Assessment of quality of antenatal care content and timing at the Holy Family Hospital, Nkawkaw- Eastern Region, Ghana

Rendering quality antenatal care (ANC) services to pregnant women would aid in reducing maternal mortality worldwide especially in Sub-Saharan Africa. Worldwide, maternal mortality is the top cause of deaths among women between the ages of 15-49 years old and according to World Health Organization (2015) it is now known that approximately 303,000 women die from pregnancy related complications each year. Approximately 800 women die of pregnancy-related complications every day in Ghana mostly occurring in rural areas and this is because pregnant women report to antenatal clinics late and often do not receive the recommended ANC services as some contents of antenatal are also not available at the health facilities. In 2015, the total ANC coverage of The Holy Family Hospital in the Kwahu West Municipality was 4416 with 3744 consisting of women of reproductive age (WRA). Maternal death was 7and still births 96 out of 3808 deliveries made. It was upon these grounds therefore that the study seeks to assess the quality of ante natal care services, content and timing at the Holy Family Hospital Nkawkaw, eastern region, Ghana using a tool, Content and Timing of Pregnancy (CTP Tool) developed by Beeckman et al (2011). Methods: This cross- sectional study was conducted at the Holy family hospital Nkawkaw, eastern region from July to September, 2016. Simple random sampling method was used to select and elicit information from 422 women between the ages of 15-49 years who were in the first week post-delivery period, attending postnatal clinic and who also utilized ANC services at the Holy Family Hospital, Nkawkaw. Data Analysis was done using Excel version 13 in entering the data and Stata version 12 in analyzing using descriptive statistics such as mean, median and standard deviation and inferential statistics such as logistic regression, Chi-square (χ2) and correlation matrix. Results: In categorizing the women according to CTP tool, the inadequate group consisted of 17.75% of the population, 15.5% of the respondents fell into the intermediate group, the sufficient group consisted of 9.5% and more than half of the women (57.25%) fell in the appropriate category. Socio-demographic characteristics such as age, parity, and NHIS status influenced the content of ANC. Pregnant women who were between 34 -39 years were less than 35% as likely to receive recommended content of ANC compared with women within the age group of 16-21yrs (OR = 0.34; 95% CI; 0.12-0.95;p-value 0.04). Women with parity of ≥3 were almost four times as likely to receive recommended content of ANC compared with women with less than 3 children (OR=3.75; 95% CI; 1.09-3.55;p-value 0.02); and those who were non-insured were less than 5% as likely to receive the recommended content of ANC compared with those who were insured (OR=0.04;95% CI; 0.009-0.23;p-value 0.00). Socio-demographic characteristics such as age, parity, basic education and NHIS status influenced the timing of ANC services. Pregnant women who were between 34–39 years were less than 35% as likely to initiate ANC in the first trimester compared with women between 16-21 years (OR= 0.31; 95% CI; 0.11-0.85;p-value 0.05). Women with parity of ≥3 were almost twice as likely to initiate ANC in the first trimester compared with women who had less than 3 children (OR= 1.76;95%CI; 0.98-3.14;p- value 0.05). Women with basic education were less than 25% as likely to initiate ANC in the first trimester compared with their counterpart with no education (OR= 0.22;95% CI; 1.02-19.21;p-value 0.04) ; and non-insured women were less than 5% as likely to initiate ANC in the first trimester compared with insured (OR=0.04;95%CI; 0.009- 0.22;p-value 0.00). In assessing client’s perspectives on quality of ANC, 75.5% of the women showed that they were satisfied with the overall quality of ANC received, 69.25% showed that they were very satisfied with the cognitive and emotional support provided at the ANC and dissatisfaction was found among (23.5%) of the women with regards to the cost of ANC services. as maternal services are to be free according to the NHIS. Conclusion: The CTP tool focusses on three basic interventions which cannot be solely used in assessing the quality of ANC as ANC encompasses more than these three interventions as recommended by WHO. The CTP tool should be revised to include other interventions to render it more accurate.

Source: KNUST