Antenatal care strengthening for improved quality of care in Jimma, Ethiopia: an effectiveness study

Abstract

BackgroundInterventions for curing most diseases and save lives of pregnant and delivering women exist, yet the power of health systems to deliver them to those in most need is not sufficient. The aims of this study were to design a participatory antenatal care (ANC) strengthening intervention and assess the implementation process and effectiveness on quality of ANC in Jimma, Ethiopia.MethodsThe intervention comprised trainings, supervisions, equipment, development of health education material, and adaption of guidelines. It was implemented at public facilities and control sites were included in the evaluation. Improved content of care (physical examinations, laboratory testing, tetanus toxoid (TT)-immunization, health education, conduct of health professionals, and waiting time) were defined as proximal project outcomes and increased quality of care (better identification of health problems and increased overall user satisfaction with ANC) were distal project outcomes. The process of implementation was documented in monthly supervision reports. Household surveys, before (2008) and after (2010) intervention, were conducted amongst all women who had given birth within the previous 12 months. The effect of the intervention was assessed by comparing the change in quality of care from before to after the intervention period at intervention sites, relative to control sites, using logistic mixed effect regression.ResultsThe continued attention to the ANC provision during implementation stimulated increased priority of ANC among health care providers. The organizational structure of the facilities and lack of continuity in care provision turned out to be a major challenge for implementation. There was a positive effect of the intervention on health education on danger signs during pregnancy (OR: 3.9, 95% CI: 2.6;5.7), laboratory testing (OR for blood tests other than HIV 2.9, 95% CI: 1.9;4.5), health problem identification (OR 1.8, 95% CI: 1.1;3.1), and satisfaction with the service (OR: 0.4, 95% CI: 0.2;0.9). There was no effect of intervention on conduct of health professionals. The effect of intervention on various outcomes was significantly modified by maternal education.ConclusionThe quality of care can be improved in some important aspects with limited resources. Moreover, the study provides strategic perspectives on how to facilitate improved quality of ANC.

Adherence to standards of first-visit antenatal care among providers: A stratified analysis of Tanzanian facility-based survey for improving quality of antenatal care

“…Refresher training for health care providers creates the opportunity to receive the up-to-date information and skills required to provide quality health care [75,76]. The results of the present study support the suggestion that refresher training guarantees better ANC care [77,78]. This may be because refresher training improved the health care providers’ knowledge and level of confidence, as these are important components in the provision of quality health services [79,80].…”

Provider-Perceived Benefits and Constraints of Complete Adherence to Antenatal Care Guideline Among Public Health Facilities, Ethiopia: A Qualitative Study

“…The results of the present study showed that the quality of pre and in-service training with supportive mentorship is the other bottleneck that hinders provider's adherence to ANC guideline. This nding is consistent with another study done in Ethiopia (35) and one in Sierra Leone (36). Therefore, integration of pre-service training to the service has to be done if there is to be better adherence to ANC guideline.…”

Utilization of reversible long acting family planning methods among married 15-49 years women in Areka town, Southern Ethiopia

“…ANC attendance efficiency were related to service provision in facilities in extent of changing behavior of client. 16,17 This study reports, ANC attendance and counselled regarding family planning was significantly associated with P-value of 0.001. Thus, lack of significance would be due to commonly practiced counselling to open (short acting, and Long acting's (reversible and irreversible), but this study focused on LARC specially.…”