Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide "focused antenatal care"

Van, Ouma, Hamel, Sikuku, Odhiambo, Munguti, Ayisi, Crawford, Kager, Slutsker, Slutsker Laurence

Description

Maternal mortality remains high in developing countries and data to monitor indicators of progress in maternal care is needed. We examined the status of maternal care before and after health care worker (HCW) training in WHO recommended Focused Antenatal Care. Methods An initial cross-sectional survey was conducted in 2002 in Asembo and Gem in western Kenya among a representative sample of women with a recent birth. HCW training was performed in 2003 in Asembo, and a repeat survey was conducted in 2005 in both areas. Results Antenatal clinic (ANC) attendance was similar in both areas (86%) in 2005 and not significantly different from 2002 (90%). There was no difference in place of delivery between the areas or over time. However, in 2005, more women in Asembo were delivered by a skilled assistant compared to Gem (30% vs.23%, P = 0.04), and this proportion increased compared to 2002 (17.6% and 16.1%, respectively). Provision of iron (82.4%), folic acid (72.0%), sulfadoxine-pyrimethamine (61.7%), and anthelminths (12.7%) had increased in Asembo compared to 2002 (2002: 53.3%, 52.8%, 20.3%, and 4.6%, respectively), and was significantly higher than in Gem in 2005 (Gem 2005: 69.7%, 47.8%, 19.8%, and 4.1%, respectively) (P < 0.05 for all). Offering of tests for sexually transmitted diseases and providing information related to maternal health was overall low (<20%) and did not differ by area. In 2005, more women rated the quality of the antenatal service in Asembo as very satisfactory compared to Gem (17% vs. 6.5%, P < 0.05). Conclusions We observed improvements in some ANC services in the area where HCWs were trained. However, since our evaluation was carried out 2 years after three-day training, we consider any significant, sustained improvement to be remarkable.

Informations

• Publié par: biomed
• Publié le: 01 janvier 2010
• Nombre de lectures: 6
• Langue: English

Extrait

Oumaet al.Reproductive Health2010,7:1 http://www.reproductivehealthjournal.com/content/7/1/1

R E S E A R C H Open Access Research Antenatal and delivery care in rural western Kenya: the effect of training health care workers to provide "focused antenatal care"

1,3 2 1,3 1,3 1,3 4 Peter O Ouma* , Anna M van Eijk , Mary J Hamel , Evallyne S Sikuku , Frank O Odhiambo , Kaendi M Munguti , 1 3 2 3 John G Ayisi , Sara B Crawford , Piet A Kager and Laurence Slutsker

Abstract Background:Maternal mortality remains high in developing countries and data to monitor indicators of progress in maternal care is needed. We examined the status of maternal care before and after health care worker (HCW) training in WHO recommended Focused Antenatal Care. Methods:An initial crosssectional survey was conducted in 2002 in Asembo and Gem in western Kenya among a representative sample of women with a recent birth. HCW training was performed in 2003 in Asembo, and a repeat survey was conducted in 2005 in both areas. Results:Antenatal clinic (ANC) attendance was similar in both areas (86%) in 2005 and not significantly different from 2002 (90%). There was no difference in place of delivery between the areas or over time. However, in 2005, more women in Asembo were delivered by a skilled assistant compared to Gem (30% vs.23%,P= 0.04), and this proportion increased compared to 2002 (17.6% and 16.1%, respectively). Provision of iron (82.4%), folic acid (72.0%), sulfadoxine pyrimethamine (61.7%), and anthelminths (12.7%) had increased in Asembo compared to 2002 (2002: 53.3%, 52.8%, 20.3%, and 4.6%, respectively), and was significantly higher than in Gem in 2005 (Gem 2005: 69.7%, 47.8%, 19.8%, and 4.1%, respectively) (P < 0.05 for all). Offering of tests for sexually transmitted diseases and providing information related to maternal health was overall low (<20%) and did not differ by area. In 2005, more women rated the quality of the antenatal service in Asembo as very satisfactory compared to Gem (17% vs. 6.5%, P < 0.05). Conclusions:We observed improvements in some ANC services in the area where HCWs were trained. However, since our evaluation was carried out 2 years after threeday training, we consider any significant, sustained improvement to be remarkable.

Background 5.5% is needed; however between 1990 and 2005 the Maternal mortality, the death of a woman while pregnant annual decline was only 0.5% in the subSaharan region, or within 42 days of termination of pregnancy, remains compared to 4.2% for the middle income countries of disturbingly high in subSaharan Africa. It is estimated Asia [1,3]. that 270 000 maternal deaths occurred in the region in Maternal mortality occurs from risks attributable to 2005 [1]. The UN millennium Development goal (MDG) pregnancy and child birth as well as from poor availability on maternal health aims to reduce the number of women and quality of health services [4]. The most common who die in pregnancy and childbirth by threequarters causes of maternal mortality in subSaharan Africa between 1990 and 2015 [2]. To achieve this goal, it is esti include haemorrhage (34%), sepsis/infections (10%), mated that an annual decline in maternal mortality of hypertensive disorders (9%), HIV/AIDS (6%), and other direct causes (5%); other indirect causes contributed approximately 17% [5]. * Correspondence: [e-mail] Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Experiences from different countries have shown that 1 Kenya reducing maternal mortality may depend in part on the Full list of author information is available at the end of the article © 2010 Ouma et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons BioMedCentral Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.