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Where is the ‘C’ in antenatal care and postnatal care : A multi‐country survey of availability of antenatal and postnatal care in low‐ and middle‐income settings
Author(s) -
Madaj Barbara,
Gopalakrishnan Somasundari,
Quach Alexandre,
Filiaci Simone,
Traore Adama,
Bakusa Dankom,
Mdegela Mselenge,
Yousofzai Abdul Wali,
Rahmanzai Ahmed Javed,
Kodindo Grace,
Gami JeanPierre,
Rostand Njiki Dounou,
Kessely Hamit,
Addo Stephen Ayisi,
Abbey Mercy,
Sapali Mary,
Omar Ali,
Ernest Alex,
Mtandu Rugola,
Agossou Abram,
Ketoh Guillaume K.,
Furtado Nicholas,
Mangiaterra Viviana,
Broek Nynke
Publication year - 2022
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.17106
Subject(s) - medicine , health facility , psychological intervention , health care , developing country , postnatal care , pregnancy , environmental health , pediatrics , family medicine , obstetrics , nursing , population , biology , economic growth , economics , genetics , health services
Objective Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention and treatment of pregnancy‐related illness and to reduce perinatal mortality. We developed signal functions and assessed availability of the essential components of care. Design Cross‐sectional survey. Setting Afghanistan, Chad, Ghana, Tanzania, Togo. Sample Three hundred and twenty‐one healthcare facilities. Methods Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component. Main outcome measure Availability of ANC PNC components. Results Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3–17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub‐Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7–86.5% of facilities. Prevention and management of TB; assessment of pre‐ or post‐term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities. Conclusions Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced. Tweetable abstract ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings.