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Table 3 Validation results for maternal and newborn intrapartum and immediate postnatal care indicators

From: Measuring progress in maternal and newborn health care in Mexico: validating indicators of health system contact and quality of care

Indicator Total N True Preva (%) Sensitivityb (95 % CI) Specificityc (95 % CI) Self-report survey estimate (%), Based on sensitivity and specificityd AUC (95 % CI) (>0.60) IFe (0.75 to 1.25) Criteria Metf
Indicators of Health Service Contacts
 Main provider labor- doctor or medical resident 580 96.2 82.3 (78.8-85.3) 27.3 (10.7-50.2) 81.9 0.55 (0.51-0.59) 0.85 IF
 Main provider delivery– doctor or medical resident 563 91.1 90.1 (87.1-92.5) 14.0 (5.8-26.7) 89.7 0.52 (0.48-0.56) 0.98 IF
Indicators of Content of Care
 Takes urine sample 572 25.2 50.0 (0.63-0.71) 84.4 (80.6-87.7) 24.3 0.67 (0.63-0.71) 0.97 Both
 Injection or IVg medication received at some time during labor, before birth of baby (general) 571 76.0 70.1 (65.5-74.3) 56.9 (48.2-65.4) 63.6 0.63 (0.59-0.68) 0.84 Both
 Episiotomy performed 580 67.8 97.7 (95.7-98.9) 63.1 (55.8-70.0) 78.1 0.80 (0.77-0.84) 1.2 Both
 Blood products given 582 2.41 35.7 (12.8-64.9) 98.4 (97.0-99.3) 2.4 0.67 (0.63-0.71) 1.0 Both
 Receives injection or IVg medication for induction or augmentation of labor 476 76.1 59.1 (53.9-64.2) 79.8 (71.3-86.8) 49.8 0.69 (0.65-0.74) 0.65 AUC
 Augments labor with uterotonic 472 75.2 49.6 (44.3-54.9) 81.2 (72.9-87.8) 42.0 0.65 (0.61-0.70) 0.56 AUC
 Membranes ruptured (labor induction or augmentation) 356 57.0 38.4 (31.7-45.5) 88.2 (82.0-92.9) 27.0 0.63 (0.58-0.68) 0.47 AUC
 Breastfeeding initiated within first hour of birthi 449 34.7 81.4 (74.4-87.2) 44.1 (38.3-49.9) 64.8 0.63 (0.58-0.67) 1.9 AUC
 First post-delivery exam, provider checks for involution 556 81.7 84.6 (80.9-87.8) 21.6 (14.0-30.8) 83.5 0.53 (0.49-0.57) 1.0 IF
 Palpates uterus after delivery of placenta 580 82.4 79.5 (78.4-85.5) 19.6 (9.7-25.4) 79.7 0.50 (0.45-0.54) 0.97 IF
 Uterotonic received 1-3 min after birth 580 64.0 61.5 (56.3-66.4) 40.7 (33.9-47.7) 60.7 0.51 (0.47-0.55) 0.95 IF
 3 AMTSLh elements: prophylactic uterotonic + controlled cord traction + uterine massage following delivery of placenta 549 81.2 75.7 (71.5-79.6) 24.0 (16.0-33.6) 75.7 0.50 (0.46-0.54) 0.93 IF
 HIV status checked 569 69.8 54.9 (49.9-59.9) 47.7 (40.0-55.4) 54.1 0.51 (0.47-0.55) 0.78 IF
 Induces labor with uterotonic 559 11.6 27.7 (17.3-40.2) 89.1 (86.0-91.7) 12.9 0.58 (0.54-0.62) 1.1 IF
 Woman received pain relief medication 581 79.4 89.4 (86.2-92.0) 20.0 (13.3-28.3) 87.4 0.55 (0.51-0.59) 1.1 IF
 First post-delivery exam, provider ask/checks for bleeding 590 80.5 87.4 (84.0-90.2) 12.2 (6.8-19.6) 87.5 0.50 (0.46-0.54) 1.1 IF
 First post-delivery exam, provider examines perineum 586 75.1 90.2 (87.1-92.8) 10.3 (5.9-16.4) 90.1 0.50 (0.46-0.54) 1.2 IF
 First post-delivery exam, provider takes temperature 586 66.9 94.4 (91.6-96.4) 8.8 (5.2-13.7) 93.4 0.52 (0.47-0.56) 1.4  
 Encourages/assists woman to ambulate during labor 580 22.2 7.8 (3.8-13.8) 91.6 (88.6-94.0) 8.3 0.50 (0.46-0.54) 0.37  
 Woman asked for pain relief medication at some time 575 44.7 32.7 (27.0-38.8) 78.9 (74.0-83.3) 26.3 0.56 (0.52-0.60) 0.59  
 Something other than breastmilk given to baby within first hour of birthi 438 21.7 71.6 (61.4-80.4) 46.1 (40.7-51.5) 57.8 0.59 (0.54-0.64) 2.7  
 Uterotonic received 1-3 min after delivery of placenta 576 20.0 95.7 (90.1-98.6) 6.3 (4.3-8.9) 94.1 0.51 (0.47-0.55) 4.7  
 Baby given to mother immediately after birthi 580 10.3 63.3 (49.9-75.4) 40.6 (36.3-44.9) 59.8 0.52 (0.48-0.56) 5.8  
Maternal Complications
 Severe bleeding (hemorrhage) 593 8.1 50.0 (35.2-64.8) 95.2 (93.1-96.9) 8.4 0.73 (0.69-0.76) 1.0 Both
 High blood pressure/convulsions (eclampsia) 594 2.4 57.1 (28.9-82.3) 79.5 (76.0-82.7) 21.4 0.68 (0.64-0.72) 9.1 AUC
 Complication (yes to any) 595 13.6 60.5 (50.3-72.3) 65.4 (61.3-69.7) 38.2 0.64 (0.60-0.68) 2.8 AUC
 None 595 86.4 65.6 (61.3-69.7) 61.7 (50.3-72.3) 61.8 0.64 (0.60-0.68) 0.72 AUC
  1. Validation analysis based on matched data, excluding ‘Don’t Know’ and missing responses. Sensitivity and specificity analysis was not performed for indicators that had fewer than 5 counts per cell of constructed two-by-two tables
  2. aTrue prevalence refers to prevalence of intervention or event as measured by direct observation by a trained third party in the study hospital facility; bTrue positive rate; cTrue negative rate; dEstimated prevalence that would be obtained through women’s self-report in a household survey (Pr), calculated using the following equation where P = true prevalence, SE = sensitivity, SP = specificity, Pr = P*(SE + SP-1) + (1-SP); eIF = Pr/P, or ratio of survey-based prevalence to the true prevalence; fAUC > 0.60 and 0.75 < IF < 1.25; gIV refers to intravenous medication; hRefers to active management of the third stage of labor; iQuestions asked of mothers whose infants were breathing at birth
  3. *Note: For full description of study indicators, please see Additional file 5: Table S1