Figures & Tables
Figures
Asiat Musenze, a Ugandan midwife, attends to a mother and her newborn with the light of the Solar Suitcase. © 2018 Zahara Abdul
- FIGURE 1
Consort Diagram of Maternal Health Care Facilities in Uganda Included in the Solar Suitcase Intervention Study
- FIGURE 2
Source of Light During the Delivery of Infant, in Periods When Facilities Had a Solar Suitcase Compared With Periods When Facilities Did Not Have a Solar Suitcase, Among Observations in Which Birth Occurred During Nighttime Hoursa
a Sources of light during the actual delivery are shown, as the percentage of the number of times each source is used out of the total number of light sources used across all nighttime deliveries. Nighttime hours refer to between 6:00 pm and 7:00 am. Figure shows only sources that made up more than 3% of observations (dropped sources include solar lantern, candle, and darkness).
- FIGURE 3
Impact of Solar Suitcase Intervention on Adequacy of Light and the 20-Item Quality of Care Index, for all Observed Deliveries (n=1,118) and for Observed Deliveries With Some Nighttime Hours (n=743) in Maternal Health Care Facilities in Ugandaa
a “Adequate light” indicates that all observed parts of observation were perceived to be under a bright light and from a satisfactory light source. Quality score is the percentage of items performed of the 20-item Tripathi index. Supplement Table 3 has detailed definitions of variables. Results from predicted margins of linear regression with facility fixed effects. Nighttime hours refers to between 6:00 pm and 7:00 am.
- FIGURE 4
Impact of Solar Suitcase Intervention on Individual Quality Items, Section of Care Indices, and Overall Indices, for Observed Deliveries in Maternal Health Care Facilities in Uganda With Some Nighttime Hoursa
a Results show point estimates and 95% confidence intervals. Standard errors are clustered at the facility level. Section and overall indices are the proportion of items performed out of the total section and overall total observed, respectively. Linear regression with facility fixed effects and clustered standard errors. Analysis includes only observed deliveries with some nighttime hours. Sterilizes equipment is coded as 1 for observations in which no reusable instruments were used (30% of observations). BP, blood pressure; PPH, postpartum hemorrhage. Analysis includes only observed deliveries with some nighttime hours (between 6:00 pm and 7:00 am).
Tables
- TABLE 1.
Baseline Characteristics of Maternity Health Care Facilities in Uganda (N=30)a Included in the Study of the Solar Suitcase Intervention on the Quality of Intrapartum Care
Overall Sequence 1 Sequence 2 N=30 n=15 n=15 No. of observations per facility, mean (SD) 38 (16) 36 (19) 39 (14) No. of days spent observing, mean (SD) 30 (12) 30 (12) 30 (12) No. of MCH staff employed, mean (SD) 7 (4) 6 (3) 8 (5) Monthly patient volume, mean (SD) 34 (17) 30 (18) 37 (16) Primary source of electricity, n (%) None/lanterns 12 (40) 6 (40) 6 (40) Grid 11 (37) 5 (33) 6 (40) Solar 7 (23) 4 (27) 3 (20) Facility government owned, n (%) 28 (93) 13 (87) 15 (100) Facility level, n (%) Health center II 5 (17) 3 (20) 2 (13) Health center III 22 (73) 11 (73) 11 (73) Health center IV 3 (10) 1 (7) 2 (13) Provider age, mean (SD) 34 (5) 33 (5) 35 (6) Provider years of experience, mean (SD) 8 (6) 7 (5) 9 (7) Proportion of providers with secondary education, mean (SD) 0.02 (0.07) 0.04 (0.10) 0.00 (0.00) Proportion of providers with certificate, mean (SD) 0.60 (0.32) 0.62 (0.35) 0.58 (0.31) Proportion of providers with diploma, mean (SD) 0.38 (0.32) 0.34 (0.34) 0.42 (0.31) Proportion of providers in officer position, mean (SD) 0.15 (0.22) 0.15 (0.22) 0.16 (0.22) Proportion of providers in midwife/nurse position, mean (SD) 0.70 (0.26) 0.61 (0.28) 0.79 (0.23) Proportion of providers in nursing assistant position, mean (SD) 0.15 (0.22) 0.24 (0.26) 0.06 (0.12) Quality score, mean (SD) 44.2 (8.4) 43.5 (7.9) 45.0 (9.0) Delay index score (minutes), mean (SD) 73.5 (16.9) 76.4 (19.4) 70.7 (14.1) Proportion of adequate light throughout observation, mean (SD) 0.44 (0.21) 0.47 (0.22) 0.41 (0.20) Mother's age (years), mean (SD) 24.5 (2.5) 25.0 (2.8) 24.1 (2.1) Mother's parity, mean (SD) 2.3 (0.6) 2.3 (0.5) 2.3 (0.7) Gestational age (weeks), mean (SD) 38.1 (0.9) 38.0 (0.9) 38.1 (0.9) Overall F-test 0.24 Abbreviations: MCH, maternal and child health; SD, standard deviation.
↵a The overall F-test is a joint test of orthogonality of all variables. Quality score is the percentage of items performed of the 20-item index. Delay index score is the sum of 6 items in the delays index (Supplement Table 3).
- TABLE 2.
Linear Estimates of the Impact of the Solar Suitcase Intervention on Light and Quality of Intrapartum Carea in Maternal Health Care Facilities in Uganda
Outcome N ICC Average before intervention, % Average after intervention, % Difference, % (95% CI) All observed deliveries I. Light brightness and source Deliveries with bright light 1,118 0.07 56.1 100 43.7 (35.9, 51.5) Deliveries with satisfactory light source 1,118 0.07 66.3 100 33.3 (27.2, 39.4) Deliveries with adequate light 1,118 0.07 54.4 99.4 45 (37.2, 52.8) II. Quality of care 20-item quality index 1,118 0.21 42.6 45.7 3.1 (−0.04, 6.24) 36-item quality index 1,118 0.21 53.9 58.1 4.2 (1.47, 6.98) 6-item delays index, min 805 0.12 74.3 63.1 −11.24 (−16.47, −6.01) Observed deliveries with some nighttime hours I. Light brightness and source Deliveries with bright light 743 0.14 42.4 100 57.5 (46.0, 69.1) Deliveries with satisfactory light source 743 0.17 55.7 100 44.7 (35.4, 53.9) Deliveries with adequate light 743 0.14 41.0 100 59 (47.6, 70.4) II. Quality of care 20-item quality index 743 0.22 42.3 46.5 4.1 (0.57, 7.68) 36-item quality index 743 0.22 53.9 58.5 4.7 (1.58, 7.78) 6-item delays index, minutes 575 0.13 76.0 66.3 −9.67 (−16.06, −3.29) Abbreviations: 95% CI, 95% confidence interval; ICC, intracluster correlation.
↵a Results show point estimates and 95% confidence intervals. Standard errors are clustered at the facility level. The constant refers to the mean outcome in the preperiod. Nighttime hours refer to hours between 6:00 pm to 7:00 pm. Bright light indicates enumerator reported “perfectly bright” or “bright” (as opposed to “dim” or “dark”) across all 4 sections of the observation. Satisfactory light source indicates that the light source during all 4 sections was either daylight, the grid, solar, or a generator. Adequate light indicates that all 4 sections of the observations used a satisfactory light source and were reported to be bright. Quality of care indices are defined in Supplement Table 3. Delays index is missing for observations in which any one of the 6 delays items is missing.
- TABLE 3.
Linear Estimates of the Impact of the Solar Suitcase Intervention in Maternal Health Care Facilities in Uganda on Objective Measures of Light Using Sensor Dataa
Outcome Average Before Intervention Average After Intervention Difference (95% CI) Minutes of light per 24 hours 856 997 141.0 (7.6, 274.3) Level of brightness during daytime (7:00 am to 6:00 pm) 47.9 54.2 6.3 (−2.2, 14.8) Level of brightness during nighttime (6:00 pm to 7:00 am) 14.5 24.7 10.1 (0.71, 19.6) Abbreviation: 95% CI, 95% confidence interval.
↵a Results show point estimates and 95% confidence intervals. Standard errors are clustered at the facility level. Regression controls for month of year and facility fixed effects. One facility (in Sequence 2) had a broken sensor and was not included. The number of minutes of light per day is calculated as the number of minutes over a threshold of 20% of the maximum seen in that facility. Results robust to using any threshold between 1% and 35% (results not shown). Level of brightness is on a 0–100 scale, as the percentage of the maximum light the sensor in each facility could read.
Supplemental material
- Text s01, PDF - Text s01, PDF
