Assessment of levels of quality of antenatal care received by women with hypertensive disorders admitted at Muhimbili National Hospital

Abstract

ABSTRACT BACKGROUND: Hypertensive disorders in pregnancy are among the conditions which contribute to the direct causes of maternal mortality. The prevalence of hypertensive disorders ranges between 5-10%, and varies from place to place, it was estimated to be 16% in Tanzania. OBJECTIVE: the objective of this study was to assess the levels of quality antenatal care received by women with hypertensive disorders admitted at MNH. METHODOLOGY: Descriptive hospital based cross section study. Most women, who are admitted at Muhimbili National Hospital, are already in severe forms of hypertensive disorders. The level of quality of antenatal care received is not known. A tool for assessing levels of quality of antenatal care was adopted from a study done in Zambia. Levels of quality in this study are good quality, adequate and poor quality depending on blood pressure measurement on every visit, screening of urine for protein on every visit and counseling on danger signs. The study was organized in two forms; quantitative and qualitative studies. We recruited 351 women and 20 women were selected among them for the in depth interview. For the quantitative study, data was collected using a checklist, case notes, and one questionnaire. A checklist was used to extract information from antenatal cards regarding, number of visits, blood pressure, and screening of urine for protein. Information from case notes was about the diagnosis and blood pressure on the day of admission while a questionnaire used for assessing whether women were counseled for danger signs or not. For the qualitative component; a questionnaire for open ended questions was used to explore, women’s view about how counseling on danger signs, blood pressure and screening of urine for protein were done. The interview was recorded, then transcribed in Swahili and translated into English verbatim in one text context. Data analysis for the quantitative component was done using SPSS version 23, where descriptive statistics for frequencies and percentage of the variables were obtained. Cross tabulation tables between the number of visits and service provision were obtained. Data for qualitative component was analyzed by qualitative content analysis. vi RESULTS: The proportion of women counseled for danger signs was (264) 75.2%, the proportion of women tested urine for protein on every visit was 89 (25.4%),The mean number of ANC Visit was 3.8visits. The proportional of women checking blood pressure for every visit was 87.5%; women who had below 4 visits were 167 (47.6%), and women with 4 and above visits were184 (52.4%) The levels of quality antenatal care were good quality37%, Adequate quality26%.poor quality.37%.Three themes which were explored from the qualitative interview are, good counseling practice, there was no feedback during blood pressure and urine test and mothers are eagerly to have shorter intervals for follow up visits. CONCLUSION: Most women, who are admitted at MNH due to hypertensive related complications, are already in severe forms of hypertensive disorders due to poor quality of care received at antenatal clinics in the line of managing hypertension at that level of care