Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Nov 19;18(1):865.
doi: 10.1186/s12913-018-3694-5.

Quality of antenatal care services in Rwanda: assessing practices of health care providers

Akashi Andrew Rurangirwa  1   2 , Ingrid Mogren  3   4 , Joseph Ntaganira  5 , Kaymarlin Govender  6 , Gunilla Krantz  7
Affiliations
Multicenter Study

Quality of antenatal care services in Rwanda: assessing practices of health care providers

Akashi Andrew Rurangirwa et al. BMC Health Serv Res. .

Abstract

Background: Although most pregnant women in Rwanda visit antenatal care (ANC) clinics, little has been studied about the quality of services being provided. We investigated the ANC providers' (HCPs) current practices in relation to prevention, management and referral of maternal conditions as well as the information provided to pregnant women attending ANC services in Rwanda.

Methods: This facility-based, cross-sectional study included 312 ANC providers as participants and a review of 605 ANC medical records from 121 health centers. Data collection was performed using an interviewer-administered questionnaire and a structured observation checklist. For the analyses, descriptive statistics and bi-and multivariable logistic regression were used.

Results: Nurses and midwives in ANC services failed to report a number of pregnancy-related conditions that would need urgent referral to a higher level of health care. Midwives did somewhat better than nurses in reporting these conditions. There was no statistically significant difference in how nurses and midwives informed pregnant women about pregnancy-related issues. Ever been trained in how to manage a pregnant woman exposed to violence was reported by 14% of the participants. In 12, 13 and 15% of the medical records there was no report on tetanus immunization, anthelmintic treatment and syphilis testing, respectively.

Conclusion: The providers in ANC clinics reported suboptimal practices on conditions of pregnancy that needed urgent referral for adequate management. Information to pregnant women on danger signs of pregnancy, recommended medicines and tests do not seem to be consistently provided. Midwifery training in Rwanda should be expanded so that most of staff at ANC clinics are trained as midwives to help lower maternal and child mortality and morbidity.

Keywords: Antenatal care; Antenatal care providers; Practices; Quality of care; Rwanda.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

The study was discussed and approved by the respective health facilities’ administrators and permission was given to access information in ANC medical records. Any identifying data was removed from the records and individual patient consent was not required. A written and signed consent was obtained from all participating HCPs. The study received clearance from the Institutional Review Board of the College of Medicine and Health Sciences, University of Rwanda and the National Institute of Statistics of Rwanda (No: 0425/2014/10/NISR).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Providers’ mentioning of conditions requiring urgent assessment at a higher level of health care by providers’ level of education (values are percentages, N = 303)
Fig. 2
Fig. 2
Summary measure of the providers’ mentioning of conditions requiring urgent assessment at a higher level of health care (values are percentages, N = 312)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. WHO: Recommendations on antenatal care for a positive pregnancy experience http://www.who.int/reproductivehealth/publications/anc-positive-pregnanc... Accessed 16 Apr 2017. - PubMed
    1. Campbell JC. Health consequences of intimate partner violence. Lancet. 2002;359(9314):1331–1336. doi: 10.1016/S0140-6736(02)08336-8. - DOI - PubMed
    1. Rurangirwa AA, Mogren I, Ntaganira J, Krantz G. Intimate partner violence among pregnant women in Rwanda, its associated risk factors and relationship to ANC services attendance: a population-based study. BMJ Open. 2017;7(2):e013155. doi: 10.1136/bmjopen-2016-013155. - DOI - PMC - PubMed
    1. Bauserman M, Lokangaka A, Thorsten V, Tshefu A, Goudar SS, Esamai F, Garces A, Saleem S, Pasha O, Patel A, et al. Risk factors for maternal death and trends in maternal mortality in low- and middle-income countries: a prospective longitudinal cohort analysis. Reprod Health. 2015;12(Suppl 2):S5. doi: 10.1186/1742-4755-12-S2-S5. - DOI - PMC - PubMed
    1. WHO: Maternal mortality http://www.who.int/entity/mediacentre/factsheets/fs348/en/. Accessed 16 Apr 2017.

Publication types