Comparative analysis of maternal and child healthcare services for quality care in selected secondary health institutions, Lagos metropolis, Nigeria

Objective: This study compared the quality of maternal and child healthcare services in selected upgraded and non-upgraded secondary health institutions in the Lagos metropolis. Methods: A comparative cross-sectional design was used across four secondary health facilities (two upgraded, two non-upgraded). Data were collected from existing maternal and neonatal health records over three months from August to October 2024. A proportional stratified random sampling technique was used to select 165 patient records. Data were collected using a validated, reliable (r=1.0) structured checklist based on the Donabedian model. Data were analysed using descriptive and inferential statistics (independent t-test) at a 0.05 significance level. Results: Upgraded facilities demonstrated a significantly better mean score for physical infrastructure (3.77 ± 0.56) compared to non-upgraded facilities (3.31 ± 0.95), with a mean difference of 0.458 (p=0.005). No significant differences were found in personnel skills/welfare (p=0.914) or the process of care delivery (p=0.152). However, outcome measures were more favourable in upgraded facilities, which had lower rates of near-miss cases (20.0% vs. 30.5%) and lower maternal (3.3% vs. 3.8%) and neonatal mortality. Conclusion: Upgraded facilities were associated with superior physical infrastructure and better maternal and neonatal outcomes, despite similar processes of care. Findings suggest that strategic investments in health facility upgrades, alongside targeted improvements in resource allocation and digital infrastructure, are crucial to enhancing service delivery and reducing mortality.