Women’s recall of maternal and newborn interventions received in the postnatal period: A validity study in Kenya and Swaziland

Background: Despite the concentration of maternal and infant deaths in the early postnatal period, information on the content and quality of postnatal care interventions is not routinely collected in most low and middle-income countries. At present, data on the coverage of postnatal care interventions mostly rely on women’s reports collected in household surveys, such as the Demographic and Health Surveys (DHS) and Multiple Indicator Cluster Surveys (MICS), which collect limited information. We assessed the validity of a set of postnatal care indicators that reflect a range of recommended interventions for both mother and newborn and have potential to be included in household surveys for monitoring of population-level coverage. Methods: We compared women’s reports in exit interviews on the content of postnatal care received in health facilities located in Kenya and Swaziland against a gold standard of direct observation by a trained third party. We calculated sensitivity, specificity and the area under the receiver operating curve (AUC) to assess individual-level reporting accuracy and the inflation factor (IF) to assess population-level accuracy. We also examined whether women’s reporting accuracy varied significantly by her sociodemographic characteristics. Results: 18 indicators in Kenya and 19 in Swaziland had sufficient sample size for analysis. Of these, 12 indicators in Kenya and five in Swaziland met criteria for acceptable individual and population-level reporting accuracy. Two indicators met acceptability criteria in both Kenya and Swaziland: whether the provider performed a breast exam or an abdominal exam. There was no significant association between women’s characteristics and reporting accuracy, across indicators. Conclusion: Women are able to accurately report on multiple aspects of care received during a postnatal visit. Findings inform the recommendation of indicators for tracking progress of critical postnatal care interventions for mothers and newborns. Improved measurement of the coverage of maternal and newborn postnatal care is warranted to monitor progress in maternal and newborn care globally