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