QUALITY ASSESSMENT OF THE PRACTICE OF FOCUSED APPROACH TO ANTENATAL CARE IN RURAL AND URBAN PRIMARY HEALTH CENTRES IN EKITI STATE

Abstract

High maternal mortality in Nigeria has been of major Public Health concern and recently it has been a major focus of Millennium Development Goals. Focused Antenatal Care (FANC) is a complete model of antenatal care adopted to improve maternal care during pregnancy and subsequently reduce maternal mortality. However, the practice is yet to be optimized and there has been a suggestion that there is inequity in access and utilization of antenatal services with the rural areas underserved. Lack of antenatal care increases the risks of maternal mortality, between a third and half of maternal deaths are caused by factors which are directly related to inadequate care in pregnancy. This study aimed at assessing the practice of FANC at the Primary Health Centers, in urban and rural areas of Ekiti state. A cross sectional study was carried out. The Local Government Areas (LGAs) were stratified into urban and rural areas, 50% of PHCs offering maternity services in each stratum were selected using simple random sampling; four hundred eligible and consenting pregnant women attending antenatal clinics of the PHCs in both urban and rural areas were selected based on proportional allocation. Adapted safe motherhood exit interview questionnaire was used to collect information from the respondents. The in-depth interview participants comprised of senior nurses and matrons; they were selected by purposive sampling. Descriptive statistics, Chi-square test, and binomial logistic regression were used to analyze quantitative data and p was set at 5% level of significance. The in-depth interview was analysed using thematic approach. The mean age of all the respondents was 27.5± 5.7 (rural areas 27.8 ±5.9, urban areas 27.2±5.5), fewer women (20.7%) in rural areas received the standard antenatal care compared with (29.3%) urban respondents (P<0.005), there was a slight rural -urban difference in the proportions that were given a range of lectures on health education in the different locations: 90.8% of women in the urban areas were taught compared to 88.5% of the rural residents. Majority (98.8%) of the respondents were satisfied with the care received at the various PHCs and opined that they would return to the facility in future (P=0.024). Skilled workers were about 2.6 times less likely to have their first antenatal visit in the first trimester than respondents not working. Findings of the in-depth interview revealed that the health providers accepted FANC and they acknowledged the support of the state government as a facilitating factor to the practice of FANC. Most mentioned challenges to antenatal care included inadequate number of skilled workers and insufficient space for antenatal clinics to hold. Health care providers still doubt the feasibility of Focused Antenatal Care, there is the need to train and retrain health workers on the benefits of Focused antenatal care, more skilled providers are needed in the PHCs s especially in the rural areas. There should be policies in place to ensure that all the pregnant women receive the standard contents of focused antenatal care regardless of their place of residence.