Quality of Antenatal Care Offered at Nambale Sub County, Busia County

Background: Focused Antenatal care (FANC) is personalized care provided to a pregnant woman which prepares her for childbirth and readiness for complications. It provides health promotion and preventive health services, including nutritional support and prevention and treatment of anemia; prevention, detection and treatment of malaria, tuberculosis and sexually transmitted infections (stis)/HIV/AIDS; and tetanus toxoid immunization. To ensure antenatal care (ANC) quality at health facilities, it is necessary that drugs and equipment are available, that health workers are available and have the necessary knowledge and skills, and that they actually provide the recommended interventions. Effectiveness of the antenatal care services provided depends on the quality of care provided during each antenatal care visit The percentage of women attending ANC at least once generally tends to be satisfactory even in low income countries but maternal and neonatal mortalities remain high. In Kenya, for example, 9 out of 10 women reported to have seen a skilled provider at least once for their most recent birth, while maternal mortality is estimated at 400 maternal deaths per 100,000 live births, and neonatal mortality at 22 neonatal deaths per 1,000 live births. Methods: The study was conducted in Nambale Sub County of Busia County in Kenya. This was a facility based cross-sectional study where 8 health facilities were surveyed for the availability of staff, infrastructure, and essential equipment and drugs necessary for the delivery of good quality antenatal care. Interactions between antenatal clients and midwives were observed, and exit interviews conducted for women. In addition, in-depth interviews with respective facility managers and one Midwife from the same facility who usually works in the ANC clinic. Findings: A total of 334 women were interviewed. Preparedness of health facilities was good in terms of infrastructure, essential equipment, and availability of essential medicines. However, Job aids and laboratory supplies were unavailable in most health facilities. Case load indicators were low. Women did not receive standard recommended care in the following areas: pelvic exams (99.4% missed opportunities); physical examination (91.9% missed opportunities); and client counseling and education (97.4% missed opportunities). Of the women interviewed, 33.7% felt that waiting time wasn’t fair. Only 2.7% of the clients were accompanied by a relative (mother or mother in-law) to the clinic . Staff shortage and lack of essential drug supplies were identified by staff interviewed as key challenges. They also said that additional nurses would help improve ANC services. Discussion: Whereas health facilities in nambale sub county were adequately equipped to provide standard antenatal care in terms of infrastructure, availability of essential equipment, and medicines, they lacked job aids and did laboratory supplies. This was evident from the low number of pregnant women who had undergone the requisite tests (hemoglobin test, syphilis test, HIV test, malaria test and urine analysis) (19.5 %) and non-adherence to prescribed standards of care as seen in the high number of missed opportunities. Clients were uncomfortable with the long waiting times while the midwives thought they were overworked. However, case load indicators for the facilities were very low (0.3 to 4.6) compared to the national average in public hospitals of 8.7 patients per provider per day and 10.4 patients per provider per day in private hospitals. The need for additional staff should be assessed and implemented on a case-by-case basis. Only 2.7% of the clients were accompanied to the clinics by female companions. None had a male companion (table 5).partner participation in antenatal care has been shown to help to ensure a fuller and safer reproductive health experience for the woman, her newborn, and her family. Conclusion: There is need to improve facility preparedness to offer antenatal services by making available laboratory supplies and job aids in addition to other important supplies. Staff supervision should be enhanced and they should be given opportunities for regular, appropriate refresher courses to ensure patients get standard services within reasonable time.