Objective To assess the content and delivery of essential antenatal services before implementation of programmes for prevention of mother-to-child transmission (PMTCT) of human immunodeficiency virus (HIV). Methods We assessed 18 antenatal care centres (eight public units and ten managed by nongovernmental organizations) in Kinshasa, Democratic Republic of the Congo. We used a survey to capture information about the number and type of antenatal health workers, infrastructure capacity and the delivery of basic antenatal care services such as: nutritional counselling; tetanus toxoid vaccination; prevention and management of anaemia, malaria, sexually transmitted infections, and tuberculosis; and counselling for postpartum contraception. Findings Antenatal care units differed with respect to size, capacity, cost, service delivery systems and content. For instance, 17 of the 18 sites offered anaemia screening but only two sites included the cost in the card that gives access to antenatal care. Nine of the clinics (50%) reported providing the malaria prophyalxis sulfadoxine pyrimethamine as per national policy. Four (22%) of the sites offered syphilis screening. Conclusion Scaling up PMTCT programmes in under-resourced settings requires evaluation and strengthening of existing basic antenatal care service delivery.
IntroductionAt the end of 2005, an estimated 38.6 million people were living with human immunodeficiency virus (HIV). Nearly two-thirds of these were in sub-Saharan Africa 1,2 where countries struggling to respond to the crisis are simultaneously battling poverty, poor infrastructure, competing health needs and, in some cases, civil unrest. In 2004, women represented 57% of all cases of HIV in sub-Saharan Africa and made up nearly three-quarters of new infections in the 15-24 years age group in the region. Approximately 700 000 children younger than 15 years were newly in--fected with the virus in 2005.1 Almost 90% of these newly infected children were born to HIV-infected mothers and acquired HIV during pregnancy, labour and delivery, or via breastfeeding. 1,3,4 Interventions to reduce the transmission