Levels and determinants of person-centred maternity care among women living in urban informal settlements: evidence from client exit surveys in Nairobi, Lusaka and Ouagadougou
Bibliographic record
Abstract
BACKGROUND: Sub-Saharan Africa's rapid urbanisation has led to the sprawling of urban informal settlements. The urban poorest women are more likely to experience worse health outcomes and poor treatment during childbirth. This study measures levels of person-centred maternity care (PCMC) and identifies determinants of PCMC among women living in urban informal settlements in Nairobi, Lusaka and Ouagadougou. METHODS: We conducted phone, home-based or facility-based exit surveys of women discharged from childbirth care in facilities serving urban informal settlements. We estimated overall and domain-specific PCMC scores covering dignity and respect, communication and autonomy, and supportive care. We ran multilevel linear regression models to identify structural, intermediary and health systems factors associated with PCMC. RESULTS: We included 1249 women discharged from childbirth care: the majority were aged 20-34 years and were unemployed. In Lusaka and Nairobi, over 65% of women had secondary education, and over half gave birth in a hospital, whereas in Ouagadougou one-third had secondary education and 30.4% gave birth in a hospital. The mean PCMC score ranged from 57.1% in Lusaka to 73.8% in Ouagadougou. Across cities, women reported high dignity and respect mean scores (73.5%-84.3%), whereas communication and autonomy mean scores were consistently poor (47.6%-63.2%). In Ouagadougou, women with formal employment, those who delivered in a private for-profit facility, and whose newborn received postnatal care before discharge reported significantly higher PCMC. In Nairobi and Lusaka, women who were attended by a physician during childbirth, and those whose newborn was checked before discharge reported significantly higher PCMC. CONCLUSIONS: Women living in urban informal settlements experience inadequate PCMC and report poor communication with health providers. Select health systems and provision of care factors are associated with PCMC in this context. Quality improvement efforts are needed to enhance PCMC and ensure women's continuity in care seeking.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".