Assessment of quality of antenatal care in Kenyatta National Hospital Kenya

Abstract

INTRODUCTION: Antenatal care is one of the most fundamental aspects that promise the success of Millennium Development Goals 4 and 5.However despite improved antenatal care attendance, parameters like maternal mortality are on the rise in Kenya, which is the reason for assessment of the quality of antenatal care in Kenyatta National Hospital(KNH). KNH being the national referral hospital, it‟s a good representation of the quality of care and nationwide statistics. OBJECTIVE: To assess the quality of antenatal care in Kenyatta National Hospital (KNH) STUDY DESIGN: Cross sectional study design. STUDYSITE: Kenyatta National Hospital, ANC-18 METHODS: 385 respondents who attended at least three antenatal visits to assess the quality of ANC and underlying factors in a broader view. Data was collected using a structured questionnaire from both interview of respondents and the respondents‟ records. Data was computerized using Epi Info and analyzed using SSPS, version 17. DATACOLLECTION: Data was collected using a structured questionnaire prepared by the principal investigator. The questionnaire was administered by the principal investigator and two research assistants, who were registered nurses. DATA ANALYSIS: Data analysis was conducted using the statistical package for social sciences version 17.0(SPSS inc, Chicago; il , USA). Using 95% C.I. RESULTS: Of 385 respondents, the mean age was 29.1 years (SD 5) with a range from 17 to 44 years, with37.7% of respondents aged 25-29 years. Majority (68.3%) of mothers had had a previous live birth, 28.1% were pregnant for the first time and 3.6% had had an abortion. Whereas majority (over 94%) of respondents had their height, weight and blood pressure taken and recorded, 4.7% of respondents had no heightmeasurement,1.04% had no weight measurementand1.04% had no blood pressure measurement and recording by third antenatal visit. Although majority 97.9% of respondents had a recorded obstetric examination, only 28.6% of respondents had a recorded general physical examination. 7.8%,19.5%,28.6%,6.2% and5.2% had no record of haemoglobin, blood group, syphilis, HIV and Urinalysis respectively ever been taken by the third ANC visit. Among the respondents informed of the results, only 16.9% and 34.8% understood the haemoglobin and Urinalysis results. Majority could however understand HIV 83.4% and syphilis 64.9% tests. The average time spent in the antenatal clinic was 3hrs 29 minutes, with a range from 1 hour 5 minutes to 5 hours 30 minutes, majority 135(35.1%) of respondents spent >3-4 hours. The respondents rated ANC services at KNH as 25.1% very good, 37.3%good, 30% fair and 7.6% as poor. Among other limitations to the suggested interventions were luck of funds to purchase drugs, out of stock for vaccines and reagents in the laboratory. CONCLUSION: The study showed that the quality of antenatal care in KNH is above average although there are gaps in the passage of information, failure to document findings and basic investigations have not been done for some clients. This can hamper the timely intervention.