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Randomised controlled trial of two antenatal care models in rural Zimbabwe
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Maternal and Child Health (IMCH). (Internationell kvinno-& mödrahälsovård/Lindmark)
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2007 (English)In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 114, no 7, 802-811 p.Article in journal (Refereed) Published
Abstract [en]

Objective To compare a five-visit antenatal care (ANC) model with specified goals with the standard model in a rural area in Zimbabwe. Design Cluster randomised controlled trial with the clinic as the randomisation unit. Setting Primary care setting in a developing country where care was provided by nurse-midwives. Population Women booking for ANC in the clinics were eligible. Main outcome measures Number of antenatal visits, antepartum and intrapartum referrals, utilization of health centre for delivery and perinatal outcomes. Methods Twenty-three rural health centres were stratified prior to random allocation to the new (n= 11) or standard (n= 12) model of care. Results We recruited 13 517 women (new, n= 6897 and standard, n= 6620) in the study, and 78% (10 572) of their pregnancy records were retrieved. There was no difference in median maternal age, parity and gestational age at booking between women in the standard model and those in the new model. The median number of visits was four for both models. The proportion of women with five or less visits was 77% in the new and 69% in the standard model (OR 1.5; 95% CI 1.08-2.2). The likelihood of haemoglobin testing was higher in the new model (OR 2.4; 95% CI 1.0-5.7) but unchanged for syphilis testing. There were fewer intrapartum transfers (5.4 versus 7.9% [OR 0.66; 95% CI 0.44-0.98]) in the new model but no difference in antepartum or postpartum transfers. There was no difference in rates of preterm delivery or low birthweight. The perinatal mortality was 25/1000 in standard model and 28/1000 in new model. Conclusion In Gutu district, a focused five-visit schedule did not change the number of contacts but was more effective as expressed by increased adherence to procedures and better use of institutional health care.

Place, publisher, year, edition, pages
2007. Vol. 114, no 7, 802-811 p.
Keyword [en]
Antenatal care, number of visits, pregnancy outcome, rural Zimbabwe
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-93615DOI: 10.1111/j.1471-0528.2007.01372.xISI: 000247225100005OAI: oai:DiVA.org:uu-93615DiVA: diva2:167145
Available from: 2005-11-02 Created: 2005-11-02 Last updated: 2011-02-09Bibliographically approved
In thesis
1. Assessing Antenatal Care in Rural Zimbabwe
Open this publication in new window or tab >>Assessing Antenatal Care in Rural Zimbabwe
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

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.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2005. 65 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 78
Obstetrics and gynaecology, antenatal, pregnancy complications, referral, risk factors, pregnancy outcome, rural, Zimbabwe, Obstetrik och kvinnosjukdomar
National Category
Obstetrics, Gynecology and Reproductive Medicine
urn:nbn:se:uu:diva-6018 (URN)91-554-6372-X (ISBN)
Public defence
2005-11-23, Rosénsalen, Akademiska sjukhuset, Ing 95/96, nbv, Uppsala, 09:15
Available from: 2005-11-02 Created: 2005-11-02Bibliographically approved

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