Assessment of the quality of antenatal care in Mozambique

Abstract

Objective: To assess the quality of antenatal care and its covariates among postpartum women in Mozambique.

Design: Cross-sectional study.

Setting: The study was undertaken either at the maternity hospital or at home, in Mozambique, in 2019.

Participants: A total of 393 women aged 18 to 49 years were interviewed immediately after giving birth.

Measurements: The quality of antenatal care was analysed based on the guidelines of the Ministry of Health of Mozambique: antenatal appointment in the first 16 weeks of gestation, 4 or more antenatal appointments, at least one laboratory test, at least 4 or more clinical-obstetric procedures, 3 doses of the prophylactic intermittent treatment for malaria, 2 doses of the tetanus vaccine, and counselling related to general health care. Women who reported all of these situations were classified as having had quality antenatal care.

Findings: All women reported at least one antenatal care visit, but only 13.0% were classified as having had quality antenatal care. Women who underwent antenatal care in previous pregnancies (aOR=4,28; 95% CI=1,45-12,62) and whose current pregnancy was planned (aOR=2,51; 95% CI=1,11-5,68) were more likely to have quality antenatal care than those who had never had access to antenatal care in previous pregnancies and those who currently had an unplanned pregnancy. It was observed that the criteria recommended by the Ministry of Health were not followed during antenatal care, especially regarding the gestational age at the beginning of antenatal care, the minimum number of consultations, performing blood tests (complete blood count, blood glucose, blood typing and Rh factor) and guidance on signs of risk in pregnancy and childbirth.

Key conclusions: In general, the criteria recommended for quality antenatal care are not incorporated into clinical practice in Mozambique.

Implications for practice: While quality antenatal care is essential to reduce maternal morbidity and mortality, many sub-Saharan countries still have low-quality antenatal care services, which is one of the reasons why these countries have the highest maternal mortality rates worldwide.

Keywords: Maternal health. Antenatal care. Quality of health care. Mozambique.