Measuring skilled attendance at birth using linked household, health facility, and health worker surveys in Ethiopia, northeast Nigeria, and Uttar Pradesh, India

Background The measurement of key intervention coverage to improve maternal health is complex. Large-scale household surveys provide high-quality estimates of the number of women who have skilled attendance at birth, but most provide little or no detail about the quality of care women receive. For example, information on the preparedness of the skilled birth attendant to manage labour is not included. Here, we describe measurement of key intervention coverage for mothers using linked household, health facility, and health worker data. Methods In 2012, linked household, health facility, and health worker survey data were collected to ascertain the relation between women having interactions with health workers and the population-level coverage of key interventions for mothers and newborns. Data from each source were linked at the level of the household cluster: sub-villages. All women living in the sub-village were interviewed, with a special module for women who had a birth in the previous 12 months. The health facility providing services to these women was surveyed to determine preparedness to provide care, and frontline health workers in the village were interviewed. The number and quality of interactions taking place and the extent to which these translated into coverage of key interventions were explored. Findings Health facility, health worker, and household data were all needed to estimate the four intrapartum interventions that usually fall under the proxy indicator skilled attendance at birth. Data are presented to illustrate measurement complexities and the gap between coverage of skilled attendance at birth and the coverage of these key intrapartum interventions. Interpretation Measurement across the continuum of care requires linking multiple data collection sources. Developing methods to estimate key intra-partum interventions for mothers and their newborns is of critical importance to develop strategies for improved survival.