A simple method of assessing quality of antenatal care - abstract

ABSTRACT

Guidelines established by the Ministry of Health for delivery of primary level antenatal care were used as a standard for evaluating the quality of antenatal care provided to cohort study mothers interviewed by the Jamaican Perinatal Morbidity and Mortality Survey. Services assessed included surveillance for pre-eclampsia (blood pressure, urine test, weight gain), screening for anaemia and syphilis, blood group identification, tetanus toxoid immunization, iron supplementation and health education (family planning, breast feeding). Provision of these services was summarized into a quality-of-care score. Mothers who received 3 or fewer of these services were considered to have had poor quality care, 4-7, average, and 8-10, good care. Non-attenders were included among those with poor care. Multiple logistic perinatal mortality and quality of care, controlling for service-related factors and social and biological predictors of perinatal death. Good quality antenatal care, as defined, contributed to reducing the risk of perinatal death after controlling for known risks. Compared to women with good care, those with average care were twice as likely, and those with poor quality care four times more likely, to experience a perinatal death. Careful attention to the basic elements of care increases the likelihood that problems will be identified. With appropriate referral for attention, improved perinatal outcome can be expected. Reducing the perinatal mortality rate can be as simple as adhering to established guidelines (AU)