Evaluating readiness for implementation of the eight antenatal care contacts as per the World Health Organization guidelines in Bukwo District, Uganda

Abstract

Background: Low and Middle Income Countries (LMICs) account for around 99 % of maternal deaths worldwide, with Sub-Saharan Africa (SSA) responsible for about 66 % of these demises. The new Antenatal Care (ANC) model with 8 "contacts" has been shown to be crucial in reducing these maternal deaths. This study was used to evaluate readiness for implementation of the 8 ―contacts‖ ANC as per the new WHO guidelines in Bukwo district, Uganda. Methods: A health facility-based cross-sectional mixed methods survey was conducted in 7 facilities. The In-charges of 5 and 3 selected facilities respectively gave information on the availability of ANC tracer items /services and took part as key informants (KIs). A random sample of 370 ANC clients that were found attending services at all the 7 facilities provided quantitative data. Measurement of tracer items/services availability was determined by proportion of indicators present at the facility. A facility was regarded as being "Ready" if they scored 70 % or higher, and "Not ready" if they scored less than 70 %. Similarly by proportion, pregnant women were deemed "Ready" if they self-confessed willingness to attend ANC 8 or more times by the end of their current pregnancy, and "Not ready" if not willing to do so. At bivariate analysis level, variables with p<0.2 were deemed eligible for multivariable analysis. Modified Poisson regression analysis was applied at multivariable level, which eventually yielded prevalence ratios. Results: Results: This study found tracer items relatively more available in three facilities, as compared to in two HC IIIs, where they are scarce. 36.5 % of the clients expressed willingness to attend 8 or more ANC visits and health care providers were generally positive about the new policy. The results from the multivariable analysis model revealed being on ANC visit number 3 or 4 (aPR= 0.47, p<0.001); 95 % CI [0.330, 0.667]) as a significant independent factor associated with uptake of the 8-―contacts‖ WHO new ANC guidelines amongst women. Conclusions/recommendations: Antenatal care tracer items/services are relatively more available in Hospital and health HC IV, as compared to HC IIIs. Generally, fewer than half of women are willing to attend the 8 + new ANC model. And healthcare providers in Bukwo have perceived the new ANC policy positively. I therefore recommend increased purchase and equitable supply of scarce ANC amenities by ministry of health, as well as well tailored health education messages on men and women by the Bukwo district health office for increased uptake of the 8 ANC visits.