• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
Antenatal Care by Skilled Provider (2010 TDHS)
4 5
80
82
96
Doctor/AMO Clinical Officer Nurse/midwife MCH aide Village healthworker/other
Any skilledprovider*
Percent distribution of women with a live birth in the past 5 years
*Skilled provider includes doctor/AMO, clinical officer, assistant clinical officer, nurse/midwife, and MCH aide.
Timing of Antenatal Care and Number of Visits (2010 TDHS)
• 15% of women went to their first ANC visit during the 1st trimester of pregnancy, as recommended.
• 43% of women had 4 or more ANC visits, as recommended.
• 2% of women had no ANC visits.
Components of Antenatal Care (2010 TDHS)
• 59% took iron tablets or syrup during last pregnancy
• 68% took anti-malaria drugs
• 53% were informed of signs of pregnancy complications
• 68% had blood pressure measured
• 77% had blood samples taken
• 52% had urine samples taken
Tetanus Toxoid Injections (2010 TDHS)
88% of last births were protected against neonatal tetanus. 48% of women received two or more TT injections during their last pregnancy.
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
91 9185
30
85
Hospital Health centre Dispensary Clinic Total
Availability of Antenatal Care by Facility Type
Percent of all facilities (N=1,188) offering ANC
Percent of all facilities (N=1,188) offering ANC
96
36
17
81
Government Private-for-profit Parastatal Faith-based
Availability of Antenatal Care by Managing Authority
Frequency of ANC Services
6 4
90
148
78
19
6
74
137
80
18
6
75
1-2 days per week 3-4 days per week 5 or more days per week
Hospital Health centre Dispensary Clinic Total
Among facilities offering ANC services (N=1,005), percent of facilities where ANC services are offered for the indicated number of days per week
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
Guidelines and Basic Equipment for ANC Services
61
79
83
84
93
99
99
56
Height board
Blood pressure apparatus
Stethoscope
Adult weighing scale
Measuring tape
Foetal stethoscope
Examination bed or couch
Guidelines on ANC
Percent of facilities offering ANC services (N=1,005) that have:
Infection Control
54
96
82
65
Waste receptacle
Sharps container
Latex gloves
Soap & running water or else alcohol-based hand disinfectant
Percent of facilities offering ANC services (N=1,005) that have:
Diagnostic Capacity for ANC Tests
90
52
3330 29
1
HIV Syphilis Urine protein Haemoglobin Urine glucose Blood groupingand Rh factor
Percent of facilities offering ANC services (N=1,005) that have the capacity to conduct the indicated tests in the facility
Availability of Medicines for Routine ANC
94 9592
9690
86
Iron tablets Folic acidtablets
Combined ironand folic acid
Iron or folicacid tablets
De-wormingdrugs
Tetanus toxoidvaccine
Percent of facilities offering ANC services (N=1,005) that have essential medicines and tetanus toxoid vaccine for ANC observed to be available on the day of the survey
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
Training and Supervision of ANC Providers
39 4144
4743
63
6972
68 70
Hospital Health centre Dispensary Clinic Total
In-service training related to ANC during past 24 months
Personal supervision during past 6 months
Percent of interviewed providers of ANC services (N=4,252) that received:
Training of ANC Service Providers
20
3
17
8
8
9
47
18
39
26
26
28
IPTp
STIs
FP
Complications of pregnancy
ANC screening
ANC counselling Ever
Past 2 years
Percent of interviewed ANC service providers (N=4,252) that received specific training
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
• Follow-up visit: 54%
• First visit for this pregnancy: 46%
• First pregnancy: 25%
• 4% of all observed ANC clients were in their 1st trimester of pregnancy (<13 weeks); 51% were in their 3rd trimester (27-42 weeks)
Characteristics of ANC ClientsAmong observed ANC clients (N=4,007)
Elements of Client Consultation(First-Visit ANC Clients)
50
46
8
12
86
81
91
Haemoglobin test
Urine protein or glucose test
All elements
Medicines client currently taking
Any prior pregnancy
Date of last menstrual period
Age
Percent of observed first-visit ANC consultations (N=1,853) that assessed:
RoutineTests
Client History
Basic Physical ExaminationsPercent of all observed ANC consultations (N=4,007) that assessed:
80
88
89
96
88
Measured blood pressure
Weighed client
Checked foetal position (at least 8 months pregnant)
Checked uterine/fundal height
Listented to foetal heart (at least 5 months pregnant)
Preventive InterventionsPercent of all observed ANC consultations (N=4,007) that:
31
36
60
61
75
Provider explained purpose of tetanus toxoidvaccine
Provider gave or prescribed tetanus toxoidvaccine
Provider explained purpose of iron or folic acidtablets
Provider explained how to take tablets
Provider gave or prescribed iron or folic acidtablets
Counselling on Pregnancy Complications
67
6
40
22
35
45
28
54
Any of the above risk symptoms
Cough or difficulty breathing for 3weeks or longer
Loss of, excessive or normal fetalmovement
Excessive tiredness, shortness of breath
Swollen hands or face
Headache or blurred vision
Fever
Vaginal bleeding
Percent of all observed ANC consultations (N=4,007) that included counselling on topics related to pregnancy risk symptoms
Counselling Topics Discussed during ANC Visits
13
35
3
12
9
10
70
15
51
33
Provider used any visual aids
FP postpartum
Importance of vaccination for newborn
Exclusive breastfeeding
Early initiation and prolonged breastfeeding
Care of newborn
Delivery plans
Importance of at least 4 ANC visits
Progress of pregnancy
Nutrition
Percent of all observed ANC consultations (N=4,007) that included counselling on the following
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
98 9993
86
94
Hospital Health centre Dispensary Clinic Total
Availability of PMTCT Services by Facility TypePercent of facilities offering ANC (N=1,005) that provide PMTCT services
PMTCT Services Percent of facilities offering ANC and any PMTCT services (N=947)
52
89
94
94
96
81
86
72
80
98
All 9 services
Cotrimoxazole to newborns of HIV+women
FP counselling for HIV+ pregnant women
Nutritional counselling for HIV+pregnant women and their infants
Infant and young child feedingcounselling
ARV prophylaxis for infants born to HIV+women
ART prophylaxis for HIV+ pregnantwomen
ARV prophylaxis for HIV+ pregnantwomen
HIV testing for infants born to HIV+women
HIV Testing for pregnant women
Guidelines, Equipment, Diagnostics, and Medicines for PMTCT Services
82
72
3
57
93
94
81
ARV for maternal prophylaxis
NVP syrup
AZT syrup
DBS HIV testing to test infants
Adult HIV testing capacity
Visual and auditory privacy
Guidelines on PMTCT
Percent of facilities offering ANC and any PMTCT services (N=947)
• Background of Antenatal Care (ANC) services
• Availability of ANC services
• Service Readiness
• Management Practices and Training
• Observed ANC Consultations
• Prevention of Mother-to-Child Transmission of HIV
• Malaria in Pregnancy
© 2013 Jennifer Applegate, Courtesy of Photoshare
Guidelines, Equipment, Diagnostics, and Medicines for Malaria in ANC Facilities
30
85
14
83
96
90
78
61
94
12
35
Haemoglobin
RDT or microscopy
Malaria microscopy
Malaria RDT
Iron or folic acid
Quinine
IPTp DOT
SP
ACT
ITN
Guidelines on IPTp
Percent facilities offering ANC (N=1,005)
Diagnostics
Medicines
Malaria-related Interventions during ANC VisitsPercent of all observed ANC consultations (N=4,007)
18
35
44
1
10
Dose of SP ingested in presence of provider
Provider explained purpose of IPTp
Provider gave or prescribed IPTp
Client given ITN or directed to obtainelsewhere in facility
Importance of using ITN explained
Malaria-related Training of ANC Providers
16
17
19
39
36
42
Case management/treatmentof malaria
How to perform malaria RDT
Diagnosing malaria
Ever
In 2 years beforesurvey
Percent of interviewed ANC service providers (N=4,251) that received malaria specific training
Key Findings
• 85% of facilities offer ANC services
• 8% of first-visit ANC client consultations had all elements of client history assessed
• 67% of ANC client consultations discussed any risk symptoms for pregnancy complications
• 52% of facilities provided all nine PMTCT services
• 44% of observed ANC clients were prescribed or given a dose of SP by the provider