Abstract
BackgroundNigeria has one of the highest rates of maternal mortality in the world (576/100,000 births), with a significant proportion of death attributed to hypertensive disorders in pregnancy (HDPs). High quality antenatal care (ANC) plays a crucial role in early detection and management of HDPs. We conducted an assessment of quality of antenatal care, and its capacity to detect and manage HDPs, in two tiers of Nigerian facilities, with the aim of describing the state of service delivery and identifying the most urgent gaps.MethodsQuality of antenatal care was assessed and compared between primary healthcare centers (PHCs) (n = 56) and hospitals (secondary + tertiary facilities, n = 39) in seven states of Nigeria. A cross-sectional design captured quality of care using facility inventory checklists, semi-structured interviews with healthcare providers and clients, and observations of ANC consultations. A quality of care framework and scoring system was established based on aspects of structure, process, and outcome. Average scores were compared using independent sample t-tests and measures of effect were assessed by multivariate linear regression.ResultsAll domains of quality except provider interpersonal skills scored below 55%. The lowest overall scores were observed in provider knowledge (49.9%) and provider technical skill (47.7%). PHCs performed significantly worse than hospitals in all elements of quality except for provider interpersonal skills. Provider knowledge was significantly associated with their level of designation (i.e., obstetrician vs. other providers).ConclusionsIn order to provide high quality care, ANC in Nigeria must experience massive improvements to inventory, infrastructure and provider knowledge and training. In particular, ANC programs in PHCs must be revitalized to minimize the disparity in quality of care provided between PHCs and hospitals. The relatively low quality of care observed may be contributing to Nigeria’s high rate of maternal mortality and burden of disease attributed to HDPs.
Highlights
Nigeria has one of the highest rates of maternal mortality in the world (576/100,000 births), with a significant proportion of death attributed to hypertensive disorders in pregnancy (HDPs)
This paper explores the quality of antenatal care (ANC) in seven states across the six geopolitical zones of Nigeria using a well-established framework for assessing Quality of Care (QOC), with a focus on its capacity to detect and manage hypertensive disorders in pregnancy
The average client was 27.78 years of age, with those visiting primary healthcare center (PHC) being significantly younger than those visiting hospitals (24.9 vs. 28.3 years; p = 0.001)
Summary
Nigeria has one of the highest rates of maternal mortality in the world (576/100,000 births), with a significant proportion of death attributed to hypertensive disorders in pregnancy (HDPs). Antenatal care (ANC) describes the services offered to pregnant women, including health promotion and communication, screening and diagnosis, disease prevention, and emotional and psychological support. As of 2015, hypertensive disorders in pregnancy (HDPs), including pre-eclampsia and eclampsia, were the greatest cause of facility-based maternal mortality (29.0%) in Nigeria [2]. Because HDPs tend to have detectable clinical parameters [4], increasing utilization of quality ANC is essential to reducing maternal mortality caused by this class of disease. Facilities should be well stocked with essential commodities, services should be provided by competent healthcare workers, and clients should leave well-informed, satisfied, and respected
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