International Journal for Quality in Health Care, 2019, 31(1), 43–48 doi: 10.1093/intqhc/mzy105 Advance Access Publication Date: 11 May 2018 Article Article Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO’s antenatal care guideline PATRICK OPIYO OWILI 1,2,3 , MIRIAM ADOYO MUGA 4,† , BOMAR ROJAS MENDEZ 5 , and BRADLEY CHEN 5,6 1 Department of Public Health, University of Eastern Africa, Baraton, Eldoret 30100, Kenya, 2 Master of Public Health Program and Master in Global Health Program, School of Health Sciences, University of Eastern Africa, Baraton, Eldoret 30100, Kenya, 3 Institute of Environmental & Occupational Health Sciences, National Yang Ming University, Taipei 112, Taiwan, 4 Department of Foods, Nutrition and Dietetics, School of Science and Technology, University of Eastern Africa, Baraton, Eldoret 30100, Kenya, 5 International Health Program, National Yang Ming University, Taipei 112, Taiwan, and 6 Institute of Public Health, National Yang-Ming University, Taipei 112, Taiwan Address reprint requests to: Bradley Chen, Institute of Public Health, National Yang-Ming University, 155, Sec. 2, Linong Street, Taipei, 112, Taiwan. Tel: +886228267285; Fax: +886228221942; E-mail: bradleychen@ym.edu.tw † Co-first author. Editorial Decision 5 April 2018; Accepted 24 April 2018 Abstract Objective: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA). Design: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence inter- val (CI). Setting: We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda. Participants: Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries. Main Outcome Measures: Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided. Results: Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08–1.48), were well- equipped (AOR = 1.65; 95% CI, 1.41–1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05–1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81–2.65), and piped water (AOR = 1.30; 95% CI, 1.09–1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43–2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01–3.44) were more likely to provide optimal information as well. Provider’s qualification and experience were also important in information provision and clinical care independently. Conclusion: The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA. Key words: quality of care, Service Provision Assessmentantenatal care, multilevel analysis, sub-Saharan Africa © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 43 Downloaded from https://academic.oup.com/intqhc/article-abstract/31/1/43/5182877 by guest on 09 June 2020