Browsing by Author "Musukuma M"

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Assessing courtesy reporting bias in facility-based surveys on person-centred maternity care: evidence from urban informal settlements in Nairobi and Lusaka.
(2025-Mar-28) Jiwani SS; Mutua MK; Jacobs C; Musukuma M; Njeri A; Adero G; Ngosa D; Abajobir A; Faye CM; Boerma T; Amouzou A; Population and Global Health, University of Manitoba, Winnipeg, Manitoba, Canada.; African Population and Health Research Centre, Dakar, Senegal.; African Population and Health Research Centre, Nairobi, Kenya.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of Epidemiology and Biostatistics, School of Public Health, University of Zambia, Lusaka, Zambia.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Experience of care is typically measured through client exit surveys administered in the facility. Evidence suggests that such measures suffer from courtesy reporting bias whereby respondents do not accurately report on their experiences while in the facility. We explored the presence of courtesy bias by comparing women's reported experience of person-centred maternity care (PCMC) from facility-based client exit surveys to mobile phone-based surveys out of the facility in Nairobi and Lusaka's urban informal settlements. METHODS: We randomly and independently sampled women in the facilities for either a facility-based survey (n = 233 in Lusaka and n = 112 in Nairobi) or a mobile phone-based survey (n = 203 in Lusaka and n = 300 in Nairobi) within one to two weeks of facility discharge. The questionnaire included a validated PCMC scale. After adjusting for differences in women's characteristics across groups, we compared PCMC scores between facility and phone-based samples. We ran multilevel linear regression models to assess PCMC by survey modality in each city. RESULTS: In both cities, over 70.0% of women were aged 20-34 years and were married, at least two thirds had secondary education, and over 95.0% were unaccompanied during labour/delivery. The overall PCMC score was 69.3% among women surveyed on the phone compared to 70.2% among those surveyed in the facility in Nairobi. In Lusaka, it was 57.5% on the phone compared to 56.8% in-facility. We found no statistically significant differences in PCMC scores between survey modalities in both cities, after adjusting for differences in women's characteristics. CONCLUSIONS: We did not detect significant courtesy reporting bias in PCMC in facility-based client exit surveys in the context of urban informal settlements in Nairobi and Lusaka. Experience of PCMC can be measured through in-facility client exit surveys or mobile phone surveys. However, it is critical to address challenges related to a mobile phone-based approach.
Levels and determinants of person-centred maternity care among women living in urban informal settlements: evidence from client exit surveys in Nairobi, Lusaka and Ouagadougou.
(2025-Mar-15) Jiwani SS; Cissé K; Mutua MK; Jacobs C; Njeri A; Adero G; Musukuma M; Ngosa D; Sissoko FB; Kouanda S; Abajobir A; Faye CM; Boerma T; Amouzou A; Population and Global Health, University of Manitoba, Winnipeg, Manitoba, Canada.; African Population and Health Research Center, Nairobi, Kenya.; African Population and Health Research Center, Dakar, Senegal.; Epidemiology and Biostatistics, University of Zambia School of Public Health, Lusaka, Zambia.; Centre National de Recherche Scientifique et Technologique, Institut de Recherche en Sciences de la Santé, Ouagadougou, Burkina Faso.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA sjiwani1@jhu.edu.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: Sub-Saharan Africa's rapid urbanisation has led to the sprawling of urban informal settlements. The urban poorest women are more likely to experience worse health outcomes and poor treatment during childbirth. This study measures levels of person-centred maternity care (PCMC) and identifies determinants of PCMC among women living in urban informal settlements in Nairobi, Lusaka and Ouagadougou. METHODS: We conducted phone, home-based or facility-based exit surveys of women discharged from childbirth care in facilities serving urban informal settlements. We estimated overall and domain-specific PCMC scores covering dignity and respect, communication and autonomy, and supportive care. We ran multilevel linear regression models to identify structural, intermediary and health systems factors associated with PCMC. RESULTS: We included 1249 women discharged from childbirth care: the majority were aged 20-34 years and were unemployed. In Lusaka and Nairobi, over 65% of women had secondary education, and over half gave birth in a hospital, whereas in Ouagadougou one-third had secondary education and 30.4% gave birth in a hospital. The mean PCMC score ranged from 57.1% in Lusaka to 73.8% in Ouagadougou. Across cities, women reported high dignity and respect mean scores (73.5%-84.3%), whereas communication and autonomy mean scores were consistently poor (47.6%-63.2%). In Ouagadougou, women with formal employment, those who delivered in a private for-profit facility, and whose newborn received postnatal care before discharge reported significantly higher PCMC. In Nairobi and Lusaka, women who were attended by a physician during childbirth, and those whose newborn was checked before discharge reported significantly higher PCMC. CONCLUSIONS: Women living in urban informal settlements experience inadequate PCMC and report poor communication with health providers. Select health systems and provision of care factors are associated with PCMC in this context. Quality improvement efforts are needed to enhance PCMC and ensure women's continuity in care seeking.