Unfolding information needs to improve the utilization of antenatal care services: a descriptive case study in the Western Cape

Smeda, Winston (2017-12)

Thesis (MCur)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY : Background: The utilization of Antenatal care (ANC) is essential for better outcomes in pregnancy, birth and motherhood. ANC is regarded as specialised care that is available to pregnant women from conception until birth. The provision of this care prepares pregnant women for birth and motherhood while detecting health problems, risk factors and complications. Booking in this study refers to the first antenatal visit whereby a complete maternal history-taking, physical examination, gestational age and risk assessment is done (Republic of South Africa, 2007:20). The preferred booking time must be in the first three months of the pregnancy (after the second period is missed) and the minimum number recommended for basic antenatal care (BANC) follow up visits in low risk pregnancies are seven, which is at 20, 26-28, 30-32, 34, 36, 38 and 40. Each year in Africa 30 million women become pregnant while around 250,000 women die of pregnancy-related causes. Globally, approximately 56% of pregnant women attend the recommended minimum of four antenatal care visits. The other 44% either utilize the services too late or not at all. This study was based in a rural level one hospital where pregnant women utilize the basic antenatal care (BANC) services late or not at all. A reduced interest and uptake of ANC were observed in Saldanha sub-district, West Coast region of the Western Cape. Purpose: The aim of the study was to explore the factors that influenced the utilization of BANC services while understanding how information could be utilized to enhance the uptake of BANC services, in order to improve maternal and neonatal outcomes in Saldanha sub-district. Methods: The study utilized a qualitative methodology with a single case study approach with embedded units of analysis. The population for this study was all the pregnant women who booked after 32 weeks of pregnancy as one unit of analysis, and midwives working in the labour ward where the women delivered and midwives who provided the antenatal care in the clinics as another unit of analysis. In-depth interviews were conducted with nine (9) un-booked and two (2) late booked pregnant women. A further eleven (11) midwives participated in the two focus group discussions and two (2) individual interviews which were conducted. Findings: The study found that pregnant women were subjected to personal, social, economic and institutional factors that prevented them from using the recommended BANC services. Personal feelings that influenced the motivation, and institutionally based factors like access to services and waiting times, were revealed as barriers. The study further revealed a variety of information needs that pregnant women have and methods to disseminate the information. Information such as the availability of the recommended services, the competency levels of the healthcare workers, communication skills, attitude and support were identified. Conclusion: Personal, social and institutional barriers to the recommended BANC services were identified, which could serve as an indicator for change in the Sub-district. These findings will be submitted to the West Coast district health services that could assist in the process of future planning towards objectives to improve the utilization of such services by pregnant women.

AFRIKAANSE OPSOMMING : Agtergrond: Die gebruik van voorgeboorte sorg (VGS) is belangrik vir die uitkomste en resultate van swangerskap, geboorte en moederskap. VGS word beskou as gespesialiseerde sorg wat beskikbaar is vir swanger vroue vanaf bevrugting tot geboorte. Die voorsiening van die sorg berei swanger vroue voor vir die geboorte proses en moederskap terwyl die voorkoms van gesondheidsprobleme, risiko faktore en komplikasies gemonitor word. Bespreking vir swangerskap verwys na die eerste voorgeboortesorg besoek waartydens n volledige geskiedenis, fisiese ondersoek, gestasie bepaling en risiko gradering gedoen word (Republiek van Suid Afrika, 2007:20). Die verkieslike besprekingstyd moet in die eerste drie maande van swangerskap geskied (nadat die tweede menstruasie gemis is) en die minimum aantal opvolg besoeke moet sewe wees (20, 26-28, 30-32, 34, 36, 38, en 40 weke gestasie). Elke jaar word 30 miljoen vroue swanger in Afrika en ongeveer 250,000 vroue sterf aan swangererskap verwante oorsake. Globaal woon ongeveer 56% van swanger vroue die aanbevele vier minimum VGS besoeke by terwyl die ander 44% die dienste laat of nooit gebruik nie. Die studie was gebaseer opn landelike vlak een hospitaal waar swanger vroue die geneigdheid het om laat te bespreek vir basiese voorgeboorte sorg of om glad nie te bespreek nie. Min belangstelling en gebruik van voorgeboorte sorg was waargeneem in Saldanha sub-distrik. Doel: Die doel van die studie was uit te vind watter faktore die gebruik van voorgeboorte sorg beinvloed om te verstaan hoe informasie gebruik kan word om die gebruik van voorgeboorte sorg aan te moedig ten einde die moederlike en neonatale uitkomste of resultate te verbeter in Saldanha sub-distrik. Metode: n Kwalitatiewe metodologie was gebruik met n enkel gevalle studie benadering. Die populasie was alle onbespreekte of laat bespreekte (na 32 weke) swanger vroue as een eenheid van ontleding, vroedvroue van die kraamsaal en voorgeboorte klinieke as n ander eenheid van ontleding. Nege (9) onbespreekte, twee (2) laat bespreekte swanger vroue het deelgeneem in die indiepte onderhoude en elf (11) vroed vroue het deelgeneem in die twee fokus groep besprekings en twee (2) indiepte onderhoude. Resultate: Die studie het bevind dat swanger vroue onderwerp is aan persoonlike, sosiale, ekonomiese en institusionele faktore wat die gebruik van voorgeboorte sorg verhoed. Persoonlike gevoelens wat hul motivering beinvloed tot instansie gebaseerde faktore soos toegang en lang wagperiodes was geidentifiseer as hindernisse. Die studie het ook verskeie informasiebehoeftes en maniere om die informasie te versprei aan die lig gebring. Informasiebehoeftes soos die beskikbaarheid van dienste, vaardigheid van die gesondheidswerkers, kommunikasie vaardighede, gesindheid, houding en ondersteuning was geidentifiseer. Afsluiting: Persoonlike, sosiale en institutionele hindernisse tot voorgeboorte sorg was geidentifiseer wat kan dien as indikators vir veranderinge in die Sub-distrik. Die bevindinge sal voorgele word aan die Weskus Gesondheidsdistrik bestuur wat kan help in die proses van toekomstige beplanning van doelwitte om die gebruik van VGS deur swanger vroue te verbeter.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/102878
This item appears in the following collections: