Effect of a new antenatal care programme on the attitudes of pregnant women and midwives towards antenatal care in Harare.

OBJECTIVE: The aim was to study the effect of a new antenatal care (ANC) programme on the attitudes of pregnant women and midwives towards antenatal care. DESIGN: This was a controlled trial in which the attitudes of women and staff using the standard programme of ANC were compared to those using a new one. The new programme contained fewer but objective oriented visits, and was designed to improve consumer and provider satisfaction with ANC. SETTING: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 200 pregnant women and 65 midwives. MAIN OUTCOME MEASURES: The satisfaction of pregnant women and staff with ANC, reasons for lack of satisfaction, and time spent waiting for consultations. RESULTS: The new programme did not make any impact on the time spent by women waiting to be seen at the clinics, nor on the time made available for the consultations. There was no significant impact on the degree of satisfaction with the care among the women. In the control clinics, significantly more staff wished the women to make fewer visits, and in the study clinics, significantly more staff thought the use of appointments was appropriate. The major problem limiting access to ANC was lack of money to pay for the booking fees. Other problems mentioned by the women were ignorance regarding the best time to book, lack of privacy and insufficient staff at the clinics. CONCLUSIONS: The solutions to some of the problems identified require infrastructural changes at policy making level, rather than changes within the antenatal care programmes.

PIP: In an effort to increase client and staff satisfaction with antenatal services, a program was introduced in Harare, Zimbabwe, that reduced the number of antenatal visits from 12 to 6, eliminated routines such as urinalysis and weighing at each visit, and scheduled patients for a specific time rather than just a date. The impact of these programmatic changes was investigated in a comparative study of 200 low-income women randomized to attend Harare City Health Department clinics that offered either standard antenatal care or the modified program. There were no significant differences between the two groups of clinic clients in terms of their satisfaction with services received and communication with midwives. A comparison of responses from 28 midwives recruited from standard clinics and 37 assigned to the experimental program indicated those in the former group were significantly more likely to think pregnant women should be required to make fewer prenatal visits while those in the latter group were significantly more supportive of set appointment times; there were no differences in overall satisfaction, however. Observations at the clinics revealed women who were given set appointments ignored them and presented about 2 hours early to avoid waiting in line for their visit, which averaged only 3 minutes in both groups. Key problems identified by both clients and midwives included booking fees, inadequate numbers of midwives at the clinic, privacy concerns, and insufficient seating in the waiting rooms. Improvements in the satisfaction of providers and recipients of antenatal care may require infrastructural rather than programmatic changes.

Health education for pregnancy care in Harare. A survey in seven primary health care clinics.

OBJECTIVE: The aim of this study was to evaluate how health education is currently practiced in the antenatal clinics in Harare and to make recommendations for its improvement. DESIGN: This was a descriptive study in which data was collected through subject interviews and by observations of antenatal clinics in progress. SETTINGS: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 100 pregnant women and 65 midwives. MAIN OUTCOME MEASURE: The timing, frequency and methods used in health education and the attitude of the pregnant mothers and staff to health education. RESULTS: The results revealed that health education was given once in pregnancy, on the first visit only. The lecture was the most used teaching method. The lecture was full of distractions which affected the concentration of the audience. Midwives decided on the subject matter for health education without consultation with the expectant women. As a result many women could not follow the practical advice given to them. Midwives overestimated their use of other methods of health education. Both the staff and the pregnant women agreed that there should be greater use of written material for women to read at home with their spouses. CONCLUSION: The lecture is not the most appropriate method of health education during pregnancy and greater use should be made of other methods of communication such as the mass media and pamphlets.

PIP: An evaluation of prenatal health education in 7 primary care clinics in Harare, Zimbabwe, during 1989-91 indicated a need for more attention to this program aspect. Interviews were conducted with 65 clinic midwives and 100 randomly selected pregnant women who had made 2 or more prenatal visits. In addition, educational sessions were observed. Health education was provided only once during pregnancy, generally at the end of the day of the first visit. The education usually took the form of a group lecture without visual aids or written handouts. The lecture covered nutrition and hygiene recommendations, pregnancy risk factors, and sexually transmitted diseases. Only 33% of pregnant women indicated they would be able to follow the advice given by the midwives. Midwives identified women's cultural and religious beliefs, noise and inattention during the lecture, the lack of questions from mothers, and women's skepticism about the information imparted as the main obstacles to effective health education. The pregnant women cited the inconvenient time of day the lectures were scheduled, their hurried nature, and the failure of midwives to solicit topics of interest to clients as the main obstacles. Optimally, prenatal education should increase pregnant women's knowledge, correct misconceptions, strengthen confidence, and offer women an opportunity to express their fears and concerns. It is unlikely that a single lecture without written materials to take home can impart any meaningful new knowledge or produce behavioral change. Among this study's recommendations are training of midwives in communication skills, production of a small pamphlet containing answers to the questions most frequently asked during pregnancy, and individualized health education throughout pregnancy.