Quality of antenatal care in rural southern Tanzania: a reality check

Malabika Sarker,Olaf Müller,Florian Neuhann,Theodora Mbunda,Manuela De Allegri,Sylvia Kirenga,Gerhard Schmid,Isaack Lekule,Elin Larsson

doi:10.1186/1756-0500-3-209

Abstract

BackgroundCounselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications.FindingsThe study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping.ConclusionLinking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions.

Highlights

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality
Linking danger signs to clinical and laboratory examination results during antenatal care (ANC) with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions
Key interventions to reduce maternal deaths include the promotion of antenatal care (ANC), presence of skilled assistants during childbirth and provision of emergency obstetric care [2]

Summary

Introduction

Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications. Key interventions to reduce maternal deaths include the promotion of antenatal care (ANC), presence of skilled assistants during childbirth and provision of emergency obstetric care [2]. The high MMR in Tanzania, despite good antenatal and delivery care coverage, highlights the issue that the use of maternal health services alone is not sufficient to reduce maternal mortality. Studies report that very few women in rural Tanzania can identify three or more obstetric danger signs [4,10]. The quality of care in health facilities has been reported to be very poor [14,15,16]

Objectives

Methods

Conclusion