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

Autor:	Kihara AB; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ruby Medical Centre, Kiambu West, Kenya., Harries AD; International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK., Bissell K; International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand., Kizito W; Médecins Sans Frontières (MSF) Belgium, Nairobi, Kenya., Van Den Berg R; Medical Department, Brussels Operational Center, MSF-Luxembourg, Luxembourg., Mueke S; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ministry of Health, Nairobi, Kenya., Mwangi A; Moi University School of Medicine, Eldoret, Kenya., Sitene JC; Moi University School of Medicine, Eldoret, Kenya., Gathara D; Ruby Medical Centre, Kiambu West, Kenya., Kosgei RJ; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya., Kiarie J; Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya., Gichangi P; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
Jazyk:	angličtina
Zdroj:	Public health action [Public Health Action] 2015 Mar 21; Vol. 5 (1), pp. 23-9.
DOI:	10.5588/pha.14.0070
Abstrakt:	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.
Databáze:	MEDLINE
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