TY - JOUR
T1 - How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania
AU - Magoma, Moke
AU - Requejo, Jennifer
AU - Merialdi, Mario
AU - Campbell, Oona M.R.
AU - Cousens, Simon
AU - Filippi, Veronique
N1 - Funding Information:
The study was funded by the World Health Organization as a grant to London School of Hygiene and Tropical Medicine. Additional funding was from Ford Foundation sponsorship to MM as part of the scholarship for a PhD degree at London School of Hygiene and Tropical Medicine. We offer special thanks to all participants in this study: women participants and providers and Heads and administrators in all health units involved and Ngorongoro District Health Administration. Our sincere gratitude to TBAs and elder men in the two major ethnic groups in Ngorongoro for their support at all stages of the study implementation. We also offer our appreciation and gratitude to Symon Wandiembe and Erin Anastasi, London School of Hygiene and Tropical Medicine for their constructive comments at various stages of this manuscript. Disclaimer: The views expressed in this paper do not necessarily reflect those of the World Health Organization.
PY - 2011/9/24
Y1 - 2011/9/24
N2 - Background: 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. 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.Methods: The 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.Results: The 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.Conclusion: Although 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.
AB - Background: 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. 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.Methods: The 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.Results: The 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.Conclusion: Although 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.
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U2 - 10.1186/1471-2393-11-64
DO - 10.1186/1471-2393-11-64
M3 - Article
C2 - 21943347
AN - SCOPUS:80053171921
SN - 1471-2393
VL - 11
JO - BMC pregnancy and childbirth
JF - BMC pregnancy and childbirth
M1 - 64
ER -