Antenatal care processes in rural Southern Nepal: gaps in and quality of service provision—a cohort study

Abstract

ObjectivesThis study aimed to compare a standard quality of care definition to one that reflected focused antenatal care (FANC) guidelines and examine associations with receipt of good quality of care.DesignThis study was a longitudinal cohort study.SettingsFive government health posts in the Sarlahi district of Southern NepalParticipantsPregnant women between the ages of 15 and 49 who presented for their first antenatal care (ANC) visit at the study health posts.Main outcomesThere were two quality of care definitions: (1) provision of seven services at least once during pregnancy (QOC1) and (2) provision of services to reflect the FANC guidelines by incorporating a frequency of care dimension for certain services (QOC4+).ResultsThere was variation in service provision both in terms of frequency of provision and by gestational age at the visit. There were 213 women (49.1%) that received good quality care by the first definition, but when the frequency of service provision was included for the second definition the percentage dropped to 6.2%. There were significant differences in provision of quality care by health post for both definitions. The number of visits (QOC1 adjusted risk ratio (aRR) 1.18, 95% CI 1.13 to 1.23; QOC4+ aRR 1.46, 95% CI 1.11 to 2.80) and care during the first trimester (QOC1 aRR 1.22, 95% CI 1.01 to 1.49) and maternal age (QOC1 aRR 1.27, 95% CI 1.03 to 1.58) were associated with greater likelihood of good quality ANC.ConclusionThis analysis demonstrated that measuring quality of care by receipt of services at least once during pregnancy may overestimate the true coverage of quality of ANC. Future efforts should improve feasibility of including frequency of care in quality of care definitions.

Validation of maternal recall of number of antenatal care visits attended in rural Southern Nepal: a longitudinal cohort study

“…Nepal DHS does not report maternal mortality ratios at the district level, so there is no more recent comparable data. Approximately 60% of women in this area attended four or more ANC visits in the period 2010–2016, which is lower than the average among rural regions 11 15. Most ANC, especially in rural areas, is provided through public facilities, although there are some private facilities and hospitals.…”

“…Approximately 60% of women in this area attended four or more ANC visits in the period 2010–2016, which is lower than the average among rural regions. 11 15 Most ANC, especially in rural areas, is provided through public facilities, although there are some private facilities and hospitals. Five public health posts at Pharadwa, Laxmipur, Pidari, Pipariya and Kabilasi village development committees (VDCs) were designated to be the study sites because of their high attendance at ANC and accessibility to both the clients and the study team.…”

“…Therefore, the validity of this question in such household surveys is unknown. Previous studies have investigated the validity of ANC coverage indicators like quality of care, nutritional interventions, nutrition counselling and iron-folic acid supplementation in the same Nepal cohort, but the validity of frequency of ANC visits has not been explored 11–13. The objective of this study is to examine the validity of maternal report of total number of ANC visits and factors associated with the accuracy of maternal report.…”

Designing Indonesian Maternal and Child Health Mobile Applications using User-Centered Design

“…Antenatal Care WHO (2018) defines antenatal care (ANC) as care provided to pregnant women during pregnancy by skilled healthcare providers, often in first-level health facilities (Bryce et al 2021). In addition to the WHO definition, there is another definition from the Republic of Indonesia's Ministry of Health.…”

“…Antenatal care provides an opportunity for pregnant women to identify risk factors for pregnancy through screening, prevent and manage diseases (both pre-existing and pregnancy-related), and provide education and health promotion (Bryce et al 2021). In addition, ANC also plays a role in reducing perinatal morbidity and mortality by detecting and treating prenatal complications and identifying women who are classified as high risk to ensure delivery takes place in skilled settings (Atukunda et al 2021).…”