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Table 1 Attributes of care: structure, process and outcome

From: Detecting and managing hypertensive disorders in pregnancy: a cross-sectional analysis of the quality of antenatal care in Nigeria

Attributes of qualityIndicators
Structure attributes: Infrastructure equipment and supplies (0–38)
Data source: facility inventory
Data collection tools (0–3)Registers for: ANC visits, inpatients and referrals, maternal deaths
Infrastructure (0–6)Source of clean water, 24 h power for fridge, autoclave/sterilization, lighting, infection prevention buckets, chlorine for processing equipment
PE/E Guidelines (0–5)Protocols for diagnosis PE/E, managing PE/E, administering MgSO4
General Equipment (0–11)Stethoscopes, sphygmomanometers, urine collection containers, dipsticks, patella hammers, self-retaining catheter, urine bag, 20 ml syringe, saline (IV), IV equipment, syringe/needles
Availability of Drugs (0–5)Availability of magnesium sulfate, calcium gluconate, anti-hypertensives, xylocaine, misoprostol
Referral Mechanisms (0–4)Transport system/ambulance, 24/7 referral system, facility makes transport arrangements, client is accompanied to referral facility
Capacity for HDP-specific services (0–4)See pre-eclamptic/eclamptic patients in ANC visits, admit pre-eclamptic patients into labor ward, admit clients with eclampsia to maternity ward
Structure attributes: provider knowledge and training (0–66)
Data source: provider interview
Trainings in past 3 years (0–7)Any maternal/FP training, emergency obstetric care, ANC, safe delivery, skilled birth attendant, family planning, lab investigations
Signs and Symptoms of HDPs (0–12)Definition of HDPs, signs of mild PE (Y/N), signs of eclampsia (Y/N), signs of severe PE: high BP, proteinuria, severe headaches, changes in vision, light sensitivity, upper abdominal pain, nausea/vomiting, decreased urine output, edema
Management/Treatment of PE (0–8)Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, administer anti-hypertensive, refer to nearest doctor/specialist
Management of Severe PE (0–9)Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, administer anti-hypertensive, administer anti-seizure/magnesium sulfate, refer to nearest doctor/specialist
Management of Eclampsia (0–11)Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, keep tongue blade ready for possible seizure, administer anti-hypertensive, administer anti-seizure/magnesium sulfate, induce delivery, refer to nearest doctor/specialist
Diagnosis of HDPs (0–3)Chronic hypertension, PE, eclampsia
Use of MgSO4 (0–7)Know total loading dose for MgSO4, know maintenance dose for MgSO4, 2 ways to monitor toxicity, drug used to treat toxicity, how to administer drug to treat toxicity, 1 advantage/disadvantage of using MgSO4, believe that morbidity/mortality will decrease with use of loading dose
Eclampsia Prophylaxis (0–4)Guidelines on giving prophylaxis to prevent PE, which drug to give to prevent PE, currently use aspirin among women at risk of PE/E, 1 advantage/disadvantage of using prophylaxis to prevent PE
Antihypertensive Drugs (0–5)Use antihypertensive to control HT in PE patients, use vasodilators to control severe HT in PE/E patients, know correct BP at which anti-hypertensives are administered, know correct BP at which vasodilators are administered, use antihypertensive to treat pregnant women with high BP
Process attributes: provider technical skills (0–37)
Data source: client-provider observations and client exit interview
History taking (0–9)Date of last menstrual period, any current medication, general health problems, history of hypertension/high BP, diabetes, asthma, TB, malaria, STI/STD
Previous pregnancy history taking
Type and duration of last delivery, history of miscarriage/abortion, stillbirth, neonatal death, cesarean section
Physical examination (0–9)Weight, blood pressure, pulse, conjunctiva, body temperature, edema, abdomen palpation, fetal movement/heart rate
Lab tests (0–2)Urine: glucose, albumin
Health promotion/ disease prevention (0–12)Provided: malaria prophylaxis, tetanus toxoid injection, iron/folic acid supplements, HIV test; took blood sample, urine sample; gave advice/information on: diet & nutrition, insecticide-treated bed nets, STIs/AIDS, PMTCT of HIV, danger signs of pregnancy, self-care
Encouragement of continuation of care (0–3)Told when and where to return for follow-up, given written reminder of date for follow-up
Documentation (0–2)nfo recorded on: client’s ANC card, in registers
Process attributes: provider interpersonal skills (0–11)
Data source: client-provider interactions
Rapport (0–7)Used client’s name, greeted client in friendly manner, requested client to take a seat, maintained audio & visual privacy, treated client with respect, client felt comfortable asking questions
Communication (0–4)Used words client could understand, listened to client attentively, inquired for need of other services, answer client’s inquiries
Outcome attributes: client experiences (0–16)
Data source: client exit interview
Wait and cost (0–3)Time spent waiting was reasonable, time with provider was reasonable, amount paid was reasonable
Satisfaction (0–5)Satisfied with services received, would recommend to a friend, will return: before giving birth, 1 week after birth, 6 weeks after birth
Health comprehension/literacy (0–8)Opportunity to ask questions, encouraged to return for another visit, discussed progress of pregnancy, provided results from: checkup, blood pressure, urine test; explained results from: blood pressure, urine test
Categorical and Continuous Outcome Measures
Wait time (average)Wait before seeing provider
Time spent with provider (average)Length of consultation
First ANC VisitProportion of women attending a first ANC visit in < 10 weeks, 10–19 weeks, 20–29 weeks, or 30+ weeks
Amount willing to payAmount client is willing to pay for services (in USD)
SatisfactionProportion of women satisfied, somewhat satisfied, or not at all satisfied with services
Knowledge of danger signsProportion of women who know none, 1, 2, or 3 danger signs of pregnancy that would make them return to the facility