Counselling as a Complementary Maternal and Child Health Intervention in Ghana: The Effect on Pregnancy Outcomes

Abstract

Abstract Objectives To identify the main issues midwives reportedly counsel pregnant women on, the influence of counseling on pregnancy outcomes and the implementation gaps. Methods Mixed method design was used. Quantitative data included interviews with 299 pregnant women above 27 gestational weeks randomly recruited from five hospitals in Ghana who had four or more antenatal care (ANC) visits. Their maternal health record books were reviewed for documented counseling sessions. Where half of the recommended topics were discussed, it was considered as adequate counseling (AC). Binary logistic regression was modeled in STATA to estimate the unadjusted odds ratio (OR) of AC on pregnancy outcomes. For the qualitative data, in-depth were conducted with 15 midwives and exit interviews with all the women and analyzed thematically. Results According to the women, the most discussed topics were usage of insecticide-treated nets (60.5%), personal/environmental hygiene (57.5%) and breastfeeding (52.3%). Conversely, the midwives documented discussing mostly nutrition/anaemia (37.6%), danger signs in pregnancy (30.1%) and birth preparedness/complication readiness (29.9%). Most women disliked group counseling and cited non-tailoring of advice. Main implementation gaps were heavy work schedules, inadequate staff, limited time for counseling and hefty documentation. The 45% who were adequately counseled significantly reduced their likelihood for poor dietary intake (OR: 0.54, 95% CI: 0.32–0.90), incidence of malaria (OR: 0.22, 95% CI: 0.06–0.78), preeclampsia (OR: 0.25 CI: 0.06–0.99) and need for neonatal intensive care (OR: 0.29 CI: 0.09–0.94) while increasing the newborn's birth weight (OR: 1.85 CI: 1.08–3.19). Conclusions Strengthening ANC, training midwives to counsel effectively using different skills in varying situations and adopting peer counsellors would facilitate client-centred nutrition education and empower women to take healthier actions, thus promoting behaviour change. Funding Sources None.