Abstract
BACKGROUND: It is increasingly recognized that improving the quality of maternal health care delivery is of utmost importance in many countries. In Laos, the quality of antenatal care (ANC) service remains inadequate, but it has never been assessed thoroughly. This study aims to determine the ANC quality at the urban and rural public health facilities in Laos and provides suggestions to improve health education and counseling in addition to other routine care in public ANC services.
METHODS: This health-facility based, cross-sectional observation study included both health providers (n = 77) and pregnant women (n = 421) from purposively selected health facilities (n = 16). Information on the mothers' current pregnancies, previous visits and their last children was collected. The time spent for each ANC session as well as ANC services provided were recorded. Descriptive and inferential statistics were applied to analyze the data.
RESULTS: Overall performance of ANC services by health care providers was poor in both urban and rural areas. Insufficient provision of information on danger signs during pregnancy, nutrition, breast feeding and iron supplements was revealed. Generally the communication skills, behavior and attitude of health providers were very poor. Less than a quarter of pregnant women were treated with kindness and respect. Only 4% of the observed ANC session took privacy into consideration. Less than 10% of available information materials were used during each ANC session. None of the health providers in both rural and urban areas performed specific counseling. Overall mean (SD) time-spent for each ANC session was 16.21 (4.28) minutes. A positive correlation was identified between the length of working experience of health providers and their physical performance scores (adjusted R square = 0.017).
CONCLUSIONS: The overall performance of ANC services by health care providers was inadequate in both urban and rural areas. Insufficient provision of health education and poor communication skills of health care providers were revealed. Existing IEC materials were scarcely used. Taking action to improve the quality of ANC services by training and providing specific guidelines, creating dedicated rooms, and providing sufficient and effective materials for counseling are all greatly needed in public health facilities in Laos.
| Original language | English |
|---|---|
| Article number | 449 |
| Pages (from-to) | 1-12 |
| Number of pages | 12 |
| Journal | BMC Health Services Research |
| Volume | 19 |
| DOIs | |
| Publication status | Published - 4 Jul 2019 |
Funding
This study was part of a research project on the situation analysis of maternal and child health care in Lao PDR, which received ethical approval from the Ethics Committee of the University of Health Sciences, Ministry of Health, Lao PDR. We obtained written informed consent from all pregnant women and health care providers before beginning with observation. 1Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Samsenthai Street, Pearvath Village, Sisathanark District, P.O. Box: 7444, Vientiane Capital, Lao PDR. 2Athena Institute and Amsterdam Public Health Institute, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands. 3Guelph International Health Consulting, Guelph, Ontario, Canada. 4Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Microbiology Laboratory, Mahosot Hospital, Vientiane, Lao PDR. 5Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK.
Keywords
- Counseling
- Health education
- Laos
- Public ANC services
- Urban-rural areas
