Abstract
BackgroundAlthough most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers’ (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.MethodsThis facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.ResultsNurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.ConclusionThe providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.
Highlights
Most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided
Using the formula; sample size = n / [1 + (n/ population)] where n = Z * Z [P (1-P)/(D*D)], P = the expected frequency value of ANC providers with poor knowledge of pregnancy conditions calling for urgent assessment at a higher level of care, D = the acceptable margin of error (5%) and Z = area under normal curve corresponding to the desired confidence level (95%/1.960), the sample size was calculated to 319 participants [21]
Similar procedures were used to describe the providers mentioning of conditions needing urgent assessment at a higher-level health facility and procedures that were or were not recorded during visits made to the ANC clinics
Summary
Most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. Studies from low-income countries have revealed significant gaps and weaknesses in knowledge and practices of ANC providers regarding provision of essential elements of the ANC package including counseling pregnant women on danger signs [14, 15]. If women and their families were thoroughly informed about danger signs and advised to seek health care immediately if any occurs, maternal morbidity and mortality could be reduced dramatically [16]
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