Abstract
Objective: To ascertain that standard antenatal care (Focused antenatal care) is being received at the Primary Health Care level in urban and rural areas of Ekiti State and to determine the facilitating factors and challenges to the practice of FANC in urban and rural areas. Design: Cross sectional. Setting: Primary Health Centers Participants: Pregnant women and Heads of health facilities. Methods: Two hundred respondents each from urban and rural areas primary health centres were proportionately selected from 18 primary health centers using simple random sampling. Exit interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package. In-depth Interviews were conducted with the heads of selected facilities. Data was analysed using descriptive statistics and Chi square test and content analysis for indepth interview. Results: More respondents 58 (29.3%) from the urban areas had the minimum contents compared to 41 (20.7%) of the rural respondents (p state were received by a small proportion of the respondents, suggesting that focused antenatal care had not fully translated into quality service; one major challenge to the delivery of standard antenatal care was inadequate number of skilled health workers especially in the rural areas. The gap between quality and utilisation of antenatal in urban and rural areas is gradually being closed up; this success should be improved upon and maintained.
Highlights
Focused antenatal care (FANC) became the recommended type of antenatal care following the publication of a WHO trial on antenatal care where it was discovered that more frequent visits do not necessarily improve pregnancy outcomes and advocate a minimum of 4 visits for pregnancies without complications scheduled as First visit: within 16 weeks or when woman first thinks she is pregnant, Second visit: At 20 - 24 weeks or at least once in second trimester, Third visit: At 28 - 32 weeks and Fourth visit: At 36 weeks or later
One major reason that could explain the low standard of FANC is the one provided some years ago [8] which is that when policies have been adopted, they do not automatically translate into quality services at the local level which in this case is at the primary health care level; this means that the standard model of antenatal care in the Primary Health Centers (PHCs) is presently experiencing a gradual transition to become the high quality and efficient model it is meant to be
Qualitative aspect of this study looked at the facilitating factors and challenges to the practice of FANC in Ekiti state PHCs; one major facilitating factor is the free health service project in government PHCs in the state
Summary
Focused antenatal care (FANC) became the recommended type of antenatal care following the publication of a WHO trial on antenatal care where it was discovered that more frequent visits (of the traditional antenatal care approach) do not necessarily improve pregnancy outcomes and advocate a minimum of 4 visits for pregnancies without complications scheduled as First visit: within 16 weeks or when woman first thinks she is pregnant, Second visit: At 20 - 24 weeks or at least once in second trimester, Third visit: At 28 - 32 weeks and Fourth visit: At 36 weeks or later. Limited resources of developing countries like Nigeria can be redirected to give better quality antenatal care services across the recommended four visits [1]. About 52,900 women die from pregnancy related complication and maternal mortality ratio in Nigeria is 545 per 100,000 live births. One in 13 Nigerian women stands a chance of experiencing maternal death. Neonatal mortality is high in Nigeria it is about 48 per 1000 live births. Most of these mortalities are of preventable and treatable causes [3]
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