THE RELATIONSHIP BETWEEN KNOWLEDGE OF GOAL ORIENTED ANTENATAL CARE AND ADHERENCE TO GOAL ORIENTED VISITS BY ANTENATAL CLIENTS

10th SOMSA CONGRESSST GEORGE HOTEL TSWANE

By Mrs. SOTAH MAHANYA 05 December 2012

OUTLINE

Background problem statement purpose and objectivesMethods sampling instruments data handlingResultsDiscussion

BACKGROUND

Complications during pregnancy and child birth are the leading causes of mortality and morbidity among women of reproductive age

WHO has recommended the new goal oriented ANC as a proven effective tool in preventing pregnant related complications.

- Four antenatal visits providing focused services

BACKGROUND

The old model consisted of 12-15 visits

The effectiveness of goal oriented ANC is based on adherence to recommended visits.

Zimbabwe is committed to fulfillment of the MDGs 4and 5, hence has adopted this protocol.

Other countries have also adopted it e.g. sub- Saharan countries

Problem Statement.

An increase in the number of pregnancy related complications was noted.

Of concern were stillbirths which had increased by 1.85% between 2006 and 2007

Reduction of mortality rate is expected instead of increase

- hence this has become a concern.

Problem Statement Cont.

Zimbabwe had a stillbirth rate of 17 per 1000 in 2000 and an infant mortality rate of 27 per 1000.

In 2007 the infant mortality rate increased to 60 per 1000 live births.

In 2011 the infant mortality rate of 29.5 per 1000 and stillbirth rate of 20 per 1000 live births

Southern Africa had an infant mortality rate of 23 per 1000 and still births rate of 21 per 1000

Globally 3.3 million babies are still born yearly.

Purpose

The purpose of this study was: - to examine the relationship between

knowledge of goal oriented antenatal care and adherence to goal oriented visits among antenatal clients at Morgenster Hospital.

Objectives

To assess adherence to goal oriented antenatal visits by antenatal clients

To identify the level of knowledge on goal oriented ANC among the antenatal clients

To examine the relationship between knowledge of goal oriented ANC and adherence to goal oriented antenatal visits

Methods

Study DesignA descriptive correlational design used.Sampling procedureSimple random sampling of 80 para 1,

gravida 2, and para 2,gravida 3 antenatal clients

Inclusion criterion was 36 weeks gestation and above.

The antenatal register was used to establish a sampling frame.

Research Instrument

Interview schedule comprising three sections used

• Section A – Demographic data questionnaire• Section B – Knowledge of goal oriented ANC • Section C – Adherence to goal oriented visits Questionnaire pre-tested at a rural health

center using a sample of 5.The instrument’s items were judged to have face

validity

Data Collection

Face to face interviews were conducted in English or vernacular.

The investigator recorded the responses for consistency.

At least twenty minutes were spent with each participant and private room was used.

Ethical Consideration

Permission to collect data was sought and granted by the Zimbabwe Medical Research Council

From hospital administrationWritten informed consent was sought

from the participants prior to the interviews.

The consent form addressed principles of beneficence, autonomy, and justice.

Data Analysis

Data analysis was done using the Statistical Package for Social Science (SPSS)

Descriptive statistics used to describe the data.

Inferential statistics namely Pearson’s Product Moment (r) as well as Regression analysis used to examine the relationship between the variables.

RESULTS

27.5% were aged 20-23 “youth” and those aged 32-35 constituted 13.8%

82.5% were married while 17.5% were either single, divorced or widowed

80% had attained secondary and higher education

56.3% booked before 16 weeks However, only 48.8% attended ANC

according to recommended dates, i.e. 51.2% non-adherence.

RESULTS

While 52.5% had correct information about the recommended number of goal oriented visits.

Knowledge on the services provided during goal oriented visits was limited

knowledge on signs and symptoms of pregnancy related complications also limited

- gross swelling of the face and feet (46, 25%) - severe pallor (36, 25%) - upper abdominal pain (32, 5%).

DISCUSSIONThe youth are prone to complications in

pregnancy hence – adherence important. World health report (2005)indicates that

educated women are in better position to understand information regarding their health.

The 51.2% non-adherence supports the findings by Mathole et al. (2004)

- women were not satisfied with the goal oriented visits and preferred the old model with more visits.

DISCUSSION

Danger symptoms should be informed to the clients from 26 weeks so that they report early.(Majoko et al 2006)

Non-adherence could have resulted in the limited knowledge

RelationshipThe correlation coefficient (r) between

knowledge of goal oriented ANC and adherence to goal oriented visits was -0.518.

DISCUSSION

This relationship was significant with R2=0.269.

This suggests that adherence to goal oriented antenatal visits is affected by knowledge of goal oriented ANC.

52.5% knowledge is, however marginal considering the participants, level of education

This also suggests that there could be other factors affecting adherence to goal oriented antenatal visits

- considering results from other studies that some prefer the old protocol

RECOMMENDATIONS

Goal oriented antenatal care protocol should be strengthened and adherence emphasized .

Health education to include explaining the goal oriented ANC protocol

Pamphlets on signs of pregnant related complications , and signs of labor in both vernacular and English .

A study focusing more on barriers to adherence to goal oriented antenatal visits.

 Limitations: study carried out at 1 institution

CONLUSIONGoal oriented antenatal care protocols if adhered to,

results in good quality ANC and reduction of complications.

any slight increase especially in stillbirths or maternal mortality would cause concern.

The findings showed that attendance of ANC according to recommended times is affected by the knowledge acquired from health education by midwives .

Health education should therefore aim at ensuring that the clients appreciate its effectiveness of goal oriented ANC through adherence.

THANK YOU