Cent Afr J Med. 1999 Nov; 45(11): 294-9.

Antenatal care patterns and factors associated with perinatal outcome in two rural districts in Zimbabwe.

Kambarami RA, Chirenje MZ, Rusakaniko S.

Department of Paediatrics and Child Health, Medical School, Avondale, Harare, Zimbabwe.

OBJECTIVE: To study antenatal care (ANC) patterns, to identify factors associated with poor perinatal outcome and quality of ANC. DESIGN: Cross sectional community based survey. SETTING: Murewa and Madziwa rural Districts. SUBJECTS: 644 women aged between 15 to 50 years who had been pregnant in the immediate 24 months preceding the survey. MAIN OUTCOME MEASURES: Perinatal outcome, ANC attendance, distance from health centre, ability to pay for ANC, gestation at first booking, frequency of ANC visits, use of herbs in pregnancy, pregnancy related morbidity and quality of ANC. RESULTS: A total of 644 women were interviewed. Overall perinatal mortality was 115 per 1,000 births. 511/644 (79.3%) visited a health centre for ANC. The woman herself (41.8%) as well as husbands (41.8%) were commonly the decision makers regarding starting ANC. Only 298/510 (58.4%) of women used primary health care facilities for ANC. 211/629 (35.1%) of women lived more than 5 kms from the health care centre. 153/629 (24.3%) were not able to pay for ANC. Only 110/509 (21.6%) started ANC in the first trimester. 307/495 (62.0%) made five or less ANC visits. Pregnancy related morbidity was high 209/644 (32.5%) and use of traditional herbs was common 158/644 (24.%). There were significant differences between districts as far as perinatal outcome, ANC attendance, distance from health centre, ability to pay for ANC, gestation at first booking, frequency of ANC visits, use of herbs in pregnancy, pregnancy related morbidity and quality of care all having p values of 0.001 or less. On further analysis using logistic regression, having problems with pregnancy and vaginal bleeding were significant predictors of poor perinatal outcome with odds ratio (95% CI) of 2.8 (1.4 to 5.9) and 3.0 (1.1 to 8.6) respectively. Quality of ANC was rated as sub-optimal. CONCLUSION: Majority of rural women attended clinics for ANC. Perinatal mortality rate and pregnancy related morbidity were high. Vaginal bleeding was the strongest predictor for mortality. There is need to improve quality of antenatal care as this was found to be suboptimal. More objective oriented antenatal care visits and waiting mother's shelters form part of the solutions. Further studies are called for.