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Table 1 Possible methods for estimating national UUIFB coverage

From: Uterotonic use immediately following birth: using a novel methodology to estimate population coverage in four countries

Method (ranked by validity)

Feasibility and validity considerations

Example

1 Observational assessments of quality of care

Most accurate information for those births observed

Done in MCHIP Quality of Care assessments and now included as an optional Demographic and health Survey (DHS) Service Provision Assessment (SPA) module (done in Kenya; planned for Malawi)

Not commonly done

Expensive to conduct

When done, not likely to be on a large and nationally representative sample

Likely excludes home births

2 Facility readiness assessments

Need to extrapolate from availability of commodity/personnel to actual use of uterotonic

DHS SPA, Service Availability and Readiness Assessment (World Health Organization)

Expensive to conduct on a representative sample on a regular basis

Likely excludes home births

3 Routine Health Management Information System (HMIS) data

Only possible where data are recorded in registers and reported to higher levels

Included in registers in some countries (e.g., Mozambique)

HMIS data quality variable

No additional data collection costs required

May not include community-level reporting on home births

4 Data from sentinel surveillance sites

Only possible where such sites are available

MCHIP used this method in Kenya (results unpublished)

No additional data collection costs required

Question of generalizability

5 Extrapolation from service contact data

Estimates require extrapolation with questionable assumptions (i.e., that skilled birth attendant and/or institutional birth implies use of uterotonic in most or all of covered births).

Suggested method – expert panel not aware of previous experience with this

No additional data collection costs required

6 Survey of key informants

Easy and low cost to interview individuals or group of informants

Suggested method – expert panel not aware of previous experience with this.

Likely to be subjective with opinions likely biased and/or based on incomplete information