Quality of antenatal care in rural southern Tanzania: a reality check

The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping.Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions.Complications like haemorrhage, sepsis and hypertensive disorders account for most of the maternal deaths in developing countries [1]. Key interventions to reduce maternal deaths include the promotion of antenatal care (ANC), presence of skilled assistants during childbirth and provision of emergency obstetric care [2]. The cornerstones of effective ANC and timely referrals during complications are the identification of pregnancy complications and women's awareness of the danger signs [2-7]. Although certain obstetric emergencies cannot be predicted through antenatal screening, women can be educated to recognize and act on symptoms that potentially lead to serious conditions