Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007–2013

This is a retrospective cross-sectional study using routine programme data.

Abstract

Setting

A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya.

Objectives

Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors.

Design

Retrospective cross-sectional study using routine programme data.

Results

During the study period, 2635 women delivered at the RMC: 50% were aged 16–24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births.

Conclusion

This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.

This research was supported by the UK Department for International Development’s Operational Research Capacity Building Programme led by the International Union Against TB and Lung Disease (The Union)

Citation

A-B. Kihara, A. D. Harries, K. Bissell, W. Kizito, R. Van Den Berg, S. Mueke, A. Mwangi, J. C. Sitene, D. Gathara, R. J. Kosgei, J. Kiarie, P. Gichangi (2015) Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007 – 2013. Public Health Action International Union Against Tuberculosis and Lung Disease Health solutions for the poor vol 5 no 1 https://dx.doi.org/10.5588%2Fpha.14.0070

Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007 – 2013

Published 21 March 2015