Abstract:
Background: Antenatal care (ANC) provides an important opportunity for pregnant women with a wide range of
interventions and is considered as an important basic component of reproductive health care.
Methods: In 2008, severe maternal morbidity audit was established at Saint Francis Designated District Hospital
(SFDDH), in Kilombero district in Tanzania, to ascertain substandard care and implement interventions. In addition, a
cross-sectional descriptive study was carried out in 11 health facilities within the district to assess the quality of ANC
and underlying factors in a broader view.
Results: Of 363 severe maternal morbidities audited, only 263 (72%) ANC cards were identified. Additionally, 121
cards (with 299 ANC visits) from 11 facilities were also reviewed. Hemoglobin and urine albumin were assessed in
22% – 37% and blood pressure in 69% - 87% of all visits. Fifty two (20%) severe maternal morbidities were
attributed to substandard ANC, of these 39 had severe anemia and eclampsia combined. Substandard ANC was
mainly attributed to shortage of staff, equipment and consumables. There was no significant relationship between
assessment of essential parameters at first ANC visit and total number of visits made (Spearman correlation
coefficient, r = 0.09; p = 0.13). Several interventions were implemented and others were proposed to those in control
of the health system.
Conclusions: This article reflects a worrisome state of substandard ANC in rural Tanzania resulting from inadequate
human workforce and material resources for maternal health, and its adverse impacts on maternal wellbeing. These
results suggest urgent response from those in control of the health system to invest more resources to avert the
situation in order to enhance maternal health in this country.
