The WHO antenatal care model: the defects

The preference and practice of Nigerian obstetricians regarding focused versus standard models of prenatal care

OBJECTIVE

To determine preferences, practices, and acceptance of focused versus standard prenatal-care models among Nigerian obstetricians.

METHODS

A cross-sectional survey was performed among clinicians who attended a conference held in Lagos, Nigeria, between November 27 and 29, 2013. The questionnaire assessed sociodemographic characteristics and opinions on prenatal care.

RESULTS

A total of 201 delegates returned complete questionnaires. All respondents were aware of both models of prenatal care. Although 70 (34.8%) respondents stated a preference for focused care, only 6 (3.0%) used this model in clinical practice. The main reason for their preference was the evidence base (23.4%). Overall, 185 (92.0%) respondents stated institutional protocol determined preference for and practice of standard care, 108 (53.7%) believed patients preferred standard care, and 89 (44.3%) felt standard care had health benefits. Preference for one model over the other was significantly associated with type and level of the healthcare practice (P=0.002 and P<0.001, respectively). Modification of the focused model to meet local, national, and cultural needs was recommended by 171 (85.1%) respondents.

CONCLUSION

Most obstetricians are skeptical about focused prenatal care and have not embraced this model owing to personal, institutional, and sociocultural factors.

Women's perception as a barrier to focused antenatal care in Nigeria: the issue of fewer antenatal visits

The attitude of pregnant women to a new antenatal care model with four antenatal visits (focused antenatal care) is examined using a cross-sectional survey in Enugu, Nigeria. Only 20.3% of the parturients desired a change to the new model. Parturients who defaulted from antenatal care three or more times, those dissatisfied with their current antenatal care, senior civil servants and parturients who received secondary school education or less most commonly desired a change to the new model (P < 0.05). Default from antenatal care and dissatisfaction with current antenatal care were most predictive of the desire for change in multiple logistic regression analysis. The most common reasons for desiring the change were convenience (65.1%) and cost considerations (24.1%). Reasons given for the rejection of the new model were: fear of inadequate learning during antenatal care (45.7%), the suspicion that four visits were inadequate for familiarization with care providers (12.9%), the need for early detection of disease (6.7%) and social satisfaction from antenatal visits (6.7%). These concerns are amenable to change by health education and social mobilization.

Clients' perceptions of the quality of antenatal care

OBJECTIVES

To assess perceptions of pregnant women about quality of antenatal care.

METHODS

Descriptive cross-sectional study in a developing country setting. Three-hundred-ninety-five previously booked pregnant women randomly selected from private and public health facilities at the 3 levels of care were interviewed using a 52-stem interviewer-administered, semistructured questionnaire. The questionnaire sought information about bio data, health information and services, interpersonal communications, amenities and constellation of services.

RESULTS

Mean gestational age at booking was 18.5 +/- 6.3 weeks. Only 25.8% of respondents booked in the first trimester. Mean number of antenatal visits was 4.0 +/- 2.4. Mean time spent during clinic visits was 3.9 +/- 1.4 hours. Waiting time was rated as appropriate by most women (67.1%). Women with high education and in upper socioeconomic class tended to rate the waiting time as too long. Counseling for HIV was the predominant health education subject. More than half (53.9%) of respondents did not receive information about cervical cancer. About 10% of patients did not receive information about danger signs during pregnancy, breast self-examination, family planning and prevention of sexually transmitted infections. Clinic amenities and constellation of services were rated highly. Most women (96.5%) were satisfied with the care received, would use the same facility in future pregnancies and would recommend it to friends.

CONCLUSIONS

The majority of pregnant women were satisfied with the care they received. However, frequent antenatal visits and long waiting times are the norm of our antenatal service. Measures for improving elements of quality of antenatal care are imperative.

What is the place of the new WHO antenatal care model in a teaching hospital setting?

The basic component of the new World Health Organization (WHO) antenatal care model prescribes reduced number of clinic visits and limited investigations for low-risk pregnant women. The objectives of this study were to determine the proportion of pregnant women seeking antenatal care in a Nigerian teaching hospital who qualify for the basic component and to document difficulties that may arise with the classifying form.

In December 2004, 234 pregnant women who had initiated antenatal care were enrolled for the study. Using the classifying form, 157 (67%) were eligible for the basic component, 41 (18%) for special care, but 36 (15%) women could not be classified. Those that did not know the birth weight of their last babies accounted for most (89%) of the unclassified group.

The WHO antenatal care model was the most appropriate and relevant method for our hospital where a large percentage (67%) of prenatal women were eligible for the basic component. However, we consider that the classifying form should be adapted to accommodate all pregnant women.