Quality of antenatal care in rural Tanzania : counselling on pregnancy danger signs

Background: The high rate of antenatal care attendance in sub-Saharan Africa, should facilitate information on signs of potential pregnancy complications and advice the women on referral where indicated. The aim of this study was to assess quality of antenatal care with respect to providers’ counselling of pregnancy danger signs and adherence to referral criteria in Rufiji district, Tanzania. Methods: A cross-sectional study was conducted in 18 primary health facilities. Thirty two providers were observed providing antenatal care to 438 pregnant women. Information on counselling on pregnancy danger signs and women’s use of health facility for delivery was collected by an observer. Exit interviews were conducted to 435 women. Results: One hundred and eighty five (42%) clients were not informed of any pregnancy danger signs. The most common pregnancy danger sign informed on was vaginal bleeding 50% followed by severe headache/blurred vision 45%. Maternal Child Health Aides (MCHAs) were three times more likely to inform a client of a danger sign than nurse auxiliaries (OR=3.7; 95% CI: 2.1-6.5) while public health nurses and registered/enrolled nurses were both two times more likely to inform on danger signs (OR=2.3: 95% CI: 1.3-4.3 and OR=2.4; CI: 1.4-4.2 respectively). Among grand multiparous and primigravida below 20 years identified on exit interview, 63% and 71% had been informed of the risk factors during the during interaction with providers. Conclusion: Two out of five clients were not counselled on danger signs of obstetric complication and not advised to use referral services, despite of having a risk factor. Nurse auxiliaries were less capable of counselling clients. Supportive supervision should be made to enhance counselling of danger signs and adherence to referral indications. Nurse auxiliaries should be encouraged and given chance for further training and upgrading to improve their performance and increase human resource for health