Quality of antenatal care counseling in selected health centers in Morogoro Region, Tanzania

Abstract

Background: Antenatal care (ANC) is a critical entry point for pregnant women to access health services. Tanzania adopted the WHO Focused Antenatal Care (FANC) model in 2002 and country wide trainings on this new ANC model were implemented with the aim of improving the content and quality of ANC. However, little is known about the quality of these services, particularly that of ANC counseling. This study aimed to describe the quality of ANC counseling in primary health facilities in five districts of Morogoro Region, Tanzania.

Methods: The quality of ANC counseling was assessed by examining how structural inputs such as infrastructure, equipment and supplies, provider and client profiles combine to affect ANC counseling processes and outcomes of patient knowledge on ANC. Data collection methods included direct observations of equipment, supplies and infrastructure; direct observations of counseling of ANC clients; client exit interviews; and a provider survey. Data analysis was done using both bivariate and multivariable methods.

Results: While physical infrastructure, equipment and supplies were modestly available in the health facilities, deficits in human resources were observed and 56%.of those providing ANC were unqualified as they did not receive any training on FANC. Among ANC consultations observed (n=203), less than 50% of recommended counseling content was provided to patients. The median duration of ANC consultations fell from 28 minutes during the first consultation to 13 minutes in repeat visits. Health providers who received inservice training in ANC and those with a shorter work experience spent more time with women (Adjusted Regression coefficient (ARC)= 0.75 and -1.50 respectively) compared to their counterparts. Counseling on HIV and pregnancy danger signs were more likely to be covered when counseling duration increased by one minute (ARC= 0.15, 0.07 respectively). Women’s knowledge on selected ANC components post counseling was found to be low with the average scores falling below 50%..

Conclusion: Physical infrastructure, equipment and supplies were modestly available in the facilities studied. There was a critical deficiency in the number of staff qualified to provide ANC. Coverage of recommended counseling messages and duration of counseling were found to be inadeaquate. In-service ANC training was
associated with increased content of messages and counseling duration. Messages on HIV and pregnancy danger signs were observed with greater frequency as counseling duration increased. Knowledge retention among counseled clients was low indicating that the counseling was ineffective. We recommend reviewing the volume of messages approved for delivery during ANC to ensure appropriateness and feasibility of delivering them. We also recommend development and evaluation of innovative counseling strategies including emphasis on group counseling and use of multimedia to increase exposure to critical ANC messages.

Keywords: Antenatal care, FANC, quality of counseling, duration of counseling, counseling messages