Maternal Health Measurements

1. Maternal Health Measurements Moussa LY , MPH Monitoring & Evaluation Specialist Maternal Health/Family Planning Project Dakar - Senegal

2. Outline course • To determine causes related to maternal health complications • To identify best indicators (Independent variables associated with maternal health complications) • To use epidemiology approaches to test the association between maternal health complications and suspected causes.

3. Delivery of Improved Services for Health Project • Aims related to reproductive and maternal health: • increase service availability • improve the quality of services • increase public knowledge, change attitudes and behavior • increase sustainability of services

4. Phase I Phase II Timeline for Evaluation Activities PERIOD OF THE EVALUATION Project Implementation Population- based surveys Facility- based surveys ABS KABS KABS HFR, CEI, HPI HFR, CEI, OHPC HFR, OHPC

5. Measurements and Analysis:1. Data collection • Questionnaire to administer to community members (sisters method), exit clients, health providers • Medical records from health facilities • Focus group discussion with communities • Observation of Health providers and clients inter-action

6. Measurements and Analysis:2. Selected variables DEPENDANT VARIABLE • Number of Antenatal Care clients with complications or those who died INDEPENDANT VARIABLES • Socio-demographic factors (Age, Marital status, Level of education, place of residence) • Nutrition status • Reproductive Health history (Parity, Abortions, Age at the first sexual intercourse, Age at the first birth, Unwanted pregnancies, etc…) • Previous diseases • Complications related to the diseases

7. Measurements and Analysis:3. Measures of Association • Chi square (2) test with  = 0.05 and P the level of significance • 2 tabulate = 2 • 2 tabulate > 2 • Hypotheses • H0: No significant association between Maternal health complications with independent variables • H1: Existence of significant association between Maternal health complications with independent variables • Decision rule • Reject H0 if P <  • Accept H0 if P ≥

8. Measurements and Analysis:3. Measures of Association (Cont.) • Odd ratio: The ratio of the odds of a condition in the exposed compared with the odds of the condition in the unexposed. • Decision rule: • OR = 1: No association • OR > 1: Diseases are risk factors • OR < 1: Diseases are protective

9. Measurements and Analysis:3. Measures of Association (Cont) • Expression of misclassification in terms of sensitivity and specificity of Knowing the likelihood of maternal health complications with a positive test and in those with negative test. • Sensitivity is the probability of a test given that a woman with one of the independent variables has health complications • Specificity is the probability of a negative test given • Receiver Operating Characteristic (ROC) curve is a plot of the true positive rate against false positive rate for the different possible cut off points of a diagnostic test

10. Interpretation of the ROC curve

11. Normal Probability Plot

12. Logistic Regression • Logistic regression model is simply a non linear transformation of the linear regression. Binary logistic regression is a type of regression analysis where the dependant variable (maternal death) is dummy variable (coded 0, 1) • 1: When the woman has health complications • 0: When the woman has not health complications

13. References • Management Sciences for Health, Evaluation Handbook, Dec. 2003 • Measure Evaluation, Guideline for Family Planning Monitoring and Evaluation, 2000 • UNAIDS, Guideline for AIDS monitoring and Evaluation, 2000 • USAID, Management of Reproductive, Maternal and Child Health Project, 2000