Abstract
AUDIT OF ANTENATAL CARE AT PRIMARY HEALTH CARE CENTERS, AL QASSIM REGION, SAUDI ARABIA

Dr. Mohammed Al Alfi*, Dr. Abdullah Al Saigul, K. Chandra Sekhar, Dr. Mahmoud Alghoshah, Saleh Al Gabbany, Dr. Najma Javed

ABSTRACT

Background: The prime objective of antenatal care (ANC) is to monitor healthy pregnant women to detect early signs of pregnancy associated illnesses, risk factors related to a particular condition for intervention for safer outcomes.Current study was done to evaluate the extent of implementation of the ANC model in Primary Health care centers in Al-Qassim region, KSA. Objective: To evaluate the level of quality of performance and outcome of the ANC model in Primary Health care centers (PHCs) in Al Qassim region, in term of frequency and timing of antenatal visits and classification into low / high risk groups and outcome in terms of alive mother and newborn using antenatal cards, antenatal care and high risk registers used in PHCs settings. Materials & Methods: A retrospective study was conducted at Primary Health care centers (PHCs) in Al Qassim region of KSA from the year march 2013 to October 2013. Out of 170 existing PHCs in Al Qassim region, 10% (17 centers) were selected randomly and from the registered women in antenatal clinic in the selected PHCC who was deliver during the year 2012 from January up to October 2012, a total 173 women were selected randomly and enrolled in this study which represents approximately one percent (1%) of expected target population of women attended ANC services during the study year. Information was collected using structured questionnaire and data was extracted from the health records and antenatal care file by trained female physicians working in selected centers. Data comprised of age, gestational age, number of abortions, details of 1st, 2nd, 3rd and 4th visits, family history, past and current obstetrical history and medical history, high risk group, vaccination status, referral and outcome of pregnancy. Analysis of data was done by using Epi-info-7 statistical software package. Results: Total 173 women were enrolled. Mean age of pregnant woman’s was 31 years (±6.1std). Majority of the women 99 (57%) were in 28-38 years age group. Mean gestational age at 1st, 2nd, 3rd and 4th visit was 15, 26.3, 32.0 and 36.3 weeks respectively. Of the 173 women’s, 73 (47%) had their first ANC at the recommended period before 16 weeks where late entry to ANC was 14% (n = 22). Regarding previous history of abortions; 50 (29%) women had at least one abortion. Abortions were more common in younger age groups and most of the women had their abortions in their first trimester. More than half 92 (53%) were classified as high risk pregnancy based on family history, medical history and current & past obstetrical history. 120 (69%) women did not have any kind of family history of illness. Mean BMI (Body Index Mass) was 28. 1 (± 5.6 Std) and 22% of study population was obese (>32.3). Regarding tetanus toxoid (TT) vaccination, 103 (59.5%) were fully vaccinated, 63 (36.5%) were partially vaccinated. Out of 173 women booked, 154 (89.5%) ended safely (alive mother and newborn), three (1.78%) aborted and one (0.58%) had still birth. 14 (8.14%) lost to follow up. Conclusion: Based on the study results, out of 173 antenatal mothers, more than half 92 (53%) were classified as high risk pregnancy, only 42 (24%) of pregnant women’s were completed all the four antenatal visits, about 19.6% were multigravida, and 28.9% mothers were giving > one abortions history. Only 62% mothers were received required doses of Tetanus toxoid doses including previous TT immunizations. There is a need to improve and adopt new WHO model of ANC programme at PHCC where more number of visits will give more exposure to health care facility to safe guard of mother and child in terms of mortality and morbidity.

Keywords: Age, Vaccination status, ANC visits, ANC cards, Pregnancy outcome, Al Qassim Region.


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