|Quality of antenatal care in Zambia: a national
||Nicholas N A Kyei, Collins Chansa and Sabine Gabrysch
||BMC Pregnancy and Childbirth , 12:151
||Background: Antenatal care (ANC) is one of the recommended interventions to reduce maternal and neonatal
mortality. Yet in most Sub-Saharan African countries, high rates of ANC coverage coexist with high maternal and
neonatal mortality. This disconnect has fueled calls to focus on the quality of ANC services. However, little
conceptual or empirical work exists on the measurement of ANC quality at health facilities in low-income countries.
We developed a classification tool and assessed the level of ANC service provision at health facilities in Zambia on a
national scale and compared this to the quality of ANC received by expectant mothers.
Methods: We analysed two national datasets with detailed antenatal provider and user information, the 2005
Zambia Health Facility Census and the 2007 Zambia Demographic and Health Survey (DHS), to describe the level of
ANC service provision at 1,299 antenatal facilities in 2005 and the quality of ANC received by 4,148 mothers
between 2002 and 2007.
Results: We found that only 45 antenatal facilities (3%) fulfilled our developed criteria for optimum ANC service,
while 47% of facilities provided adequate service, and the remaining 50% offered inadequate service. Although 94%
of mothers reported at least one ANC visit with a skilled health worker and 60% attended at least four visits, only
29% of mothers received good quality ANC, and only 8% of mothers received good quality ANC and attended in
the first trimester.
Conclusions: DHS data can be used to monitor “effective ANC coverage” which can be far below ANC coverage as
estimated by current indicators. This “quality gap” indicates missed opportunities at ANC for delivering effective
interventions. Evaluating the level of ANC provision at health facilities is an efficient way to detect where
deficiencies are located in the system and could serve as a monitoring tool to evaluate country progress.
Keywords: Maternal health services, Prenatal care, Health care quality, Africa South of the Sahara