Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar

Sumiyo Okawa; Hla Hla Win; Hannah H Leslie; Keiko Nanishi; Akira Shibanuma; Phyu Phyu Aye; Masamine Jimba

doi:10.1136/bmjgh-2018-001078

Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar

BMJ Glob Health. 2019 Mar 19;4(2):e001078. doi: 10.1136/bmjgh-2018-001078. eCollection 2019.

Authors

Sumiyo Okawa^{1

2}, Hla Hla Win³, Hannah H Leslie⁴, Keiko Nanishi⁵, Akira Shibanuma¹, Phyu Phyu Aye⁶, Masamine Jimba¹

Affiliations

¹ Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
² Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
³ Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, The Republic of the Union of Myanmar.
⁴ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁵ Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
⁶ Department of Public Health, Ministry of Health and Sports, Naypyidaw, The Republic of the Union of Myanmar.

Abstract

Introduction: Access to maternal and newborn healthcare has improved in Myanmar. However, regular contact with skilled care providers does not necessarily result in quality care. We assessed adequate contact made by women and newborns with skilled care providers, reception of high-quality care and quality-adjusted contacts during antenatal care (ANC), peripartum care (PPC) and postnatal care (PNC) in Myanmar.

Methods: This cross-sectional study was conducted in a predominantly urban township of Yangon and a predominantly rural township of Ayeyawady in March 2016. We collected data from 1500 women. We measured quality-adjusted contact, which refers to adequate contact with high-quality care, as follows: ≥4 ANC contacts and receiving 11-14 of 14 intervention items; facility-based delivery assisted by skilled care providers, receiving 7 of 7 PPC intervention items; and receiving the first PNC contact ≤24 hours postpartum and ≥2 additional contacts, and receiving 16-17 of 17 intervention items. Using multilevel logistic regression analysis with a random intercept at cluster level, we identified factors associated with adequate contact and high-quality ANC, PPC and PNC.

Results: The percentage of crude adequate contact was 60.9% for ANC, 61.3% for PPC and 11.5% for PNC. However, the percentage of quality-adjusted contact was 14.6% for ANC, 15.2% for PPC and 3.6% for PNC. Adequate contact was associated with receiving high-quality care at ANC, PPC and PNC. Being a teenager, low educational level, multiparity and low level in the household wealth index were negatively associated with adequate contact with healthcare providers for ANC and PPC. Receiving a maternal and child health handbook was positively associated with adequate contact for ANC and PPC, and with receiving high-quality ANC, PPC and PNC.

Conclusion: Women and newborns do not receive quality care during contact with skilled care providers in Myanmar. Continuity and quality of maternal and newborn care programmes must be improved.

Keywords: child health; effective coverage; maternal health; quality of care.