2 (1-3) |
1429 |
98 |
No |
– |
– |
– |
– |
– |
| 444 |
1 (0-4) |
Follow-up interview, women’s self-report |
426 |
2 |
9 (1-17) |
424 |
91 |
No |
– |
– |
– |
– |
– |
| Prophylactic uterotonic administered during third stage of labor to prevent postpartum haemorrhage: | |||||||||||||
| 1867 |
96 (93-98) |
Exit interview, women’s self-report |
1775 |
0 |
94 (92-95) |
1763 |
93 |
Yes |
95 (94-96) |
33 (22-45) |
0.64 (0.58-0.70) |
0.98 |
IF |
| 442 |
96 (93-97) |
Follow-up interview, women’s self-report |
426 |
1 |
83 (78-87) |
420 |
82 |
Yes |
84 (80-88) |
26 (9-51) |
0.55 (0.45-0.66) |
0.88 |
IF |
| 1501 |
96 (92-98) |
Maternity register, health worker documentation |
1338 |
0 |
93 (90-95) |
1332 |
90 |
No |
– |
– |
– |
– |
– |
|
Care for the newborn: | |||||||||||||
| Mother and newborn kept in the same room after delivery: | |||||||||||||
| 1755 |
97 (96-98) |
Exit interview, women’s self-report |
1775 |
1 |
96 (94-97) |
1704 |
97 |
Yes |
98 (97-99) |
40 (24-58) |
0.69 (0.61-0.77) |
1.00 |
IF |
| 427 |
95 (90-98) |
Follow-up interview, women’s self-report |
426 |
0 |
88 (81-93) |
406 |
85 |
No |
– |
– |
– |
– |
– |
| Essential newborn care:‖ | |||||||||||||
| 1889 |
42 (29-56) |
Exit interview, women’s self-report |
1774 |
0 |
51 (36-65) |
1774 |
87 |
Yes |
92 (90-94) |
83 (81-85) |
0.88 (0.86-0.89) |
1.15 |
AUC, IF |
| 445 |
36 (19-57) |
Follow-up interview, women’s self-report |
445 |
0 |
64 (44-80) |
445 |
60 |
Yes |
83 (76-89) |
47 (41-53) |
0.65 (0.61-0.69) |
1.77 |
none |
| 1516 |
39 (26-53) |
Maternity register, health worker documentation |
1297 |
0 |
95 (90-97) |
1297 |
44 |
Yes |
97 (95-98) |
6 (5-8) |
0.52 (0.51-0.53) |
2.46 |
none |
| Newborn immediately dried with a towel: | |||||||||||||
| 1472 |
95 (89-98) |
Exit interview, women’s self-report |
1435 |
2 |
94 (89-97) |
1393 |
98 |
Yes |
99 (98-99) |
68 (53-81) |
0.83 (0.77-0.90) |
1.00 |
AUC, IF |
| 430 |
91 (81-96) |
Follow-up interview, women’s self-report |
426 |
3 |
91 (78-97) |
397 |
86 |
No |
– |
– |
– |
– |
– |
| Newborn immediately placed skin-to-skin: | |||||||||||||
| 1759 |
77 (57-89) |
Exit interview, women’s self-report |
1775 |
3 |
72 (53-85) |
1681 |
94 |
Yes |
94 (92-95) |
93 (90-95) |
0.93 (0.92-0.95) |
0.96 |
AUC, IF |
| 427 |
67 (38-87) |
Follow-up interview, women’s self-report |
426 |
1 |
75 (50-90) |
402 |
78 |
Yes |
90 (86-94) |
52 (43-61) |
0.71 (0.66-0.76) |
1.15 |
AUC, IF |
| Immediate initiation of breastfeeding: | |||||||||||||
| 1744 |
49 (34-63) |
Exit interview, women’s self-report |
1775 |
2 |
51 (37-65) |
1686 |
90 |
Yes |
94 (92-95) |
87 (84-89) |
0.90 (0.89-0.92) |
1.08 |
AUC, IF |
| 424 |
42 (23-63) |
Follow-up interview, women’s self-report |
426 |
0 |
67 (46-83) |
404 |
62 |
Yes |
87 (81-92) |
44 (38-50) |
0.66 (0.62-0.70) |
1.66 |
none |
| Chlorhexidine administered to newborn’s cord to prevent infection: | |||||||||||||
| 1425 |
85 (74-92) |
Exit interview, women’s self-report |
1435 |
5 |
80 (68-89) |
1323 |
95 |
Yes |
96 (95-97) |
84 (77-89) |
0.90 (0.87-0.93) |
0.99 |
AUC, IF |
| Baby weighed at birth: | |||||||||||||
| 1785 |
84 (76-90) |
Exit interview, women’s self-report |
1774 |
9 |
80 (64-90) |
1603 |
86 |
Yes¶ |
– |
– |
– |
– |
– |
| 439 |
78 (71-84) |
Follow-up interview, women’s self-report |
426 |
11 |
62 (40-80) |
377 |
66 |
Yes¶ |
– |
– |
– |
– |
– |
| 1439 |
90 (76-96) |
Maternity register, health worker documentation |
1421 |
0 |
94 (84-98) |
1403 |
87 |
Yes |
95 (93-96) |
16 (10-23) |
0.55 (0.52-0.58) |
1.04 |
IF |
| Newborn outcome: low birth weight§: | |||||||||||||
| 1604 |
5 (3-8) |
Exit interview, women’s self-report |
1424 |
57 |
3 (1-5) |
606 |
98 |
Yes¶ |
– |
– |
– |
– |
– |
| 1432 |
6 (3-10) |
Maternity register, health worker documentation |
1338 |
0 |
17 (9-32) |
1180 |
83 |
Yes |
62 (50-73) |
85 (83-87) |
0.73 (0.68-0.79) |
3.22 |
AUC |
| Newborn outcome: pre-term birth: | |||||||||||||
| 1515 |
2 (1-7) |
Maternity register, health worker documentation |
1169 |
0 |
2 (1-7) |
1167 |
99 |
No |
– |
– |
– |
– |
– |
| Newborn outcome: stillbirth: | |||||||||||||
| 1516 | 3 (1-6) | Maternity register, health worker documentation | 1375 | 0 | 3 (1-5) | 1365 | 99 | Yes | 82 (66-92) | 100 (99-100) | 0.91 (0.84-0.97) | 0.97 | AUC, IF |
CI – confidence interval, IF – inflation factor, AUC - area under the receiver operating curve
*Observed women were interviewed before discharge from the facility (exit interview) and at home nine to 22 mo after childbirth (follow-up interview). Health workers documented childbirth events in facility maternity registers.
†For health worker documentation in facility maternity registers, data were available for 4 of 5 data collection rounds (N = 1516 observations): March 2017, August 2017, March 2018, and August 2018. For exit interviews, data from June 2016 data collection (round 1) were not available for: (i) blood pressure taken – initial client assessment; (ii) episiotomy performed; (iii) newborn immediately dried with a towel; and (iv) chlorhexidine applied to newborn’s cord to prevent infection. For exit interviews, data from June 2016 and March 2017 data collection (rounds 1 and 2) were not available for: (i) woman allowed to move and change positions during labor; (ii) woman allowed to drink and eat during labor; and (iii) woman allowed to deliver in preferred position.
‡AUC = area under the receiver operating characteristic curve; IF = inflation factor. AUC criteria for high reporting accuracy: AUC≥0.7; IF criteria for low population bias: 0.75<IF<1.25.
§For validation analyses, the following indicators were converted into binary variables: age at delivery (adolescent births); prior parity (prior parity, four or more births); and baby’s birthweight (low birthweight, <2500 g).
‖In the facility maternity register, essential newborn care is a composite indicator for (i) immediate initiation of breastfeeding and (ii) baby kept warm.
¶For these indicators with >5 observations per cell, validation analyses were not conducted due to >5% “don’t know” responses.