Content of antenatal care services in secondary health care facilities in Nigeria: implication for quality of maternal health care.

OBJECTIVE: To assess the contents of antenatal care and to relate the findings to the adequacy of maternal health care.

DESIGN: Cross-sectional study.

SETTING: Public secondary health-care facilities.

PARTICIPANTS: Pregnant women.

INTERVENTIONS: Three hundred and ninety consecutive pregnant women attending 12 selected secondary health facilities were recruited proportionate to the client load recorded for each facility during the year preceding the study. Interviews were conducted using the antenatal care exit interview form of the Safe Motherhood Needs Assessment package.

MAIN OUTCOME MEASURES: Antenatal care services provided to pregnant women in current pregnancy.

RESULTS: Blood pressure measurement, abdominal palpation and detection of foetal heart rate were provided to all participants. Three hundred and eighty-six (99%) were reached with at least one educational message. One hundred and sixty-seven (42.8%) had haemoglobin or packed cell volume estimated, whereas 168 (43.1%) had urine checked for protein, at least once during antenatal visits. Routine iron and folate supplements, and malaria prophylaxis were, respectively, given to 142 (36.4%) and 25 (6.4%).

CONCLUSIONS: The antenatal care service as provided had reasonable capacity for intervention against pre-eclampsia and some foetal problems, and could contribute to delivery in a health facility and by a health worker. Capacity to address the possible effects of severe anaemia and malaria in pregnancy was lacking. Equipping health-care facilities with capacity to detect anaemia and proteinuria as well as ensuring that iron and folate supplements, and malaria prophylaxis are given to all pregnant women would help to meet national guidelines and improve quality of service.