Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania

Abstract

BackgroundThe potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed.MethodsCombining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision.ResultsThe delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy".ConclusionsEfforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture.

Evaluation of the Quality of Antenatal Care (ANC) Service at Higher 2 Health Center in Jimma, South West Ethiopia

“…Similarly the adequacy of trained man power those were trained on the FANC in our study is different from the study done in the four selected (RCH) clinics where only one out of the three care providers had been trained on the FANC guidelines [8]. This difference might be related to differences in setup and methods of study.…”

Assessment of the Content and Utilization of Antenatal Care Services in a Rural Community in Cameroon: A Cross-Sectional Study

“…These results are similar to those found by Dairo and Owoyokun in Ibadan [18], Oladapo et al [27] in South Western Nigeria where 97.1% and 85.6% of women respectively who attended ANC received similar information. On the contrary, Gross et al found that in the Kilombere valley, South Eastern Tanzania only 19% of women had information on the appropriate diet in pregnancy, meanwhile 28% had HIV counselling and 3% had information on medicines safe to use in pregnancy [28]. On other information received, like on the danger signs during pregnancy our findings of 82% were similar those of 86.6% documented by Dairo and Owoyokum [18] but different from those of Gross et al [28] and Ouma et al [29] where only 3% and 10% respectively had this information.…”

Reported Knowledge, Attitude and Practice of Antenatal Care Services among Women in Dodoma Municipal, Tanzania

“…This is an important point to be considered in every pregnancy women and as usually in high proportion of them receiving SP very late during their antenatal booking [26][27][28][29][30][31][32][33][34][35][36]. These practices were significantly associated with poor pregnancy outcome regarding intermittent presumptive treatment against malaria in pregnancy during antenatal care.…”