Evidence of application of the Basic Antenatal Care principles of good care and guidelines in pregnant women’s antenatal care records

Patience, Ngxongo Thembelihle Sylvia; Sibiya, Nokuthula; Gwele, Nomthandazo S

doi:10.4102/phcfm.v8i2.1016

Cited by 7 publications

(6 citation statements)

References 2 publications

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“…For the antenatal cases, the overall completeness was about 82%-88% with lower quality for treatment (27%-78%) and laboratory findings (35%-43%) [39]. Another study from South African observed missing information for 54%-98% of antenatal cases [40]. We also documented lower (case record completeness and quality at baseline, which improved to 90% for most of the components with the QI efforts across the facilities and districts.…”

Section: Plos Onementioning

confidence: 56%

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

et al. 2021

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Introduction Improving quality of care (QoC) for childbirth and sick newborns is critical for maternal and neonatal mortality reduction. Information on the process and impact of quality improvement at district and sub-district hospitals in India is limited. This implementation research was prioritized by the Haryana State (India) to improve the QoC for maternal and newborn care at the busy hospitals in districts. Methods This study at nine district and sub-district referral hospitals in three districts (Faridabad, Rewari and Jhajjar) during April 2017-March 2019 adopted pre-post, quasi-experimental study design and plan-do-study-act quality improvement method. During the six quarterly plan-do-study-act cycles, the facility and district quality improvement teams led the gap identification, solution planning and implementation with external facilitation. The external facilitators monitored and collected data on indicators related to maternal and newborn service availability, patient satisfaction, case record quality, provider’s knowledge and skills during the cycles. These indicators were compared between baseline (pre-intervention) and endline (post-intervention) cycles for documenting impact. Results The interventions closed 50% of gaps identified, increased the number of deliveries (1562 to 1631 monthly), improved care of pregnant women in labour with hypertension (1.2% to 3.9%, p<0.01) and essential newborn care services at birth (achieved ≥90% at most facilities). Antenatal identification of high-risk pregnancies increased from 4.1% to 8.8% (p<0.01). Hand hygiene practices improved from 35.7% to 58.7% (p<0.01). The case record completeness improved from 66% to 87% (p<0.01). The time spent in antenatal clinics declined by 19–42 minutes (p<0.01). The pooled patient satisfaction scores improved from 82.5% to 95.5% (p<0.01). Key challenges included manpower shortage, staff transfers, leadership change and limited orientation for QoC. Conclusion This multipronged quality improvement strategy improved the maternal and newborn services, case documentation and patient satisfaction at district and sub-district hospitals. The processes and lessons learned shall be useful for replicating and scaling up.

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Section: Plos Onementioning

confidence: 56%

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

et al. 2021

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“…Similar findings have been reported from other research in South Africa, for example in the context of antenatal care guideline adherence. 56 This is a global challenge, with the WHO recognising the importance of quality health workforce training in realising UHC. 57 One of the contradictions from our findings was that despite training gaps and primary care provider workload, one of the doctors said that 'nurses know more than doctors'.…”

Section: Discussionmentioning

confidence: 99%

‘Building on shaky ground’—challenges to and solutions for primary care guideline implementation in four provinces in South Africa: a qualitative study

et al. 2020

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ObjectivesClinical guidelines support evidence-informed quality patient care. Our study explored perspectives of South African subnational health managers regarding barriers to and enablers for implementation for all available primary care guidelines.DesignWe used qualitative research methods, including semistructured, individual interviews and an interpretative perspective. Thematic content analysis was used to develop data categories and themes.SettingWe conducted research in four of nine South African provinces with diverse geographic, economic and health system arrangements (Eastern Cape, Western Cape, KwaZulu-Natal, Limpopo). South Africa is a middle-income country with high levels of inequality. The settings represented public sector rural and peri-urban health facilities.ParticipantsTwenty-two participants with provincial and district health management roles, that comprised implementation and/or training on primary care guidelines, were included.ResultsParticipants recommended urgent consideration of health system challenges, particularly financial constraints, impacting on access to the guidelines themselves and to medical equipment and supplies necessary to adhere to guidelines. They suggested that overcoming service delivery gaps requires strengthening of leadership, clarification of roles and enhanced accountability. Participants suggested that inadequate numbers of skilled clinical staff hampered guideline use and, ultimately, patient care. Quality assurance of training programmes for clinicians—particularly nurses—interdisciplinary training, and strengthening post-training mentorship were recommended. Furthermore, fit-for-purpose guideline implementation necessitates considering the unique settings of facilities, including local culture and geography. This requires guideline development to include guideline end users.ConclusionsGuidelines are one of the policy tools to achieve evidence-informed, cost-effective and universal healthcare. But, if not effectively implemented, they have no impact. Subnational health managers in poorly resourced settings suggested that shortcomings in the health system, along with poor consultation with end users, affect implementation. Short-term improvements are possible through increasing access to and training on guidelines. However, health system strengthening and recognition of socio-cultural–geographic diversity are prerequisites for context-appropriate evidence-informed practice.

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“…This evidence comes as a concern, while there is a universal rule in nursing that "what is not recorded is regarded as not being done". 26 This emphasizes good record-keeping across nursing and midwifery practices, as it is considered integral to the quality and effective care. Congruently, the South African guidelines for maternal care prescribe standards for medical record-keeping during antenatal care.…”

Section: Discussionmentioning

confidence: 99%

The Preterm Birth Rate in a Resource-Stricken Rural Area of the Limpopo Province, South Africa

Malwela¹,

Maputle²

2022

NRR

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Background: Midwives play a pivotal role in providing primary prevention of preterm birth. Midwives screen and diagnose preexisting medical conditions, manage all conditions as guided by their scope of practice and refer all cases to other relevant team members. Purpose:The study aimed to determine and describe factors contributing to the escalating preterm birth rate in Limpopo, South Africa. Methods: Descriptive survey was used to determine factors related to increased preterm births. The non-probability purposive sampling selected 55 midwives, and data were collected using self-administered questionnaires. Data were analyzed through SPSS version 23. Results: Health facilities in Limpopo province had constrained resources as evidenced by a shortage of midwives, a lack of medical supply, poorly maintained, and old infrastructure. The skills of midwives and their working environment were affected by this constrained resource. The results from midwives that were perceived to affect them were 66% of participants reported lack of equipment, 29.1% participants agreed that pregnant women were presenting after 12 weeks to initiate antenatal care, while 45.3% pointed out they used steroids to prevent preterm labor. Record-keeping was viewed as an essential aspect to manage PTB when providing care. Despite the constrained resources, midwives were providing care to prevent PTB. This was evidenced by 78.2% agreeing that keep records from the first booking until the last antenatal visit, while 96.2% monitored the fetal heart rate, 98.1% screened for infections, and 90.9% referred all women at risk to the doctor. Thus, most of the midwives were competent with a confidence interval of (95%) and a prevalence of 9% and 9.5% that, is 9/10, which could prevent PTB. Conclusion: Lack of resources, including staffing and specialized care, contributed to escalating PTB at health facilities in Limpopo province.

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Evidence of application of the Basic Antenatal Care principles of good care and guidelines in pregnant women’s antenatal care records

Cited by 7 publications

References 2 publications

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

Improving quality of care for pregnancy, perinatal and newborn care at district and sub-district public health facilities in three districts of Haryana, India: An Implementation study

‘Building on shaky ground’—challenges to and solutions for primary care guideline implementation in four provinces in South Africa: a qualitative study

The Preterm Birth Rate in a Resource-Stricken Rural Area of the Limpopo Province, South Africa

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