Quality of routine data related to facility-based maternal mortality measurement in Kampala City, Uganda

Abstract

Abstract Background Routine health facility data are an important source of health information. Regular quality assessments are necessary to improve the reliability of routine data for different purposes, including estimating facility-based maternal mortality. The objective of this study was to assess the quality of routine data on deliveries, livebirths and maternal deaths in Kampala City, Uganda. Methods We reviewed routine data reported by health facilities through the district health information system (DHIS2) from 2016 to 2021. This time period included an upgrade of the DHIS2 resulting in two datasets (2016–2019 and 2020–2021) that were managed separately. We analysed data for all facilities that reported at least one delivery in any of the six years, and for a subset of facilities designated to provide emergency obstetric care (EmOC). We used the World Health Organization data quality review framework to assess completeness and internal consistency of the three data elements, using 2019 and 2021 as reference years. Primary data was collected to verify the accuracy of reporting in four purposively selected EmOC facilities. Descriptive statistics, including frequencies and percentages, were computed using STATA (v14) and Microsoft Excel. Results We included 255 facilities from 2016–2019 and 247 from 2020–2021; of which 30% were EmOC facilities. The overall completeness of data for deliveries and livebirths ranged between 53% and 55%, and was < 2% for maternal deaths (98% of monthly values were zero). Among EmOC facilities, completeness was higher for deliveries and livebirths at 80%; and was < 6% for maternal deaths. For the whole sample, the prevalence of outliers for all three data elements was < 2%. Inconsistencies over time were mostly observed for maternal deaths, and underreporting of maternal deaths was noted in one of the EmOC facilities verified. Conclusion Routine data from facilities providing childbirth services in Kampala were generally suboptimal, but of acceptable quality in EmOC facilities. However, given likely underreporting of maternal deaths, further efforts to verify and count all maternal deaths in health facilities are essential to accurately estimate facility-based maternal mortality. There is still a need to improve facility reporting, especially in non-EmOC facilities.