Piloting a Streamlined Index for Assessment of Quality of Labor and Delivery Care: Findings from Tanzania

Presenter: Gaudiosa Tibaijuka, Jhpiego

Background: There is a need for streamlined observation-based tools to assess routine labor and delivery (L&D) care quality. Using data from Maternal and Child Health Integrated Program Maternal and Newborn Quality of Care (QoC) facility surveys, a study was developed and validated a comprehensive index of 20 L&D quality indicators. A pilot in Tanzania assessed this tool’s feasibility for use.

Methodology: The pilot evaluated the tool’s usability, reliability, and validity. Data collection was conducted in four health centers and three hospitals in Kilimanjaro, Pwani, and Tanga regions. Deliveries were observed by pairs, including a “veteran” L&D observe for previous QoC Surveys and a new observer; district supervisor. Observers received a two-day training including observation practice. Data collection included quantitative and qualitative assessment of the tool. Reliability was evaluated through kappa coefficients and intraclass correlation coefficients. Veteran observers were considered a “gold standard,” with agreement as a sign of validity.

Results: Observers documented 101 deliveries using QoC index, described the tool as easy-to-use, and useful. Veterans were less likely to describe the index as complex and more likely to describe it as useful. There was substantial (>0.6) or near-perfect (>0.8) agreement between new and veteran observers on almost all index items, and near-perfect agreement on total index score. Two items had only moderate agreement: explaining at least once what will happen in labor and assessment for lacerations after delivery. These actions may be more difficult to observe, requiring better training. Qualitative findings suggested index was considered valuable for assessing L&D care quality, but guidance is required.

Conclusions: The QoC index is a streamlined, reliable, validated tool for use in supervising L&D care.