utilization of antenatal care services at yala sub-district hospital
DESCRIPTION
Utilization of Antenatal Care Services at Yala Sub-District Hospital. Ogechi Agwu GE/NMF International Medical Fellowship May 10, 2013 Kenya. Agenda. Introduction Maternal Mortality and Maternal Health Initiatives Antenatal Care Yala Sub-District Hospital MCH Services - PowerPoint PPT PresentationTRANSCRIPT
Ogechi AgwuGE/NMF
INTERNATIONAL MEDICAL FELLOWSHIP
M AY 1 0 , 2 0 1 3K E N YA
Utilization of Antenatal Care Services at Yala Sub-District
Hospital
AgendaIntroduction
• Maternal Mortality and Maternal Health Initiatives• Antenatal Care• Yala Sub-District Hospital MCH Services
Research Objectives
Methods
Results
Discussion
Conclusion
Executive Summary
This is a hospital-based study using a questionnaire to assess the utilization of antenatal care services at YSDH’s Maternal and Child Health Clinic.
Information collected includes: demographics of women presenting for antenatal care, gestational age and gravidity at presentation, awareness and promotion of services, levels of utilization of services, and opinion of services
Perhaps the results of this study can offer incite into possible deficiencies in antenatal care service delivery and provide further strategies for addressing the problem of maternal mortality in Kenya.
Maternal Mortality
Maternal MortalityDeath of a woman while pregnant
or within 42 days of termination of pregnancy
= Global health
problem
Hemorrhage35%
Hypertension18%
Sepsis8%
Unsafe abortion
9%
Em-bolism
1%
Other Direct11%
Other Indirect
18%
Causes of Maternal Mortality
Maternal & Perinatal Health is central to global well-being
Maternal Mortality: World vs Africa
Source: Trends in Maternal Mortality 1990-2010. WHO, UNICEF, UNFPA and The World Bank.
Maternal Mortality: Kenya
Source: WHO, UNICEF, UNFPA, The World Bank and UN Population Division of Maternal Mortality Estimation Inter-Agency Group
Maternal Health Initiatives
UN Millennium Development Goal 5 Improve Maternal Health
US Government-Kenya Partnership (GHI Strategy) Reduction of maternal, neonatal and child mortality
Kenya Vision 2030 Maternal mortality reduction
Uhuru Kenyatta Maternity fee waiver
Antenatal Care
As the major causes of maternal mortality are preventable, Antenatal care (ANC) has been targeted as a potential prevention strategy.
Important gateway for overall Women’s health
Focused ANC: evidence-based approach recommended for low-risk pregnancies 4 intervention-focused visits (one within first trimester)
syphilis serologic screening malaria prevention education and provisions anti-tetanus immunization (TT) prevention of mother-to-child transmission of HIV (PMTCT)
Goals: Emergency preparedness (early detection and treatment) Birth preparedness Health promotion
YSDH Maternal & Child Health Services
Fetal monitoring
Testing (e.g. BP, Antenatal profile, HIV, malaria)
Medications (e.g. Malaria ppx, Iron, ARVs)
Vaccinations (e.g. TT)
ITNs
Education (e.g. PMTCT)
Research Objectives
• Determine whether ANC is being promoted
• Assess for utilization of ANC services as per WHO recommendations (FANC)
• Assess whether gravidity affects utilization of ANC
Methods
20-question survey (YES/NO and open-ended questions)
April 10 – 18th, 2013
MCH Clinic peak hours (9 am – 1pm)
CHW served as translator (Kiswahili and Luo)
SAMPLE SURVEY
Results
Demographics of cohort (n=38)Age (years)
≤19 6 (16%)
20-34 28 (74%)
≥35 4 (11%)
Marital statusMarried 30 (79%)
Single 8 (21%)
Gestational age (months)unknown 1 (3%)
0-3 1 (3%)
4-6 13 (34%)
7-9 23 (60%)
GravidityG1 7 (18%)
G2-G4 25 (66%)
G5+ 6 (16%)
Results (cont’d)
ANC promotion 76% aware of ANC prior to becoming pregnant
Majority (45%) of women were informed about ANC by a Non-pregnant friends/family member
24% credited school/media/self;16% reported skilled health professional/pregnant friend or family member
ANC utilization 18% presented for first ANC visit
71% presenting at GA ≥ 5 months
82% had completed 2 or more ANC visits
82% report full utilization
Results (cont’d)
Take iron?
50%
50%
Deworming meds taken?
42%
32% 26%
Malaria tested?
79%
21%
Sleep with mosquito net?
95%
5%
ANC utilization: malaria interventions vs anemia interventions
Results (cont’d)
G1 vs G2+ levels of utilization First ANC visits: 43% of G1s vs 13% G2+
2 or more ANC visits: 57% of G1s, 87% of G2+
Opinion of services 95% rated services as “Very important”
92% rated services as “Good, would not change anything”
Discussion
ANC promotion Majority of the women were aware of ANC prior to becoming pregnant Based on awareness, mothers tended to be the biggest promoters of ANC
ANC utilization Majority of the women had completed 2 or more visits Majority of those presenting for the first visit presented far into pregnancy Women tended not to miss appointments; tend to adhere to
recommendations
Gravidity Majority of the women (both the primigravids and multigravids) had
completed at least 2 ANC visits
Conclusion
Women are aware of ANC services prior to becoming pregnant but do not present for care until late in second trimester.
While women tend to present late in second trimester, they are compliant with given recommendations.
There is no gross difference in levels of utilization of ANC between multigravids and primigravids.
The most common ANC service women are aware of is HIV testing. 92% reported being tested , 21% reported taking ARVs
Women are generally not being instructed about warning signs of pregnancy complications 68% reported not having been instructed about warning signs
Limitations Language barrier makes open-ended responses harder to assess. Education level and plans for delivery/delivery location were not assessed.
Future research considerations: When are women aware of their pregnancy status? Why are women not seeking ANC in the first trimester? What is the level of utilization of ANC services for women who plan to deliver at home? Why are warning signs of pregnancy complications not being addressed during ANC visits?
Acknowledgement
GE/NMFSpecial Thanks:
Dr Awino, Dr. Momanye, Mr. Opere Hassan O. Ramadhan Dr. Odero, Dr. Onyango, Dr. Wagude Dr. Omoto Dr. Anyona, Brian (CDC/KEMRI at SDH) Survey participants and CHWs at the MCH in
YSDH
References
Kenya National Bureau of Statistics and ICF Macro. 2010. 2008-09 Kenya Demographic and Health Survey. Calverton, Maryland: KNBS and ICF Macro.
Ministry of Public Health and Sanitation and Ministry of Medical Services, GOK. 2011. Global Health Initiative Kenya Strategy (2011-2014). Nairobi, Kenya: MOH.
GOK. 2007. Kenya Vision 2030: A Globally Competitive and Prosperous Kenya. Nairobi, Kenya: Ministry of Planning and National Development and the National Economic and Social Council (NESC).
National Coordinating Agency for Population and Development. 2010. Policy Brief No. 9, Maternal Deaths on the Rise in Kenya: A Call to Save Women’s Lives. Nairobi, Kenya: NCAPD.
WHO/UNDP/UNICEF/UNFPA/World Bank. Mother-Baby Package: Implementing Safe Motherhood in Countries. Geneva: World Health Organization, 1994
Ouma PO, van Eijk AM, Hamel MJ, Sikuku ES, et al. Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provided “focused antenatal care.” Reproductive Health 2010, 7:1