The childbirth-related health technologies assessed in this study were drawn directly from published WHO guidelines for managing complications associated with the major causes of maternal and neonatal mortality. Midwives, nurses, pediatricians, obstetricians, and medical officers that are members of the following organizations were e-mailed a request for participation with a corresponding link to the web-based survey: Global Alliance for Nursing and Midwifery listserv (approximately 2,500 members), numerous African and Asian midwife societies (approximately 300 members), CHILD2015 international child healthcare information and learning discussion group (approximately 3,000 members), and the American Academy of Pediatrics Section on International Child Health listserv (approximately 900 members). These organizations were selected based on their strong associations with birth facilities in Africa and Asia.
Inclusion criteria were clinicians that (a) currently work or have recently worked in birth facilities in Africa and Asia, and (b) had comprehensive knowledge of the childbirth-related health technologies available in the birth facilities in which they work or worked. Surveys were screened to ensure that only a single entry from each center was included in the analysis.
The web-based questionnaire was developed and designed using a secure, commercially available internet platform (SurveyMonkey;
http://www.surveymonkey.com). This anonymous cross-sectional survey took place over a 10 month period, from June 2009, to March 2010. The questionnaire was comprised of sections focused on (i) birth facility demographic information including country location, annual birth rate, and childbirth team composition; (ii) the availability of general supplies and medicines including soap and clean water for handwashing, instruments (i.e. cannulae, needles, and syringes), thermometer, antibiotics, and oxygen; (iii) the availability of supplies and medicines that support maternal care including blood pressure cuff, urine dipstick, partograph, intravenous fluids, oxytocin, magnesium sulfate, anti-hypertensive medication, antenatal corticosteroids, and blood transfusion capacity; (iv) the capacity for cesarean section delivery on-site, capacity for referral for cesarean section, and average time of transport for women requiring referral for cesarean section; and (v) the availability of supplies and medicines that support newborn care including a sterile instrument for cutting the umbilical cord, clean towels for drying and cleaning the baby after birth, suction device, bag-and-mask, warming unit or incubator, phototherapy unit, vitamin K, and topical ophthalmic antibiotics. In all, availability of 23 essential technologies was assessed.
Data were imported from the SurveyMonkey website and downloaded directly into Microsoft Excel (Microsoft Corp, Redmond, WA). Countries were stratified by gross national income (GNI) per capita, which is the World Bank’s main criterion for classifying economies
. Characteristics of birth facilities were reported using percentages. Ninety-five percent confidence intervals were calculated for these percentages using generalized estimating equations, adjusting for clustering of birth facilities within countries
. Comparisons of characteristics across groups of birth facilities were performed using Rao-Scott chi-square tests
, again adjusting for clustering of birth facilities within countries. All analyses were performed using SAS statistical software (SAS Institute Inc 2010. SAS OnlineDoc, Version 9.2. Cary, NC. URL
The study was declared exempt by the Office of Human Research Administration at the Harvard School of Public Health.