Assessing Antenatal Care in Rural Zimbabwe

Antenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit goal-oriented antenatal care model against standard care. In the same population was also determined the sensitivity of factors used for risk screening to predict pregnancy complications and the effectiveness of the referral system in managing women with identified risk markers or pregnancy complications.Pregnancy records of 10 572 out of total 13 517 recruited women were available for analysis. The new model did not change the number of visits but resulted in better use of health care. The classical risk screening system had low predictive value and identified too large a risk group for referral. Nulliparous women had an increased risk for pregnancy complications whereas women with previous uncomplicated pregnancies were at low risk of complications even with high parity. Multiparous women with previous complications had an increased risk of complications but better utilisation of health care services for delivery reduced adverse perinatal outcomes. There was a functional referral system in Gutu and women complied with referral indications but efficiency of the system was reduced by failure of care providers to comply with referral recommendations…


Historical background of antenatal care
The risk concept in antenatal care
Questioning antenatal care
Earlier antenatal care trials
Main research issues in a rural African context
Thesis objectives
Research objectives
Zimbabwe: facts and figures
Health care system in Zimbabwe
Study area
Study design
Ethical considerations
The randomisation process
Referral criteria
Antenatal care activities/procedures and their justification
Preparatory work
Field work
Data handling
Statistical methods
Patient flow
Adherence to new model
Risk factors and screening for complications
Obstetric history
Referral system
Summary statement
Study limitations
Rationale of changing antenatal care programmes
Design choices/ study methodology
Statistical matters
Assessing implementation of the model
Success of reduced visits programmes
Quality of care
Risk factor screening
Parity as marker of risk
Obstetric historical factors
Effectiveness of risk screening
Referral practices
Compliance with referral recommendations

Author: Lundgren, Maria

Source: Uppsala University Library

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