Abstract
BackgroundAntenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care.MethodsIn 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital (SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC and underlying factors in a broader view.ResultsOf 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121 cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in 22% – 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control of the health system.ConclusionsThis article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These results suggest urgent response from those in control of the health system to invest more resources to avert the situation in order to enhance maternal health in this country.
Highlights
Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care
Out of the total 754 ANC visits made by these 263 women with antenatal cards, blood pressure (BP), Hb and albumin in urine were assessed in only 69%, 25% and 22% respectively
The audit team attributed 52 (20%) of the 263 mothers with ANC cards to substandard antenatal care. Of these 39 (75%) were mothers presenting with severe anemia in pregnancy and eclampsia combined who had attended ANC clinics regularly but the respective parameters were never checked
Summary
Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions and is considered as an important basic component of reproductive health care. Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of interventions including education, counseling, screening, treatment, monitoring and promoting the well-being of the mother and fetus [1,2,3]. Evidence of the effectiveness of ANC interventions exists around the world when sought early in pregnancy and quality care continues until delivery [2,4,5]. Tanzania has adopted the World Health Organization (WHO) recommendation of a minimum of four goaloriented ANC visits during a woman’s pregnancy [6,7]. A second phase was carried out in December 2010 to assess in a broader view the quality of antenatal care services and underlying factors in Kilombero district, Tanzania
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