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Quality of antenatal care services in Rwanda: Assessing practices of health care providers 11 Medical and Health Sciences 1117 Public Health and Health Services

Journal article
Authors Akashi Andrew Rurangirwa
I. Mogren
J. Ntaganira
K. Govender
Gunilla Krantz
Published in Bmc Health Services Research
Volume 18
Issue 1
ISSN 1472-6963
Publication year 2018
Published at Institute of Medicine, Department of Public Health and Community Medicine, Public Health Epidemiology Unit
Language en
Keywords Antenatal care, Antenatal care providers, Practices, Quality of care, Rwanda
Subject categories Epidemiology, Reproductive and perinatal care


Background: Although most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda. Methods: This facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used. Results: Nurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively. Conclusion: The providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity. © 2018 The Author(s).

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