Randomised controlled trial of two antenatal care models in rural Zimbabwe

Abstract

Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standard model in a rural area in Zimbabwe.Design Cluster randomised controlled trial with the clinic as the randomisation unit.Setting Primary care setting in a developing country where care was provided by nurse-midwives.Population Women booking for ANC in the clinics were eligible.Main outcome measures Number of antenatal visits, antepartum and intrapartum referrals, utilization of health centre for delivery and perinatal outcomes.Methods Twenty-three rural health centres were stratified prior to random allocation to the new (n = 11) or standard (n = 12) model of care.Results We recruited 13 517 women (new, n = 6897 and standard, n = 6620) in the study, and 78% (10 572) of their pregnancy records were retrieved. There was no difference in median maternal age, parity and gestational age at booking between women in the standard model and those in the new model. The median number of visits was four for both models. The proportion of women with five or less visits was 77% in the new and 69% in the standard model (OR 1.5; 95% CI 1.08-2.2). The likelihood of haemoglobin testing was higher in the new model (OR 2.4; 95% CI 1.0-5.7) but unchanged for syphilis testing. There were fewer intrapartum transfers (5.4 versus 7.9% [OR 0.66; 95% CI 0.44-0.98]) in the new model but no difference in antepartum or postpartum transfers. There was no difference in rates of preterm delivery or low birthweight. The perinatal mortality was 25/1000 in standard model and 28/1000 in new model. ConclusionIn Gutu district, a focused five-visit schedule did not change the number of contacts but was more effective as expressed by increased adherence to procedures and better use of institutional health care.

Mobile Phone Intervention Reduces Perinatal Mortality in Zanzibar: Secondary Outcomes of a Cluster Randomized Controlled Trial

“…We used a robust study design with a relatively large sample of health facilities and participants. Others have used similar design for trailing complex interventions in low-resource settings [20]. Intervention and control clusters were similar in socioeconomic and obstetric background characteristics, and it is reassuring that after adjustment for identifiable potential risk factors, the crude and adjusted results are similar.…”

Acceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria

“…The traditional approach relies on 12-15 visits during the course of pregnancy. This approach was accepted worldwide and has been the standard of obstetric care [1][2][3][4][5]. The risk-based approach to antenatal care was later incorporated into the antenatal care package.…”

“…It seeks to offer women individualized goal-oriented care that best meets the woman's health needs [10,11]. Women make fewer visits [4] but still receive health promotion, screening, detection and treatment of problems, prevention of diseases, complications and birth preparedness [10]. Concerns have been raised by women and service providers that the fewer visits would result in adverse maternal and foetal outcomes [12][13][14].…”

CenteringPregnancy-Africa: A pilot of group antenatal care to address Millennium Development Goals

“…After the World Health Organization reviewed the evidence and conducted a randomized clinical trial (Bergsjø and Villar, 1997; Majoko et al 2007; Munjanja et al 1996; Villar and Bergsjø, 1997; WHO, 2001), nearly all African countries have changed their antenatal standard of care from a 10-visit model to Focused Antenatal Care (FANC), a 4-visit, patient-centered model. The resources originally used for 10 visits were expected to be reallocated toward in high quality of care since the FANC model has fewer visits.…”