The quality of care in an antenatal clinic in Kenya.

As part of an operations research project aimed at improving outpatient services in Kenya, the quality of care in Kiambu District Hospital's antenatal clinic was monitored in 1974-76 with particular emphasis on the identification of high risk women. Of the 270 patients studied, 57 (21%) were considered by midwives to be at no risk in terms of their pregnancy and 213 (79%) were considered at risk. 46% of the care observed in this study was considered adequate by the audit method; however, an implicit judgement assessment of the same care rated only 19% as adequate. Since the evaluators were familiar with the working conditions and capabilities of the staff, these low performance statistics suggest that the quality of care being provided in antenatal clinics is a serious problem. Dramatic improvements can be recorded if more attention is given by midwives to obtaining a medical and obstetric history and using an antenatal card. There is a need for clearly defined criteria and instructions for categorizing and managing high and low risk groups of pregnant women. In-service training and clinical meetings are essential to ensure that midwives can interpret abnormal findings and estimate the fundal height of the uterus. Although antenatal cards that guide midwives in the categorization of risk factors are available in Kenya, they are frequently out of stock and replaced with hastily developed, inadequate substitute forms.