SURVEY ON FACTORS AFFECTING FOURTH ANTENATAL VISITS IN DR AMBROSOLI MEMORIAL HOSPITAL - AGAGO DISTRICT
St. Mary’s Midwifery Training School
April, 2013
Background:WHO estimates that every year approximately 8 million women endure pregnancy-related complications and around half a million die as a result. Almost 9 million children die every year, of which 4 million newborn babies die within the first month of life. Inaddition, 3.3 million babies are born dead.
The evidence shows that high maternal, perinatal, neonatal and child mortality rates are associated with inadequate and poor qualityhealth services. Evidence also suggests that explicit, evidence-based, cost effective packages of interventions can improve the processesand outcomes of health care when appropriately implemented. The interventions recommended include pregnancy, childbirth, postpartal and newborn care, family planning, abortion care, and early childhood care.
Postpartal care (4th ANC visit) is an essential service promoting preventive care following childbirth, early identification and management of complications, family planning and birth spacing, HIV care and counseling and support for breastfeeding.
Methods: survey of ____ women attending ANC clinic.
Results: Respondents were overwhelmingly aware of ANC services (94%), purposes and benefits and they reported significant spousal support (98%) of their ANC attendance. The majority (74%) indicated that they should start ANC as soon as pregnancy is known, however 78% of respondents were in their 3rd trimester. 80% indicated that they intend to complete all 4 ANC visits. Majority (80%) thought the quality of services was satisfactory and 70% had no complaints. Majority of complaints included staff problems (74%) including lateness, abusive, slow and poor services given; don’t help them at night, unnecessary referral and absenteeism while 26% were for lack of drugs/equipment. Majority (92%) denied awareness of any cultural practices affecting ANC attendance. Majority of respondents (40%) travel 1-5 km to the health unit, 34% travel 5-10 km and 22% travel less than 1 km.
Reference: WHO. (2010). Packages of Interventions Maternal, for Family Planning, Safe Abortion care, Newborn and Child Health. WHO: Geneva, Switzerland
1.0Characteristics of the sample
Figure 1: Age of respondents
As shown above on figure 1, age of respondents ranged from 16 to 35 years with majority (40%) aged 16-20 years, 30% aged 21-25 years, 18% 26-30 and 12% 31-35 years.
Figure 2: Tribe
As shown in figure 2 above, the dominant tribe was Acholi (94%), with few Langi 4% and Ethur 2%.
Figure 3: Marital status
As shown above,majority (80%) of the respondents were married, 18% cohabiting and 2% single.
Figure 4: Religion
As shown above in figure 4, majority of respondents were catholic (78%) with fewer protestants (16%) and saved (6%)
Figure 5: Occupation
As shown above on figure 5, majority occupation was housewife (88%), with few others: civil servant 6%, student, VHT and ? 2% each.
2.0 KNOWLEDGE OF ANC
Figure 6: Knowledge of number of ANC visits
As shown above on figure 6, vast majority (94%) were aware that ANC should have 4 visits while 2% each thought fewer visits.
Figure 7: Gestation
As shown above in figure 7, majority of respondents were in their 3rd trimester of pregnancy (78%), while 20% was in the 2nd trimester and 2% in the first.
Table 1: Reasons for ANC attendance
percentagecheck how the baby is growing / 40%
Know their health condition / 18%
waiting for their husband / 18%
she was sick / 12%
PMCT / 4%
Follow rule of ANC / 2%
Absence of personnel at the health unit / 2%
Avoid risk during delivery / 2%
Finish all the four visit / 2%
Total / 100
As shown above on table 1, majority of respondents knew that ANC will monitor fetal growth (40%) while 18% each thought that they would know their health status and wait for their husband, 12% were sick, 4% were in PMTCT program and 2% each were following ANC rules, avoiding risk, wanting to finish all 4 visits and absent healthworker.
Figure 8: Intention to complete 4 ANC visits
As shown above on figure 8, majority of women (80%) intend to complete all 4 ANC visits while only 20% did not intend to complete all visits.
Table 2: Reasons for continued ANC
PercentageChecking condition of the baby / 56%
Plan for delivery / 10%
Know the expected date of delivery / 5%
Help the midwife in management / 2%
Complete treatment from ANC / 6%
Detect abnormality / deviation / 8%
Get all the ANC services / 3%
Rule for ANC / 2%
Happiness of the Midwife / 2%
health education / 3%
Follow appointment date / 3%
Total / 100
As shown above on table 2, majority of mothers identified checking fetal condition (56%) as the main reason for continued ANC visits while 10% identified planning for delivery, 8% to identify any abnormality, 5% to know their due date, 3% each to have all required visits, receive health education, follow appointments and 2% each help the midwife to manage health and be happy.
Figure 9: When a mother should start ANC
As shown above on figure 9, majority (74%) knew they should start ANC as soon as pregnancy is realized while 26% thought they should wait until term.
Table 3: Reasons for attending all ANC visits
percentageTreatment of other diseases / 12%
Birth preparedness & delivery place / 10%
know if the baby is at term / 1%
checking condition of the baby / 27%
create good relationship with the health worker / 3%
Follow midwives’ advice on ANC visits / 5%
detect and treat complications / 7%
check HIV status / 15%
Be referred early in case of problems / 2%
Have a healthy baby / 5%
Comply to rule of health unit/ hospital / 4%
Will not be attended to if she reports in labour / 1%
Prevent further illness / 1%
Prevent intrauterine fetal death / 1%
PMTCT / 3%
Health education / 2%
Prevent false pregnancy / 1%
Total / 100
As shown above on table 3, majority of mothers identified that ANC will check the condition of the baby (27%) while 15% would learn their HIV status, plan birth preparedness (10%), treat diseases (12%) and complications (7%) while a few thought of early referral, prevent illness, IUFD, false pregnancy and for health education.
Figure 10: Frequency of ANC services provided
As shown above on figure 10,
Figure 11: Perception of quality of ANC
As shown above on figure 11, mothers perceived ANC to be satisfactory (80%) while 20% thought ANC to be unsatisfactory.
Figure 12: Who provides ANC services
As shown above on figure 12, majority of mothers reported that ANC services are provided by midwives (84%) and 10% by the nursing assistant while 6% did not know.
Figure 13: Complaints
As shown above on figure 13, majority of women (70%) had no complaints about ANC while 24% did have complaints and 6% were not attending ANC.
Table 4: Reasons for complaints
Percentagelate reporting / 15%
drugs out of stock / 18%
mothers are sent back home if late / 7%
Do not help the mothers quickly / 4%
mothers sent to buy drugs / 4%
don’t help mothers at night / 4%
Poor services / 18%
Use of abusive words and shouting on the mothers / 18%
Unnecessaryreferral / 4%
Lack of equipment / 4%
Absenteeism / 4%
Total / 100
As shown above on table 4, majority of complaints (74%) were for staff including lateness, abusive, slow and poor services given, don’t help them at night, unnecessary referral and absenteeism while 26% were lack of drugs/equipment.
Table 5: Good parts of ANC
PercentageMidwives conduct delivery / 2%
Good to patients/welcoming / 21%
good services and daily ANC / 26%
Gives treatment / 11%
Quick services rendered / 9%
Good relationship / 5%
Does investigations / 3%
Health education / 15%
Early referral / 4%
Punctuality / 3%
Gives delivery kit / 1%
Total / 100
As shown above on table 5, majority of mothers (26%) liked the daily ANC services, 21% commented on the welcoming attitude, 15% liked the health education and information given, 11% liked treatments given, while 9% liked the quick treatment; fewer commented about punctuality, free delivery kit, early referral, investigations, good relationships and that midwives deliver them.
Table 6: Awareness of cultural practices preventing ANC attendance
PercentageNot aware / 13 / 27%
No cultural practices / 31 / 65%
Influence of TBA / 3 / 6%
Ignorance / 1 / 2%
100
As shown above on table 6, majority of respondents (65%) denied cultural practices preventing attendance at ANC while 27% were not aware of any while 6% identified TBA influence and 2% ignorance.
Figure 14: Spousal support of ANC attendance
As shown above in figure 14, majority of women (98%) had spousal support for their ANC attendance while 2% did not.
Table 7: Types of Male support
PercentageFinancial / 23%
Essential things / 25%
Escorting to ANC / 19%
Providing transport / 26%
Doing household work / 3%
Visit to waiting shelter / 1%
Helping with garden work / 3%
Total / 100
As shown above on table 7, majority of mothers indicated that the male provide transportation (26%), needed things (25%), money (23%), escort to ANC (19%), with few providing household/garden work (3% each) and visiting them at the shelter (1%).
Figure 15: Distance to the clinic
As shown above on figure 15, majority of respondents (40%) travel 1-5 km to the health unit, 34% travel 5-10 km and 22% travel less than 1 km while 4% were not sure of the distance.
Figure 16: Types of transport used to attend ANC
As shown above in figure 16, majority of women come to ANC via bicycle (44%), 30% walk, 23% use a motorcycle, an3% use a public vehicle.
Table 8: Benefits of completing 4 ANC visits
PercentageNutritional status / 1%
Knowing health status of the husband / 1%
Helps mother to know her health status / 25%
Fetal well being / 26%
baby 's lie / 7%
Detect problems / 12%
Being sure of delivering a live baby / 10%
know when to deliver / 4%
birth preparedness / 11%
Good relationship with the midwives / 2%
Helps to follow rules of ANC / 1%
Total / 100
As shown above on table 8, majority of women identified fetal wellbeing as the major benefit of ANC (26%), 25% thought knowing her own health status, 12% to detect problems, 11% for birth preparedness,10% to ensure a healthy baby, and few identified improved nutritional status, knowing baby’s lie, knowing health status of husband, good relationship with midwife and due date.