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Where is the ‘C’ in antenatal care and postnatal care: A multi-country survey of availability of antenatal and postnatal care in low-and middle-income settings

Madaj, Barbara, Gopalakrishnan, Somasundari, Quach, Alexandre, Filiaci, Simone, Traore, Adama, Bakusa, Dankom, Mdegela, Mselenge, Yousofza, Abdul Wali, Rahmanzai, Ahmed Javed, Kodindo, Grace, Gami, Jean-Pierre, Rostand, Njiki Dounou, Kessely, Hamit, Addo, Stephen Ayisi, Abbey, Mercy, Sapali, Mary, Omar, Ali, Ernest, Alex, Mtandu, Rugola, Agossou, Abram, Ketoh, Guillaume K., Furtado, Nicholas, Mangiaterra, Viviana and van den Broek, Nynke (2022) Where is the ‘C’ in antenatal care and postnatal care: A multi-country survey of availability of antenatal and postnatal care in low-and middle-income settings. BJOG An International Journal of Obstetrics and Gynaecology, 129 (9). pp. 1546-1557.

Item Type: Article


Objective: Antenatal (ANC) and postnatal care (PNC) are logical entry points for prevention
and treatment of pregnancy-related illness and to reduce perinatal mortality. We
developed signal functions and assessed availability of the essential components of care.
Design: Cross-sectional survey.
Setting: Afghanistan, Chad, Ghana, Tanzania, Togo.
Sample: Three hundred and twenty-one healthcare facilities.
Methods: Fifteen essential components or signal functions of ANC and PNC were identified. Healthcare facility assessment for availability of each component, human resources, equipment, drugs and consumables required to provide each component.
Main outcome measure: Availability of ANC PNC components.
Results: Across all countries, healthcare providers are available (median number per facility: 8; interquartile range [IQR] 3–17) with a ratio of 3:1 for secondary versus primary care. Significantly more women attend for ANC than PNC (1668 versus 300 per facility/year). None of the healthcare facilities was able to provide all 15 essential components of ANC and PNC. The majority (>75%) could provide five components: diagnosis and management of syphilis, vaccination to prevent tetanus, BMI assessment, gestational diabetes screening, monitoring newborn growth. In Sub-Saharan countries, interventions for malaria and HIV (including prevention of mother to child transmission [PMTCT]) were available in 11.7–86.5% of facilities. Prevention and management of TB; assessment of pre-or post-term birth, fetal wellbeing, detection of multiple pregnancy, abnormal lie and presentation; screening and support for mental health and domestic abuse were provided in <25% of facilities.
Conclusions: Essential components of ANC and PNC are not in place. Focused attention on content is required if perinatal mortality and maternal morbidity during and after pregnancy are to be reduced.
developing countries—obstetrics and gynaecology, health services research, maternity services
Tweetable abstract: ANC and PNC are essential care bundles. We identified 15 core components. These are not in place in the majority of LMIC settings.

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More Information

Depositing User: Mselenge Mdegela


Item ID: 15971
Identification Number:
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Users with ORCIDS

ORCID for Barbara Madaj: ORCID iD
ORCID for Mselenge Mdegela: ORCID iD
ORCID for Nynke van den Broek: ORCID iD

Catalogue record

Date Deposited: 05 May 2023 14:10
Last Modified: 11 Jul 2023 08:02


Author: Barbara Madaj ORCID iD
Author: Mselenge Mdegela ORCID iD
Author: Nynke van den Broek ORCID iD
Author: Somasundari Gopalakrishnan
Author: Alexandre Quach
Author: Simone Filiaci
Author: Adama Traore
Author: Dankom Bakusa
Author: Abdul Wali Yousofza
Author: Ahmed Javed Rahmanzai
Author: Grace Kodindo
Author: Jean-Pierre Gami
Author: Njiki Dounou Rostand
Author: Hamit Kessely
Author: Stephen Ayisi Addo
Author: Mercy Abbey
Author: Mary Sapali
Author: Ali Omar
Author: Alex Ernest
Author: Rugola Mtandu
Author: Abram Agossou
Author: Guillaume K. Ketoh
Author: Nicholas Furtado
Author: Viviana Mangiaterra

University Divisions

Faculty of Health Sciences and Wellbeing > School of Psychology


Sciences > Health Sciences

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