The effect of involving the private practioners on the quality of antenatal care of the indigent population of Tembisa

Abstract

INTRODUCTION. The perinatal mortality rate is of concern worldwide. In South Africa at the time of the study, 2000, it was estimated to be of the order of 40/1000 live births. However in the setting in which this study took place, namely Tembisa, (Ekhuruleni, Gauteng, South Africa) it was said to be 50/1000 live births. One of the patient- related avoidable factors that has been found to be associated with perinatal and to a lesser extent maternal mortality, is either no, or late initiation of antenatal care. It has been found in an area which, is in many respects similar to Tembisa that 50% of women go the private general practitioner (PGP) for confirmation of pregnancy but, due of lack of funds, do not continue care with the private practitioner but, initiate care in the public sector and in a proportion of these women, this is at an advanced gestational age, making it difficult to prevent or intervene if there are problems in the pregnancy. As (PGP’s) are well placed in the district to render antenatal care, it was decided to perform a study looking at the effect of involving them in the antenatal care of women who presented to them for confirmation of pregnancy. METHODS Sixteen general practitioners agreed to be part of the study. The women who confirmed their pregnancy and who were going to deliver in Tembisa hospital were included in the study after giving written informed consent. They comprised the intervention group, the first antenatal visit was performed, the findings were recorded on the antenatal card which is used in the public sector and which was introduced to the private practitioner at 2 workshops held by the Department of Obstetrics and Gynaecology, University of Pretoria prior to the study. The woman was then to attend antenatal care with the private practitioner until delivery. The private general practitioners waived the costs normally associated with this care for the period of the study. The control group consisted of the women who confirmed their pregnancies in the public health care sector known as the public service health care workers group (PSHCWG). Data collection took place in the postnatal ward of Tembisa hospital over the period of 3 months. By means of systematic sampling, 100 cards from the PGPG and 100 cards from the PSHCWG were obtained. The 2 groups were compared with respect to gestational age at initiation of care and a modified version of the Quality Check for Antenatal Records Score (MQCARS), an audit score which, when applied to the antenatal card, gives a measure of the effectiveness of record keeping, and whether problems in the antenatal period are detected and appropriately managed. RESULTS. There was a statistically significant difference between the two groups in terms of gestational age at initiation of care [PGPG mean gestational age -19.96 (5.86), PSHCW 25.96(5.98,) p<0.0001]. The majority of women in the PGPG initiated care in the 2nd trimester (79%) while the majority of the women in the PSHCWG (53%) confirmed their pregnancies in the third trimester. Six per cent of PGPG confirmed their pregnancies in the first trimester compared to the PSHCWG (3%). The two groups differ significantly with respect to the total MQCARS with the PGPG group performing better [(8.16 (1.55) vs. 16.34(2.58), p<0.0001]. The associated sub- scores are statistically different [History score 5.99 (0.10) vs.7 (0.96), Examination score 9.59(1.29) vs.8.03 (1.85) Interpretation Score 2.55(0.50) vs.2.80 (0.49)]. CONCLUSION Despite the limitations of the study it is felt that if private general practitioners in Tembisa are involved in the antenatal care of those women who confirm their pregnancies with them, there is a reduction in the gestational age at initiation of care. There is a small difference between the two groups in record keeping, detection and management of problems.