Assessing Compliance to the World Health Organization Schedule for Antenatal Care in Swaziland : a retrospective analysis

Abstract

In 2001, the World Health Organization (WHO) proposed to developing countries a different approach to antenatal care (ANC) service delivery called the “Goal-oriented” or “focused ANC” (FANC) approach. Since then, a number of countries have adopted this approach and Swaziland is one of the countries. Fundamentally, this model helps in reducing the number of ANC visits women need to make during pregnancy, placing more emphasis on birth planning, emergency preparedness and identification, prevention and management of life threatening complications during pregnancy, labour and delivery. Swaziland like many African states has encountered several challenges in implementing this approach. About 97 percent of pregnant women visit health facilities during pregnancy, close to 80 percent make at least four ANC visits (Swaziland Demographic and Health Survey 2006/7) but the challenge is the country does not have empirical evidence on compliance to the WHO focused approach. To assess compliance with the Focused ANC approach among women in Swaziland, a retrospective desk review of ANC records was be undertaken in 17 ANC facilities identified as ANC sentinel sites. The review used records of pregnant women attending ANC from 2010 to 2012. The primary objective was to assess compliance with the WHO FANC approach, using data from 2010-2012. The limitation of the study approach is that only existing information collected for patient monitoring was used, therefore additional information that would have been necessary for the analysis was unfortunately unavailable. There was no contact made with the women during data collection process. Epi-info was used for electronic data capturing. Data was then imported to STATA version 12 for analysis. A p-value of 0.05 was considered for statistical significance. The total sample size used was 1264 records. Descriptive statistics were generated to compare demographic information. Compliance was estimated by combining the four visits made by each woman and comparing visits with the WHO schedule for visits. Fishers exact test was used to test for probable demographic and health factors associated with compliance. The multivariate logistic regression model was used to estimate the coefficients for ANC compliance according to demographic and health factors and to control for potential confounders. Ethical clearance to conduct the study was sought from the Ministry of Health Scientific and Ethics Committee in Swaziland as well as the University of Pretoria. Permission to access data was also sought from the Strategic Information Department in the Ministry of Health. Results from this study will be used as a baseline since no other study on compliance has been done in Swaziland. The results will also be used to inform future FANC implementation as Swaziland has already reviewed the focused ANC guidelines. On the other hand, WHO is reviewing the focused ANC guidelines which will be shared with countries for adaption. This study has come just at an opportune time as results can also be used to inform the finalization of the new FANC guidelines at the global level. The findings will be presented at the University of Pretoria School of Health Systems and Public Health seminar and also at a national stakeholders’ meeting, as well as local and international conferences. Findings will also be published in the WHO Bulletin. The study found that women in Swaziland did not comply with the Focused ANC schedule. Overall compliance was 0.87% (CI: 04-1.4). There was however an observed improvement in compliance over the years, where women who presented for ANC in 2012 were four (4) times more compliant than those who presented in 2010 (OR: 3.8). These findings are presented as a journal article in partial fulfilment of the requirements for the award of a Master’s degree in Public Health at the University of Pretoria. Miss. Nomsa Mulima is the first author and Professor Andy Beke and SAS Shade Ajayi Steve Olorunju are the second and third authors respectively.