Are multidisciplinary consultation meetings for prenatal diagnosis achievable in a low-income country? A descriptive cross-sectional survey in Benin

Objective

The multidisciplinary antenatal diagnosis staff bring together practitioners who are involved in the management of the antenatal period at birth. This project was designed following the French experience to institute multidisciplinary consultation meetings for prenatal diagnosis (MCMPD) in Benin.

Methods

This is a descriptive cross-sectional study examining the knowledge, attitudes, and practices of Beninese practitioners in the field of MCMPD to develop the pilot phase of the project.

Results

We collected 108 participants from different specialties. Pediatricians and pediatric surgeons were in the majority at 23.9% and 16.5%, respectively. Sixty-seven percent of participants were from the public sector (n=75). One practitioner felt that it was not a good idea to implement these meetings. Almost all staff (96.2%) agreed that this meeting would have a positive impact on reducing neonatal mortality. Omphalocele (58.5%), spina bifida aperta (43.6%), and gastroschisis (34%) were the most commonly diagnosed antenatal conditions in Benin. No neonatal pathology required medical termination of the pregnancy according to 35.6% of the participants.

Conclusions

The objective of reducing infant mortality due to medical and surgical pathologies is a noble one and deserves to be supported. This innovative project, developed through this study, the first of its kind in the subregion, will contribute inexorably to the achievement of the third Goal Sustainable Development.

Input, process, and output factors contributing to quality of antenatal care services: a scoping review of evidence

BACKGROUND

High-quality antenatal care (ANC) provides a lifesaving opportunity for women and their newborns through providing health promotion, disease prevention, and early diagnosis and treatment of pregnancy-related health issues. However, systematically synthesised evidence on factors influencing the quality of ANC services is lacking. This scoping review aims to systematically synthesize the factors influencing in provision and utilisation of quality ANC services.

METHODS

We conducted a scoping review of published evidence on the quality of ANC services. We searched records on four databases (PubMed, Scopus, Embase, and Google scholar) and grey literature from 1 to 2011 to 30 August 2021. We analysed data using Braun and Clarke's thematic analysis approach. We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guideline for the review. We explained themes using the Donabedian healthcare quality assessment model (input-process-output).

RESULTS

Several inputs- and process-related factors contributed to suboptimal quality of ANC in many low and lower- or middle-income countries. Input factors included facility readiness (e.g., lack of infrastructure, provision of commodities and supplies, health workforce, structural and intermediary characteristics of pregnant women, and service delivery approaches). Processes-related factors included technical quality of care (e.g., lack of skilled adequate and timely care, and poor adherence to the guidelines) and social quality (lack of effective communication and poor client satisfaction). These input and process factors have also contributed to equity gaps in utilisation of quality ANC services.

CONCLUSION

Several input and process factors influenced the provision and utilization of optimum quality ANC services. Better health system inputs (e.g., availability of trained workforces, commodities, guidelines, context-specific programs) are essential to creating enabling facility environment for quality ANC services. Care processes can be improved by ensuring capacity-building activities for workforces (training, technical support visits), and mentoring staff working at peripheral facilities. Identifying coverage of quality ANC services among disadvantaged groups could be the initial step in designing and implementing targeted program approaches.

What happens during antenatal visits? An ethnographic study of pregnant women's experiences with midwives in Benin

Pregnancy and childbirth place women at risk of morbidity and mortality, particularly in Benin where the health system is fragile. This study aimed to understand women's experiences concerning their interactions with midwives during antenatal visits and to explore contextual factors influencing these interactions and the quality of care received. A qualitative study was conducted from June to August 2015 in two primary health facilities in So-Ava, Benin. One hundred seven individual in-depth interviews with 100 pregnant women, five midwives, and two physicians and one focus group discussion with seven government decision-makers were conducted. Despite midwives' good intentions, most pregnant women reported absenteeism, delays, cold attitudes, fear-based communication, and arbitrary and non-consensual interventions during antenatal visits and believed midwives would interfere with their family relationships. The suboptimal quality of care provided by midwives was interpreted as due to several factors, including lack of accountability of midwives in health facilities. The communication of midwives with pregnant women needs improvement. Results of this study highlight the importance of understanding the problem from the perspective of the political economy of the Benin health system to address its structural and systemic failures with open dialogue, including implementation of accountability measures.

[Evaluation of Maternal and Neonatal Health Services sein Guinea-Conakry and Togo.]

INTRODUCTION

The quality of mother and child healthcare remains a challenge for low and middle income countries. Quality interventions that allow a reduction of maternal and infantile mortality require the services of qualified personnel. The objective of this study is to present the results of analysis of the status of human healthcare resources and the quality of healthcare (technical, interpersonal, organisational) they provide to mothers and neonates in Guinea and Togo.

METHODS

Data were derived from Guinea and Togo case studies with embedded levels of analysis. Participants were: maternal and neonatal health care resources (MNCHR), health care beneficiaries, community members. Data collection methods comprised: observations of MNHCR clinical practice; interviews (beneficiaries, health care establishment and educational institution personnel); and focus groups (men, women, community leaders, students). Analysis consisted of qualitative analysis of the content of interviews and focus groups and quantitative analysis of quality scores.

RESULTS

The observations revealed a low level of health care quality for all criteria. Non-technical quality varied according to: the health establishment and level of experience, the MNHCR qualifications, specialisation and basic training. Geographic and financial accessibility, maternal and neonatal health care personnel capacities, continuity and extent of their services are unsatisfactory.

CONCLUSION

Recommendations target the establishment of public policies to reinforce MNHCR capacities, standard to define their practice, and organisation and work environment. Conclusions could be used as benchmarks for other countries from Sub-Saharan Africa.