Monitoring childbirth care in primary health facilities: a validity study in Gombe State, northeastern Nigeria

BACKGROUND: Improving the quality of facility-based births is a critical strategy for reducing the high burden of maternal and neonatal mortality and morbidity across all settings. Accurate data on childbirth care is essential for monitoring progress. In northeastern Nigeria, we assessed the validity of childbirth care indicators in a rural primary health care context, as documented by health workers and reported by women at different recall periods. METHODS: We compared birth observations (gold standard) to: (i) facility exit interviews with observed women; (ii) household follow-up interviews 9-22 months after childbirth; and (iii) health worker documentation in the maternity register. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. We calculated the inflation factor (IF) to determine population-level validity. RESULTS: Twenty-five childbirth care indicators were assessed to validate health worker documentation and women’s self-reports. During exit interviews, women’s recall had high validity (AUC≥0.70 and 0.75<IF<1.25) for 9 of 20 indicators assessed; six additional indicators met either AUC or IF criteria for validity. During follow-up interviews, women’s recall had high validity for one of 15 indicators assessed, placing the newborn skin-to-skin; two additional indicators met IF criteria only. Health worker documentation had high validity for four of 10 indicators assessed; three additional indicators met AUC or IF criteria. CONCLUSIONS: In addition to standard household surveys, monitoring of facility-based childbirth care should consider drawing from and linking multiple data sources, including routine health facility data and exit interviews with recently delivered women.