Challenges in implementing the revision of 4 focused antenatal care visits to 8 antenatal care visits in Lilongwe District
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Date
2021-12-10
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Kamuzu University of Health Sciences
Abstract
Executive Summary
Type of research study
The study will use a cross-sectional descriptive study design, that will employ a phenomenological qualitative approach.
The problem to be studied Maternal and neonatal mortality are issues of public health concern globally especially in developing countries, and Malawi is not an exception. Malawi, has high maternal mortality ratio (MMR) and high neonatal mortality rate (NMR) which are currently at 439 per 100,000 live births and 27 per 10000 live births respectively. For that reason, globally and nationally,several interventions have been
introduced to Some of these interventions include advocating for health facility birth by a skilled attendant and utilization of antenatal care services that includes starting antenatal care within the first trimester and attaining at least 4 antenatal care visits. Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality through early detection and management of women with and those at risk of pregnancy related complications during labor and delivery.
Different models of the antenatal care services have been implemented in Malawi over the past years as recommended by the World Health Organization (WHO). In 2016, WHO recommended that every pregnant woman should have eight ANC visits four scheduled focused antenatal care visits (FANC). The aim of the adjustment is to increase contacts of a pregnant woman with a health care worker to reduce perinatal mortality and improve women’s experience of care. In 2019, Malawi government, through the Ministry of Health and Reproductive Health Directorate, adopted and started implementing thise WHO recommendations in 2019. In 2020, however, out of the 93,801 women who attended antenatal care in Lilongwe District government health facilities, only 6736 (7.2%) attended 5+ visits. Additionally, there is insufficient data to show the impact of this ANC
model has had on health care workers and ANC users as well as the challenges encountered with the model. This study, therefore, seeks to unveil/assess the challenges affecting the implementation of 8 ANC visits in public health facilities with a focus on Lilongwe District government health facilities. The results of the study will be instrumental in the efforts of increasing the number of women who attend 5+ ANC visits.
The objectives
• Broad objective
To explore the challenges the 8 ANC visits model in health facilities of Lilongwe district.
• Specific objectives
To identify health system challenges that impact ANC provision in health facilities of
Lilongwe district.
2. To explore sociodemographic factors that influence the timing of ANC start and number of ANC visits amongst childbearing women in Lilongwe district.
3. To explore knowledge, attitudes, beliefs and perceptions of childbearing women towards ANC start and number of ANC visits amongst childbearing women in Lilongwe district.
4. To explore social cultural factors that influence ANC initiation and number of visits
amongst childbearing women in Lilongwe district
Methodology
The study will be conducted in government health facilities of Lilongwe district. Health facilities will be first stratified into urban and rural health facilities. Thereafter, there will be a random selection of health facilities proportionate to their population.
The study population will be health care workers (Nurses and/or Clinicians) working at ANC departments and pregnant women found at antenatal care clinics accessing services Purposive sampling method will be used to recruit pregnant women and
convenience sampling method will be used to recruit health care workers. Data will be collected through in-depth interviews for health care workers and focus group discussions (FGD) for pregnant women. During data collection, digital voice recorders will be used and all digital recordings will be transcribed and translated into English and coded using NVIVO qualitative software. Themes generated from the data will be analyzed using thematic content analysis.
Expected findings and their dissemination
The researcher is expecting to provide rigorous local evidence documenting the challenges affecting effective implementation of the new ANC guidelines and their impact towards the delivery of improved maternal and neonatal health care services in the hospitals.
Dissemination of the study findings and possible recommendations will be made to College of Medicine Research and Ethics Committee (COMREC), College of Medicine research dissemination seminars, Lilongwe District Health Office and all study sites. A report of the findings will also be published as a journal article
Description
Keywords
Maternal Health