Malawi: Findings from a national census of health facilities

Aim: To identify service side factors associated with access to antenatal blood pressure measurement at health facilities in Malawi. Methods: Secondary data analysis of 1499 observations of antenatal consultations undertaken in the Service Provision Assessment survey 2013-14, a census of all formal health facilities in the country. Results: Differentials in access to antenatal blood pressure measurements by client age or educational status and provider gender or in-service training did not reach statistical significance although clinically important effects cannot be excluded. There was substantial variation among districts, ranging from 14% to 100% of observed consultations. Facilities in the Central and Southern regions had lower odds of providing blood pressure measurement relative to the Northern region (OR 0.17, 95% CI 0.03 to 0.30 and 0.11, 95% 0.04 to 0.31 respectively). Facilities affiliated to the Christian Health Association of Malawi and facilities under private management had higher odds of provision relative to government facilities (OR 3.24, 95% CI 1.71 to 6.11 and 5.77, 95% CI 1.87 to 17.79 respectively). Where observed consultations included taking the client's weight and measuring the symphysis-fundus height, the odds of blood pressure measurement were significantly increased (OR 6.4, 95% CI 3.32 to 12.34 and 1.71, 95% CI 1.01 to 2.88 respectively). Conclusion: An indicator for effective coverage, the proportion of antenatal visits that included blood pressure measurement, recorded in health passports examined at the time of admission for delivery, should be tested for incorporation into the District Health Information System to enable tracking of quality improvement in antenatal care. Further research is needed to elucidate the reasons for the variations identified here.