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Background: Poor qualities of antenatal and intrapartum care are associated with poor maternal and neonatal health outcomes. Audit of care is an essential tool to identify gaps for standard protocols and guidelines that can assist with evidence based intervention to ensure consistent quality of care during antenatal and delivery.
Objectives: To measure the compliance on the specific antenatal and delivery care indicators based on national guidelines.
Method: A cross-sectional study was conducted of women who had childbirths between January and June 2021 in a midwife obstetric unit. Descriptive statistics were used to describe continuous and categorical variables. Both the mean and standard deviation (SD) were calculated for continuous and proportions for categorical variables.
Results; The mean age and gestational age of the sample were 26 years and 16 weeks respectively. Teenage pregnancy constituted 13.5%. Most of the antenatal and delivery care indicators had good compliance (> 95%). However, gaps were identified for: recording of Last Menstrual Period (78.5%), syphilis treatment at antenatal booking (72.7%), repeat syphilis test at 32 weeks (43.4%) and completion of basic antenatal care checklist (46.3%) during antenatal care. Lower rate for delivery care indicators were: recording of measurement of length and head circumference of the neonates (76.5%) and use of pain relief (5.4%) to mothers at delivery. The outcome indicators measured were good as Low Birth Weight, delivery complications and neonatal death rates were 11.6%, 10.7% and 1.4% respectively.
Conclusions: Though the study found good compliance with antenatal and delivery care provided but the few basic indicators such as basic antenatal checklist, completion of syphilis treatment and use of pain relief were poor. These results are vital for a quality improvement programme including training of midwives on basic antenatal care including maternity care guidelines in PHC facilities. A multi-centre study is also recommended for further study.
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How to Cite
United Nations Development Program. The global strategy for women’s, children’s and adolescents’ health (2016 - 2030). New York: UN, 2015.
Souza JP, Gülmezoglu AM, Vogel J, et al. Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross-sectional study. Lancet 2013;381(9879):1747-1755. https://doi. org/10.1016/S0140-6736(13)60686-8
Fink G, Ross R, Hill K. Institutional deliveries weakly associated with improved neonatal survival in developing countries: Evidence from 192 Demographic and Health Surveys. Int J Epidem 2015;44(6):1879-1888. https://doi.org/10.1093/ije/dyv115
Kassebaum NJ, Bertozzi-Villa A, Coggeshall MS, et al. Global, regional, and national levels and causes of maternal mortality during 1990 - 2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet 2014;384(9947):980-1004. https://doi.org/10.1016/ S0140-6736(14)60696-6
Kruk ME, Leslie HH, Verguet S, Mbaruku GM, Adanu RM, Langer A. Quality of basic maternal care functions in health facilities of five African countries: An analysis of national health system surveys. Lancet Glob Health 2016;4(11):e845-855. https://doi.org/10.1016/S2214- 109X(16)30180-2.
Koblinsky MA. Reducing Maternal Mortality: Learning from Bolivia, China, Egypt, Honduras, Indonesia, Jamaica, and Zimbabwe. Washington, D.C.: World Bank Publications, 2003.
Nyamtema AS, Urassa DP, van Roosmalen J. Maternal health interventions in resource limited countries: A systematic review of packages, impacts and factors for change. BMC Pregnancy Childbirth 2011;11:30. https://doi.org/10.1186/1471-2393-11-30
Tunçalp Ӧ, Pena-Rosas JP, Lawrie T, et al. WHO recommendations on antenatal care for a positive pregnancy experience – going beyond survival. BJOG 2017;6(124):860-862. https://doi.org/10.1111/1471-0528.14599
National Committee for the Confidential Enquiries into Maternal Deaths. Saving Mothers 2014 - 2016: Seventh triennial report on confidential enquiries into maternal deaths in South Africa: Short report. Pretoria: National Committee for the Confidential Enquiries into Maternal Deaths, 2019.
Hofmeyr GJ, Mentrop L. Time for ‘basic antenatal care plus’ in South Africa? S Afr Med J 2015;105(11):902-903. http://doi.org/10.7196/SAMJ.2015.V105I11.10186
Hoque AM, Buckus S, Hoque M, van Hal G. Deciphering the association of antenatal care visits and pregnancy outcomes from South Africa. Eur J Med Health Sci 2022;4(3):175-181. https://doi.org/10.24018/ejmed.2022.4.3.
Blencowe H, Cousens S, Jassir FB, et al. National, regional, and worldwide estimates of stillbirth rates in 2015, with trends from 2000: A systematic analysis. Lancet Glob Health 2016;4(2):e98-e108. https://doi.org/10.1016/S2214-109X(15)00275-2
Zhang B, Yang R, Liang SW, et al. Association between prenatal care utilisation and risk of preterm birth among Chinese women. Journal of Huazhong University of Science and Technology [Medical Sciences] 2017;37:605-611. https://doi.org/10.1007/s11596-017-1779-8
Pervin J, Rahman SM, Rahman M, Aktar S, Rahman A. Association between antenatal care visit and preterm birth: A cohort study in rural Bangladesh. BMJ Open 2020;10(7):e036699. https://doi:10.1136/bmjopen-2019-036699
Govender T, Reddy P, Ghuman S. Obstetric outcomes and antenatal access among adolescent pregnancies in KwaZulu-Natal, South Africa. S Afr Fam Prac 2018;60(1):a4614. https://doi/10.4102/safp.v60i1.4614
Hoque M, Buckus S, Hoque M. Association between antenatal care visit and preterm birth: A retrospective study from rural South Africa. Acad J Ped Neonatol 2022;11(4):555871. https://doi.org/10.19080/AJPN.2022.11.555871
Statistics South Africa. Maternal Health Indicators: Further analysis of the 1998 and 2016 South Africa Demographic and Health Surveys. Pretoria: Stats SA, 2020.
South African Institute of Race Relations. Race relations in South Africa, reasons for hope. SAIRR, 2019. https://irr.org.za/reports/occasional-reports/files/reasons-for-hope-report-final. pdf (accessed 10 October 2020).
National Department of Health, South Africa. National consolidated guidelines for the prevention of mother-to-child transmission of HIV (PMTCT) and the management of HIV in children, adolescents and adults. Pretoria: NDoH, 2015.
National Department of Health, South Africa. Guidelines for maternity care in South Africa – a manual for clinics, community health centers and district hospitals. Pretoria: NDoH, 2016.
Hoque M, Hoque ME, Van Hal G, Buckus S. Prevalence, incidence and seroconversion of HIV and syphilis infections among pregnant women of South Africa. South Afr J Infect Dis 2021;36(1):a296. https://doi.org/10.4102/sajid.v36i1.296
Stubblefield P.G. Menstrual impact of contraception. Am J Obstet Gynecol 1994;170(5):1513- 1522. https://doi.org/10.1016/s0002-9378(94)05013-1
Horner V, Rautenbach PG, Mashamba TJ, et al. Audit of antenatal care at a community health centre in Tshwane North subdistrict, Gauteng province. S Afr Fam Prac 2014;56(2):153-158. https://doi.org/10.1080/20786204.2014.10855354
National Department of Health, Statistics South Africa, South African Medical Research Council, International Classification of Functioning. 2019. South Africa Demographic and Health Survey 2016. Pretoria: NDoH, Stats SA, SAMRC, ICF, 2019.
Hoque M, Hoque E, Kader SB. Audit of antenatal care in a rural district of KZN, South Africa. S Afr Fam Prac 2008;50(3):66-66. https://doi.org/10.1080/20786204.2008.10873721
Tessema ZT, Tamirat KS, Teshale AB, Tesema GA. Prevalence of low birth weight and its associated factor at birth in Sub-Saharan Africa: A generalised linear mixed model. PloS ONE 2021;16(3):e0248417. https://doi.org/10.1371/journal.pone.0248417
Jeena PM, Asharam K, Mitku AA, Naidoo P, Naidoo RN. Maternal demographic and antenatal factors, low birth weight and preterm birth: Findings from the mother and child in the environment (MACE) birth cohort, Durban, South Africa. BMC Pregnancy Childbirth 2020;20(1):1-11. https://doi.org/10.1186/s12884-020-03328-6.
Shaaban OM, Abbas AM, Mohamed RA, Hafi HAA. Lack of pain relief during labor is blamable for the increase in the women demands towards cesarean delivery: A cross- sectional study. Facts Views Vision ObGyn 2017;9(4):175.