Do health care providers give sufficient information and good counseling during ante-natal care in Lao PDR?: an observational study

Abstract

Background It is increasingly recognized that improving the quality of maternal health care delivery is of utmost importance in many countries. In Laos, the quality of antenatal care (ANC) service remains inadequate, but it has never been assessed thoroughly. This study aims to determine the ANC quality at the urban and rural public health facilities in Laos and provides suggestions to improve health education and counseling in addition to other routine care in public ANC services. Methods This health-facility based, cross-sectional observation study included both health providers ( n = 77) and pregnant women ( n = 421) from purposively selected health facilities ( n = 16). Information on the mothers’ current pregnancies, previous visits and their last children was collected. The time spent for each ANC session as well as ANC services provided were recorded. Descriptive and inferential statistics were applied to analyze the data. Results Overall performance of ANC services by health care providers was poor in both urban and rural areas. Insufficient provision of information on danger signs during pregnancy, nutrition, breast feeding and iron supplements was revealed. Generally the communication skills, behavior and attitude of health providers were very poor. Less than a quarter of pregnant women were treated with kindness and respect. Only 4% of the observed ANC session took privacy into consideration. Less than 10% of available information materials were used during each ANC session. None of the health providers in both rural and urban areas performed specific counseling. Overall mean (SD) time-spent for each ANC session was 16.21 (4.28) minutes. A positive correlation was identified between the length of working experience of health providers and their physical performance scores (adjusted R square = 0.017). Conclusions The overall performance of ANC services by health care providers was inadequate in both urban and rural areas. Insufficient provision of health education and poor communication skills of health care providers were revealed. Existing IEC materials were scarcely used. Taking action to improve the quality of ANC services by training and providing specific guidelines, creating dedicated rooms, and providing sufficient and effective materials for counseling are all greatly needed in public health facilities in Laos.

Why Do Some Lao Mothers Have Good Practices During Pregnancy? A Qualitative Positive Deviance Study

“…This was a motivating factor for our mothers, which is in line with the findings of other studies in Ethiopia, 3 as well as our recent study. [29][30][31] Unfortunately, the quality of ANC provision in Laos remains poor, especially, as previously described, communication skills and information provision. [27][28][29] Positive deviant mothers were satisfied with the received care and all used the pink book they received during ANC, but they were aware that other mothers may not have a similar perspective.…”

“…23,24 In contrast, mothers who did not perceive the risks of pregnancy and the benefits of optimal ANC visits would have less or no ANC utilization. 24,30,31 Positive deviant mothers did not face certain barriers that others might, including the lack of transport to the clinic or barriers such as distance or language. In addition, the lack of transportation is considered as one of the barriers to using ANC for many mothers in rural areas that were identified in other studies.…”

Maternity Clients Satisfaction with Client-Health Provider Interaction in State-owned Secondary Health Facilities in Cross River State

“…Evidence from studies implicates dysfunctional or negative client-health provider interaction such as disrespect and abuse, rudeness, failure to maintain privacy and confidentiality, inadequate provision of health information and lack of support for women during periods of pains (Ajayi, 2019;Phommachanh et al, 2019;Okonofua et al, 2017;Shakibazadeh et al, 2017). Dissatisfaction with maternity care is worrisome as it affects utilization and negates efforts towards improving maternal health outcomes.…”

“…Healthcare providers are also expected to provide adequate information on pregnancy, labour, postpartum, newborn care, breastfeeding, abnormal signs of pregnancy and appropriate actions to be taken (Al-Ateeq & Al-Rusaiess, 2015). Provision of information enables the pregnant woman to be fully informed about the progress of her pregnancy, change harmful beliefs and behaviour and supports her to make informed decisions (Phommachanh, Essink, Wright, Broerse, & Mayxay, 2019).…”

“…Saka, Yahaya and Saka (2012) observed that only 47.6% of the providers gave clear and accurate information. Similarly, Phommachanh, et al (2019) argue that "provision of information on danger signs during pregnancy, nutrition, breastfeeding and iron supplements was insufficient" and "less than 10% of available health information materials" such as charts, posters and models were used during each ANC session.…”