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Research
Quality gap in maternal and newborn healthcare: a cross-sectional study in Myanmar
  1. Sumiyo Okawa1,2,
  2. Hla Hla Win3,
  3. Hannah H Leslie4,
  4. Keiko Nanishi5,
  5. Akira Shibanuma1,
  6. Phyu Phyu Aye6,
  7. Masamine Jimba1
  1. 1 Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
  2. 2 Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
  3. 3 Department of Preventive and Social Medicine, University of Medicine 1, Yangon, Yangon, The Republic of the Union of Myanmar
  4. 4 Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan
  6. 6 Department of Public Health, Ministry of Health and Sports, Naypyidaw, The Republic of the Union of Myanmar
  1. Correspondence to Masamine Jimba; mjimba{at}m.u-tokyo.ac.jp

Abstract

Introduction Access to maternal and newborn healthcare has improved in Myanmar. However, regular contact with skilled care providers does not necessarily result in quality care. We assessed adequate contact made by women and newborns with skilled care providers, reception of high-quality care and quality-adjusted contacts during antenatal care (ANC), peripartum care (PPC) and postnatal care (PNC) in Myanmar.

Methods This cross-sectional study was conducted in a predominantly urban township of Yangon and a predominantly rural township of Ayeyawady in March 2016. We collected data from 1500 women. We measured quality-adjusted contact, which refers to adequate contact with high-quality care, as follows: ≥4 ANC contacts and receiving 11–14 of 14 intervention items; facility-based delivery assisted by skilled care providers, receiving 7 of 7 PPC intervention items; and receiving the first PNC contact ≤24 hours postpartum and ≥2 additional contacts, and receiving 16–17 of 17 intervention items. Using multilevel logistic regression analysis with a random intercept at cluster level, we identified factors associated with adequate contact and high-quality ANC, PPC and PNC.

Results The percentage of crude adequate contact was 60.9% for ANC, 61.3% for PPC and 11.5% for PNC. However, the percentage of quality-adjusted contact was 14.6% for ANC, 15.2% for PPC and 3.6% for PNC. Adequate contact was associated with receiving high-quality care at ANC, PPC and PNC. Being a teenager, low educational level, multiparity and low level in the household wealth index were negatively associated with adequate contact with healthcare providers for ANC and PPC. Receiving a maternal and child health handbook was positively associated with adequate contact for ANC and PPC, and with receiving high-quality ANC, PPC and PNC.

Conclusion Women and newborns do not receive quality care during contact with skilled care providers in Myanmar. Continuity and quality of maternal and newborn care programmes must be improved.

  • child health
  • maternal health
  • quality of care
  • effective coverage

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjgh-2018-001078

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    Footnotes

    • Handling editor Sanni Yaya

    • Contributors SO, HHW, KN and MJ conceived and designed the study. AS and PPA provided critical advice on the design. SO and HHW collected the data. SO analysed the data. SO wrote the first draft of the manuscript. HHL and MJ contributed to data interpretation and critically edited the manuscript. MJ obtained funding. MJ and HHW supervised the study. All authors read and approved the final manuscript.

    • Funding This research was supported by the Japan Agency for Medical Research and Development (AMED).

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval We obtained ethical approval from the University of Medicine I, Yangon, Myanmar Ministry of Health and Sports, Department of Medical Research, and The University of Tokyo. We also obtained written consent from all participants before interviewing them.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are not publicly available because they contain information that could compromise the confidentiality or consent of the study participants.