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
 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 & Perinatal Health is central to global well-being
Causes of Maternal
Mortality
Maternal Mortality
Other
Indirect
18%
Death of a woman while pregnant or
within 42 days of termination of
pregnancy
=
Global health problem
Other Direct
11%
Embolism
1%
Unsafe
abortion
9%
Hemorrhage
35%
Hypertension
18%
Sepsis
8%
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

Maternal mortality reduction
 Uhuru

Vision 2030
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 status
Married
30 (79%)
Single
8 (21%)
Gestational age (months)
unknown
1 (3%)
0-3
1 (3%)
4-6
13 (34%)
7-9
23 (60%)
Gravidity
G1
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)
ANC utilization: malaria interventions vs anemia interventions
Malaria tested?
Take iron?
50%
21%
79%
50%
Sleep with mosquito net?
5%
95%
Deworming meds taken?
32%
26%
42%
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.


Women are generally not being instructed about warning signs of pregnancy complications


68% reported not having been instructed about warning signs
Limitations



92% reported being tested , 21% reported taking ARVs
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/NMF
Special 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