Abstract
BackgroundMany women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC) including information on pregnancy, related complications, and importance of skilled delivery attendance. We undertook a process evaluation of a successful cluster randomized trial testing the effectiveness of birth plans in increasing utilization of skilled delivery and postnatal care in Ngorongoro district, rural Tanzania, to document the time spent by health care providers on providing the recommended components of ANC.MethodsThe study was conducted in 16 health units (eight units in each arm of the trial). We observed, timed, and audio-recorded ANC consultations to assess the total time providers spent with each woman and the time spent for the delivery of each component of care. T-test statistics were used to compare the total time and time spent for the various components of ANC in the two arms of the trial. We also identified the topics discussed during the counselling and health education sessions, and examined the quality of the provider-woman interaction.ResultsThe mean total duration for initial ANC consultations was 40.1 minutes (range 33-47) in the intervention arm versus 19.9 (range 12-32) in the control arm p < 0.0001. Except for drug administration, which was the same in both arms of the trial, the time spent on each component of care was also greater in the intervention health units. Similar trends were observed for subsequent ANC consultations. Birth plans were always discussed in the intervention health units. Counselling on HIV/AIDS was also prioritized, especially in the control health units. Most other recommended topics (e.g. danger signs during pregnancy) were rarely discussed.ConclusionAlthough the implementation of birth plans in the intervention health units improved provider-women dialogue on skilled delivery attendance, most recommended topics critical to improving maternal and newborn survival were rarely covered.
Highlights
Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC) including information on pregnancy, related complications, and importance of skilled delivery attendance
The amount of time spent on health education, advice and counselling during ANC consultations is key to the effectiveness of ANC in improving health behaviours and care seeking during pregnancy, labour and delivery and in the immediate postpartum period [3]
A recent study in a rural district found that only about 25% of women attending ANC were informed of danger signs in pregnancy and labour, suggesting that coverage of health education and counselling services may be considerably lower in some regions of the country[11]
Summary
Many women in Sub-Saharan African countries do not receive key recommended interventions during routine antenatal care (ANC) including information on pregnancy, related complications, and importance of skilled delivery attendance. The scope of health education and counselling on pregnancy and related complications provided to women during ANC visits in most Sub-Saharan African countries where over half of all maternal deaths occur, is often inadequate or nonexistent[3,7]. This may be a contributing factor to the discrepant pattern of high ANC but low skilled birth attendance (SBA) uptake in many of these settings. Available evidence suggests that information on the importance of immediate postnatal care on maternal and early neonatal health is rarely provided during antenatal consultations[12]
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