maternal health: antenatal careantenatal care by skilled provider (2010 tdhs) 4 5 80 8 2 96...

2014-15 Tanzania Service Provision Assessment (TSPA)

Maternal Health: Antenatal Care

• 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.

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


Among facilities offering ANC services (N=1,005), percent of facilities where ANC services are offered for the indicated number of days per week

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

Training and Supervision of ANC Providers

39 4144

4743

63

6972

68 70


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

• 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

98 9993

86

94


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)

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

maternal health: antenatal careantenatal care by skilled provider (2010 tdhs) 4 5 80 8 2 96...

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