Assessing Antenatal Care in Rural Zimbabwe
Antenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit g...
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Uppsala universitet, Institutionen för kvinnors och barns hälsa
2005
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ndltd-UPSALLA1-oai-DiVA.org-uu-60182013-01-08T13:04:09ZAssessing Antenatal Care in Rural ZimbabweengMajoko, FranzUppsala universitet, Institutionen för kvinnors och barns hälsaUppsala : Acta Universitatis Upsaliensis2005Obstetrics and gynaecologyantenatalpregnancy complicationsreferralrisk factorspregnancy outcomeruralZimbabweObstetrik och kvinnosjukdomarObstetrics and women's diseasesObstetrik och kvinnosjukdomarAntenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit goal-oriented antenatal care model against standard care. In the same population was also determined the sensitivity of factors used for risk screening to predict pregnancy complications and the effectiveness of the referral system in managing women with identified risk markers or pregnancy complications. Pregnancy records of 10 572 out of total 13 517 recruited women were available for analysis. The new model did not change the number of visits but resulted in better use of health care. The classical risk screening system had low predictive value and identified too large a risk group for referral. Nulliparous women had an increased risk for pregnancy complications whereas women with previous uncomplicated pregnancies were at low risk of complications even with high parity. Multiparous women with previous complications had an increased risk of complications but better utilisation of health care services for delivery reduced adverse perinatal outcomes. There was a functional referral system in Gutu and women complied with referral indications but efficiency of the system was reduced by failure of care providers to comply with referral recommendations. Antenatal care can be improved in a rural setting through a focussed programme and the unpredictability of many pregnancy complications limits the value of antenatal risk screening. Until universal access to essential obstetric care facilities is attained in low resource settings, a critical re-examination of risk factors could avoid overburdening the referral system. Doctoral thesis, comprehensive summaryinfo:eu-repo/semantics/doctoralThesistexthttp://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6018urn:isbn:91-554-6372-XDigital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, 1651-6206 ; 78application/pdfinfo:eu-repo/semantics/openAccess |
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language |
English |
format |
Doctoral Thesis |
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Obstetrics and gynaecology antenatal pregnancy complications referral risk factors pregnancy outcome rural Zimbabwe Obstetrik och kvinnosjukdomar Obstetrics and women's diseases Obstetrik och kvinnosjukdomar |
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Obstetrics and gynaecology antenatal pregnancy complications referral risk factors pregnancy outcome rural Zimbabwe Obstetrik och kvinnosjukdomar Obstetrics and women's diseases Obstetrik och kvinnosjukdomar Majoko, Franz Assessing Antenatal Care in Rural Zimbabwe |
description |
Antenatal care has been associated with improved maternal and perinatal outcomes but there is no agreement on the most effective model in terms of content as well as the number and timing of visits. A cluster randomised controlled trial was conducted in a rural area of Zimbabwe to assess a 5-visit goal-oriented antenatal care model against standard care. In the same population was also determined the sensitivity of factors used for risk screening to predict pregnancy complications and the effectiveness of the referral system in managing women with identified risk markers or pregnancy complications. Pregnancy records of 10 572 out of total 13 517 recruited women were available for analysis. The new model did not change the number of visits but resulted in better use of health care. The classical risk screening system had low predictive value and identified too large a risk group for referral. Nulliparous women had an increased risk for pregnancy complications whereas women with previous uncomplicated pregnancies were at low risk of complications even with high parity. Multiparous women with previous complications had an increased risk of complications but better utilisation of health care services for delivery reduced adverse perinatal outcomes. There was a functional referral system in Gutu and women complied with referral indications but efficiency of the system was reduced by failure of care providers to comply with referral recommendations. Antenatal care can be improved in a rural setting through a focussed programme and the unpredictability of many pregnancy complications limits the value of antenatal risk screening. Until universal access to essential obstetric care facilities is attained in low resource settings, a critical re-examination of risk factors could avoid overburdening the referral system. |
author |
Majoko, Franz |
author_facet |
Majoko, Franz |
author_sort |
Majoko, Franz |
title |
Assessing Antenatal Care in Rural Zimbabwe |
title_short |
Assessing Antenatal Care in Rural Zimbabwe |
title_full |
Assessing Antenatal Care in Rural Zimbabwe |
title_fullStr |
Assessing Antenatal Care in Rural Zimbabwe |
title_full_unstemmed |
Assessing Antenatal Care in Rural Zimbabwe |
title_sort |
assessing antenatal care in rural zimbabwe |
publisher |
Uppsala universitet, Institutionen för kvinnors och barns hälsa |
publishDate |
2005 |
url |
http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-6018 http://nbn-resolving.de/urn:isbn:91-554-6372-X |
work_keys_str_mv |
AT majokofranz assessingantenatalcareinruralzimbabwe |
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1716507842987425792 |