1. THE RELATIONSHIP BETWEEN KNOWLEDGE OF GOAL ORIENTED ANTENATAL CARE AND ADHERENCE TO GOAL ORIENTED VISITS BY ANTENATAL CLIENTS 10 th SOMSA CONGRESS ST GEORGE HOTEL TSWANE By Mrs. SOTAH MAHANYA 05 December 2012

2. OUTLINE  Background problem statement purpose and objectives  Methods sampling sampling instruments instruments data handling data handling  Results  Discussion

3. BACKGROUND  Complications during pregnancy and child birth are the leading causes of mortality and morbidity among women of reproductive age  WHO has recommended the new goal oriented ANC as a proven effective tool in preventing pregnant related complications. - Four antenatal visits providing focused services

4. BACKGROUND  The old model consisted of 12-15 visits  The effectiveness of goal oriented ANC is based on adherence to recommended visits.  Zimbabwe is committed to fulfillment of the MDGs 4and 5, hence has adopted this protocol.  Other countries have also adopted it e.g. sub- Saharan countries

5. Problem Statement.  An increase in the number of pregnancy related complications was noted.  Of concern were stillbirths which had increased by 1.85% between 2006 and 2007  Reduction of mortality rate is expected instead of increase - hence this has become a concern.

6. Problem Statement Cont.  Zimbabwe had a stillbirth rate of 17 per 1000 in 2000 and an infant mortality rate of 27 per 1000.  In 2007 the infant mortality rate increased to 60 per 1000 live births.  In 2011 the infant mortality rate of 29.5 per 1000 and stillbirth rate of 20 per 1000 live births  Southern Africa had an infant mortality rate of 23 per 1000 and still births rate of 21 per 1000  Globally 3.3 million babies are still born yearly.

7. Purpose The purpose of this study was : - to examine the relationship between knowledge of goal oriented antenatal care and adherence to goal oriented visits among antenatal clients at Morgenster Hospital.

8. Objectives To assess adherence to goal oriented antenatal visits by antenatal clients To identify the level of knowledge on goal oriented ANC among the antenatal clients To examine the relationship between knowledge of goal oriented ANC and adherence to goal oriented antenatal visits

9. Methods Study Design A descriptive correlational design used. Sampling procedure Simple random sampling of 80 para 1, gravida 2, and para 2,gravida 3 antenatal clients Inclusion criterion was 36 weeks gestation and above. The antenatal register was used to establish a sampling frame.

10. Research Instrument  Interview schedule comprising three sections used Section A – Demographic data questionnaire Section B – Knowledge of goal oriented ANC Section C – Adherence to goal oriented visits  Questionnaire pre-tested at a rural health center using a sample of 5.  The instrument’s items were judged to have face validity

11. Data Collection  Face to face interviews were conducted in English or vernacular.  The investigator recorded the responses for consistency.  At least twenty minutes were spent with each participant and private room was used.

12. Ethical Consideration  Permission to collect data was sought and granted by the Zimbabwe Medical Research Council  From hospital administration  Written informed consent was sought from the participants prior to the interviews.  The consent form addressed principles of beneficence, autonomy, and justice.

13. Data Analysis Data analysis was done using the Statistical Package for Social Science (SPSS) Descriptive statistics used to describe the data. Inferential statistics namely Pearson’s Product Moment (r) as well as Regression analysis used to examine the relationship between the variables.

14. RESULTS  27.5% were aged 20-23 “youth” and those aged 32-35 constituted 13.8%  82.5% were married while 17.5% were either single, divorced or widowed  80% had attained secondary and higher education  56.3% booked before 16 weeks  However, only 48.8% attended ANC according to recommended dates, i.e. 51.2% non-adherence.

15. RESULTS  While 52.5% had correct information about the recommended number of goal oriented visits.  Knowledge on the services provided during goal oriented visits was limited  knowledge on signs and symptoms of pregnancy related complications also limited - gross swelling of the face and feet (46, 25%) - severe pallor (36, 25%) - upper abdominal pain (32, 5%).

16. DISCUSSION  The youth are prone to complications in pregnancy hence – adherence important.  World health report (2005)indicates that educated women are in better position to understand information regarding their health.  The 51.2% non-adherence supports the findings by Mathole et al. (2004) - women were not satisfied with the goal oriented visits and preferred the old model with more visits.

17. DISCUSSION  Danger symptoms should be informed to the clients from 26 weeks so that they report early.(Majoko et al 2006)  Non-adherence could have resulted in the limited knowledge Relationship  The correlation coefficient (r) between knowledge of goal oriented ANC and adherence to goal oriented visits was -0.518.

18. DISCUSSION  This relationship was significant with R 2 =0.269.  This suggests that adherence to goal oriented antenatal visits is affected by knowledge of goal oriented ANC.  52.5% knowledge is, however marginal considering the participants, level of education  This also suggests that there could be other factors affecting adherence to goal oriented antenatal visits - considering results from other studies that some prefer the old protocol

19. RECOMMENDATIONS Goal oriented antenatal care protocol should be strengthened and adherence emphasized. Health education to include explaining the goal oriented ANC protocol Pamphlets on signs of pregnant related complications, and signs of labor in both vernacular and English. A study focusing more on barriers to adherence to goal oriented antenatal visits. Limitations: study carried out at 1 institution

20. CONLUSION  Goal oriented antenatal care protocols if adhered to, results in good quality ANC and reduction of complications.  any slight increase especially in stillbirths or maternal mortality would cause concern.  The findings showed that attendance of ANC according to recommended times is affected by the knowledge acquired from health education by midwives.  Health education should therefore aim at ensuring that the clients appreciate its effectiveness of goal oriented ANC through adherence.

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