BMC Pregnancy and Childbirth | |
Quality of antenatal care in Zambia: a national assessment | |
Sabine Gabrysch2  Collins Chansa1  Nicholas N A Kyei3  | |
[1] Department of Policy and Planning, Ministry of Health Headquarters, Ndeke House, Lusaka 10101, Zambia;University of Heidelberg, Institute of Public Health, Im Neuenheimer Feld 324, Heidelberg 69120, Germany;Current address: Public Health Division, 37 Military Hospital, Accra, Ghana | |
关键词: Africa South of the Sahara; Health care quality; Prenatal care; Maternal health services; | |
Others : 1151531 DOI : 10.1186/1471-2393-12-151 |
|
received in 2012-08-02, accepted in 2012-12-05, 发布年份 2012 | |
【 摘 要 】
Background
Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries. We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a national scale and compared this to the quality of ANC received by expectant mothers.
Methods
We analysed two national datasets with detailed antenatal provider and user information, the 2005 Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers between 2002 and 2007.
Results
We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service, while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94% of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only 29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in the first trimester.
Conclusions
DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress.
【 授权许可】
2012 Kyei et al.; licensee BioMed Central Ltd.
【 预 览 】
Files | Size | Format | View |
---|---|---|---|
20150406084332180.pdf | 730KB | download | |
Figure 4. | 65KB | Image | download |
Figure 3. | 46KB | Image | download |
Figure 2. | 58KB | Image | download |
Figure 1. | 51KB | Image | download |
【 图 表 】
Figure 1.
Figure 2.
Figure 3.
Figure 4.
【 参考文献 】
- [1]WHO Facts Sheet: Maternal Mortality. [http://www.who.int/mediacentre/factsheets/fs348/en/ webcite]
- [2]WHO, UNICEF, UNFPA, The World Bank: Trends in maternal mortality: 1990 to 2008. Geneva: World Health Organization; 2010. http://whqlibdoc.who.int/publications/2010/9789241500265_eng.pdf webcite
- [3]Hogan MC, Foreman KJ, Naghavi M, Ahn SY, Wang M, Makela SM, Lopez AD, Lozano R, Murray CJ: Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010, 375(9726):1609-1623.
- [4]UNICEF, WHO, The World Bank, United Nations Population Division: Levels and Trends in Child Mortality. New York; 2012. http://www.childmortality.org webcite
- [5]Lawn JE, Blencowe H, Pattinson R, Cousens S, Kumar R, Ibiebele I, Gardosi J, Day LT, Stanton C: Stillbirths: Where? When? Why? How to make the data count? Lancet 2011, 377(9775):1448-1463.
- [6]Lawn JE, Yakoob MY, Haws RA, Soomro T, Darmstadt GL, Bhutta ZA: 3.2 million stillbirths: epidemiology and overview of the evidence review. BMC Pregnancy Childbirth 2009, 9(1):S2. BioMed Central Full Text
- [7]Yakoob MY, Lawn JE, Darmstadt GL, Bhutta ZA: Stillbirths: epidemiology, evidence, and priorities for action. Semin Perinatol 2010, 34(6):387-394.
- [8]Bullough C, Meda N, Makowiecka K, Ronsmans C, Achadi EL, Hussein J: Current strategies for the reduction of maternal mortality. BJOG 2005, 112(9):1180-1188.
- [9]Darmstadt GL, Bhutta ZA, Cousens S, Adam T, Walker N, de Bernis L: Evidence-based, cost-effective interventions: how many newborn babies can we save? Lancet 2005, 365(9463):977-988.
- [10]WHO: The World health report: 2005: make every mother and child count. Geneva: World Health Organization; 2005. http://www.who.int/whr/2005/whr2005_en.pdf webcite
- [11]Di Mario S, Basevi V, Gori G, Spettoli D: What is the effectiveness of antenatal care? (Supplement) Health Evidence Network report. Copenhagen: WHO Regional Office for Europe; 2005.
- [12]Villar J, Ba'aqeel H, Piaggio G, Lumbiganon P, Belizán JM, Farnot U, Al-Mazrou Y, Carroli G, Pinol A, Donner A, et al.: WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. Lancet 2001, 357(9268):1551-1564.
- [13]WHO: Antenatal care in developing countries. Promises, achievements and missed opportunities: An analysis of trends, levels and differentials, 1990 – 2001. Geneva: World Health Organization; 2003. http://whqlibdoc.who.int/publications/2003/9241590947.pdf webcite
- [14]WHO: WHO statement on antenatal care. Geneva: World Health Organization; 2011. http://whqlibdoc.who.int/hq/2011/WHO_RHR_11.12_eng.pdf webcite
- [15]Central Statistical Office (CSO), Ministry of Health (MoH), Tropical Diseases Research Centre (TDRC), University of Zambia, Macro International Inc: Zambia Demographic and Health Survey 2007. Final report. Calverton, Maryland, USA: CSO and Macro International Inc; 2009. http://www.measuredhs.com/publications/publication-FR211-DHS-Final-Reports.cfm webcite
- [16]WHO, UNICEF: Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn and child survival. Geneva: World Health Organization; 2010. http://whqlibdoc.who.int/publications/2010/9789241599573_eng.pdf webcite
- [17]Graham WJ, Varghese B: Quality, quality, quality: gaps in the continuum of care. Lancet 2012, 379(9811):e5-6.
- [18]Shankar A, Bartlett L, Fauveau V, Islam M, Terreri N: Delivery of MDG 5 by active management with data. Lancet 2008, 371(9620):1223-1224.
- [19]van den Broek NR, Graham WJ: Quality of care for maternal and newborn health: the neglected agenda. BJOG 2009, 116(Suppl 1):18-21.
- [20]Donabedian A: Evaluating the Quality of Medical Care. Milbank Mem Fund Q 1966, 44(3):166-206.
- [21]Donabedian A: The quality of medical care. Science 1978, 200(4344):856-864.
- [22]Donabedian A: The quality of care. How can it be assessed? JAMA 1988, 260(12):1743-1748.
- [23]Maxwell RJ: Quality assessment in health. Br Med J 1984, 288(6428):1470-1472.
- [24]WHO: Quality of care: A process for making strategic choices in health systems. Geneva: World Health Organization; 2006. http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf webcite
- [25]Institute of Medicine: Crossing the quality chasm: a new health system for the 21st Century. Washington, DC: National Academies Press; 2001. http://www.nap.edu/html/quality_chasm/reportbrief.pdf webcite
- [26]Kotelchuck M: An evaluation of the Kessner Adequacy of Prenatal Care Index and a proposed Adequacy of Prenatal Care Utilization Index. Am J Public Health 1994, 84(9):1414-1420.
- [27]Beeckman K, Louckx F, Masuy-Stroobant G, Downe S, Putman K: The development and application of a new tool to assess the adequacy of the content and timing of antenatal care. BMC Health Serv Res 2011, 11:213. BioMed Central Full Text
- [28]Rani M, Bonu S, Harvey S: Differentials in the quality of antenatal care in India. Int J Qual Health Care 2008, 20(1):62-71.
- [29]Mpembeni RN, Killewo JZ, Leshabari MT, Massawe SN, Jahn A, Mushi D, Mwakipa H: Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets. BMC Pregnancy Childbirth 2007, 7:29. BioMed Central Full Text
- [30]Naariyong S, Poudel KC, Rahman M, Yasuoka J, Otsuka K, Jimba M: Quality of antenatal care services in the Birim north district of Ghana: contribution of the Community-Based Health Planning and Services Program. Matern Child Health J 2011, 14:14.
- [31]Boller C, Wyss K, Mtasiwa D, Tanner M: Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania. Bull World Health Organ 2003, 81(2):116-122.
- [32]Hozumi D, Fronczak N, Noriega Minichiello S, Buckner B, Fapohunda B: Profiles of Health Facility Assessment Methods. MEASURE Evaluation, USAID. Arlington, VA: USAID and MEASURE Evaluation; 2006. [http://www.cpc.unc.edu/measure/tools/monitoring-evaluation-systems/hfa-methods/ webcite]
- [33]Ministry of Health Zambia, International Health Facility Assessment Network (IHFAN): Template Health Facility Census: Study Documentation. Lusaka: Ministry of Health, Directorate of Planning and Development; 2008.
- [34]Gabrysch S, Cousens S, Cox J, Campbell OM: The influence of distance and level of care on delivery place in rural Zambia: a study of linked national data in a geographic information system. PLoS Med 2011., 8(1)
- [35]Gabrysch S, Simushi V, Campbell OM: Availability and distribution of, and geographic access to emergency obstetric care in Zambia. Int J Gynaecol Obstet 2011, 114(2):174-179.
- [36]WHO: Global action for skilled attendants for pregnant women. Geneva: Department of Reproductive Health and Research, World Health Organization; 2002. http://whqlibdoc.who.int/hq/2002/WHO_RHR_02.17.pdf webcite
- [37]Kabakian-Khasholian T, Campbell O, Shediac-Rizkallah M, Ghorayeb F: Women's experiences of maternity care: satisfaction or passivity? Soc Sci Med 2000, 51(1):103-113.
- [38]WHO, UNICEF, UNFPA, World Bank: Packages of interventions for family planning, safe abortion care, maternal, newborn and child health sexual and reproductive health. Geneva: World Health Organization; 2010. http://whqlibdoc.who.int/hq/2010/WHO_FCH_10.06_eng.pdf webcite
- [39]Hawkes S, Matin N, Broutet N, Low N: Effectiveness of interventions to improve screening for syphilis in pregnancy: a systematic review and meta-analysis. Lancet Infect Dis 2011, 15:15.
- [40]Ministry of Health Zambia: National Health Strategic Plan 2006–2010. Lusaka; 2005.
- [41]Ministry of Health Zambia: Mid-Term Review of the National Health Strategic Plan 2006–2011. Lusaka; 2008.
- [42]Ministry of Health Zambia: Joint Annual Review for 2010. Lusaka; 2011.
- [43]Ministry of Health Zambia: National Health Strategic Plan 2011–2015. Lusaka; 2011.
- [44]Ministry of Health Zambia: Operational Implementation Manual for Results Based Financing (RBF) in Pilot Districts in Zambia. Lusaka; 2011.
- [45]Simkhada B, Teijlingen ER, Porter M, Simkhada P: Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs 2008, 61(3):244-260.
- [46]Shengelia B, Tandon A, Adams OB, Murray CJL: Access, utilization, quality, and effective coverage: An integrated conceptual framework and measurement strategy. Soc Sci Med 2005, 61(1):97-109.
- [47]Xu K, Saksena P, Evans DB: Health financing and access to effective interventions. World Health Report (2010) Background Paper, No 8. Geneva: World Health Organization; 2010. http://cdrwww.who.int/entity/healthsystems/topics/financing/healthreport/8Accesstocare.pdf webcite
- [48]Lawn JE, Lee AC, Kinney M, Sibley L, Carlo WA, Paul VK, Pattinson R, Darmstadt GL: Two million intrapartum-related stillbirths and neonatal deaths: where, why, and what can be done? Int J Gynaecol Obstet 2009, 107(1):S5-18. S19
- [49]Kinney MV, Kerber KJ, Black RE, Cohen B, Nkrumah F, Coovadia H, Nampala PM, Lawn JE: Sub-Saharan Africa's Mothers, Newborns, and Children: Where and Why Do They Die? PLoS Med 2010, 7(6):21.
- [50]Lincetto O, Mothebesoane-Anoh S, Gomez P, Munjanja SP: Antenatal care. In Opportunities for Africa's newborns: Practical data, policy and programmatic support for newborn care in Africa. Edited by Joy L, Kate K. PMNCH, Cape Town; 2006. http://www.who.int/pmnch/media/publications/africanewborns/en/ webcite
- [51]Boerma T, Chopra M, Evans D: Health systems performance assessment in the Bulletin. Bull World Health Organ 2009, 87(1):2.
- [52]Kyei NNA, Campbell OMR, Gabrysch S: The influence of distance and level of service provision on antenatal care use in Rural Zambia. PLoS One 2012, 7(10):e46475.