Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data.
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ABSTRACT: Background
Research suggests that women's experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda.Methods
We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC.Results
PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC.Conclusions
This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.
SUBMITTER: Miller P
PROVIDER: S-EPMC8037834 | biostudies-literature |
REPOSITORIES: biostudies-literature
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| S-EPMC8039412 | biostudies-literature
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| S-EPMC9641107 | biostudies-literature
Project description:IntroductionThe government of Rwanda is exploring strategies that may reduce the incidence of prematurity and low birth weight. Large-scale implementation of group antenatal care (ANC) and postnatal care (PNC) within the context of the Rwanda national health care system is under consideration. To launch a cluster randomized controlled trial of group ANC and PNC in 5 districts in Rwanda, the implementation team needed a customized group care model for this context and trained health care workers to deliver the program.ProcessAdapting the group ANC and group PNC model for the Rwandan context was accomplished through a group process identical to that which is fundamental to group care. A technical working group composed of 10 Rwandan maternal-child health stakeholders met 3 times over the course of 3 months, for 4 to 8 hours each time. Their objectives were to consider the evidence on group ANC, agree on the priorities and constraints of their ANC delivery system, and ultimately define the content and structure of a combined group ANC and PNC model for implementation in Rwanda. The same group process was employed to train health care workers to act as group ANC facilitators.OutcomesA customized group ANC and PNC model and guidelines for its introduction were developed in the context of a cluster randomized controlled trial in 36 health centers. Descriptions of this model and the implementation plan are included in this article.DiscussionOur experience suggests that the group process fundamental to successful group ANC and PNC is an effective method to customize and implement this innovative health services delivery model in a new context and is instrumental in achieving local ownership.
| S-EPMC6220997 | biostudies-literature
Project description:BackgroundAlthough most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.MethodsThis facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.ResultsNurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.ConclusionThe providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.
| S-EPMC6245627 | biostudies-literature
Project description:BackgroundAntenatal care (ANC) is the provision of health services to pregnant women by trained health professionals before the birth of their babies to reduce maternal mortality and morbidity. So, the study aimed to identify the factors associated with Antenatal care utilization in Ethiopia.MethodsA Community-based Crossectional study design was used for 8885 women aged 15 to 49. The dependent variable was the utilization of Antenatal care services. Independent variables were Socio-demographic and Socioeconomic factors. The data was from the 2019 Ethiopian Mini demographic and health survey. Bivariate and multilevel binary logistic regression was used.ResultsOut of 8885 of all women considered for this study, 3910(44%) were utilized Antenatal Care (ANC) four or more times. 72.81% of the women were aged 15-34 years. On the other hand, high portions of women were from Amhara, Oromia and Southern Nations Nationalities Regional State with their respective percentages of 10.7%, 11.8% and 11.3%. Women from Somalia Region were 0.285 times less likely to utilize Four or more Antenatal Care (ANC) as Compared to a Women from Tigray Region [AOR = 0.285, 95% CI = 0.109-0.747].ConclusionThe utilization of the Antenatal Care service was underutilized in Ethiopia. Education status, Ages of mothers, Size of family, Religion and Place of Residence were major Factors of influenced ANC utilization. The concerned government body should also create a better environment for impoverished women to participate in entrepreneurial activities.
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