Users’ opinion about antenatal visits quality: implementation research in Nampula, Mozambique

Abstract

Background: Access to and quality of maternal and child health services are essential to reduce morbidity and mortality in these groups, which are extremely high in Africa, including Mozambique. The reasons for this are complex but one important factor is the availability of efficient, timely, patient centred antenatal care for all pregnant women. Antenatal visits are important, and they should be performed as early as possible during pregnancy. To contribute to reduce maternal and new-born mortality rates in Nampula, the Faculty of Health Sciences at Lúrio University and the University of Saskatchewan, carried out an implementation research, including training activities for local health units’ professionals in maternal and child health care. This research will assess the impact of health professionals training in ​​maternal and child health, on the quality of services of antenatal visits at the Marrere Health Centre in Nampula, Mozambique. Methods: Descriptive, quantitative pre-post study, applying three cross-sectional surveys on user’s opinion about antenatal visit quality. The baseline surveys included a sample of women in antenatal consultation (with a 10% margin error and 90% confidence interval) and for post surveys, after completion of four and eight professional training modules, the samples were calculated with a 95% confidence interval and a 5% margin of error. The three groups of different subjects underwent a private survey, using a five-point Likert scale, after signing an informed consent form. The surveys were entered into a database, and analysed to assess frequency, percentage, average and standard deviation. This research was approved by the Lúrio University and the University of Saskatchewan’ Bioethics Committees. Results: 309 pregnant women were surveyed during antenatal visits, and the principles of good care assessment shows a positive evolution about communication and information; some shortcomings persist. Regarding labour conditions and new-born care, we see a positive evolution, such as with receiving information about the right they have to a companion during childbirth (72.9%, namely a traditional birth attendant) and the importance to start breastfeeding in the first hour following delivery (88.7%). Pregnant women globally rated their experience in antenatal consultation in 2019 as excellent (42.5%) and good (48%). The evolution of this service, however, was unfavourable in terms of privacy. Conclusion: Antenatal visits quality at Marrere Health Centre, in the users’ opinion, improved and health professionals are practising according to the national Ministry of Health protocol, yet with some deficiencies in information and communication, to overcome by continuous professional development. The women’ low level of schooling, needs an information campaign on sexual and reproductive health and family planning, widely disseminated in rural communities and among most disadvantaged populations.