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A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT

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Abstract
Objectives : To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration-intervention project for Safe Motherhood and prevention of mother-to-child transmission of HIV in Kenya. Methods : Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single-dose nevirapine (sd-NVP). Results : About half of women in rural and urban settings (52.2% and 49.2%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30% (5894/19 432) of women. By mid-2006, provision of nevirapine to HIV-positive women had increased from 32.5% and 11.7% in rural and urban clinics, to 67.0% and 74.6%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate. Conclusion : Provision of ANC services, including sd-NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence-based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.
Keywords
SINGLE-DOSE NEVIRAPINE, CHILD HIV TRANSMISSION, MATERNAL HEALTH-CARE, SUB-SAHARAN AFRICA, PREVENTION, PROGRAM, HIV, Kenya, maternal health services, prenatal care, nevirapine, IMMUNODEFICIENCY-VIRUS TRANSMISSION, IMPLEMENTATION, COUNTRIES, PARTICIPATION

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Citation

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Chicago
Delva, Wim, Elodie Yard, Stanley Lüchters, Matthew Chersich, Esther Muigai, Vicky Oyier, and Marleen Temmerman. 2010. “A Safe Motherhood Project in Kenya: Assessment of Antenatal Attendance, Service Provision and Implications for PMTCT.” Tropical Medicine & International Health 15 (5): 584–591.
APA
Delva, W., Yard, E., Lüchters, S., Chersich, M., Muigai, E., Oyier, V., & Temmerman, M. (2010). A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT. TROPICAL MEDICINE & INTERNATIONAL HEALTH, 15(5), 584–591.
Vancouver
1.
Delva W, Yard E, Lüchters S, Chersich M, Muigai E, Oyier V, et al. A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT. TROPICAL MEDICINE & INTERNATIONAL HEALTH. 2010;15(5):584–91.
MLA
Delva, Wim, Elodie Yard, Stanley Lüchters, et al. “A Safe Motherhood Project in Kenya: Assessment of Antenatal Attendance, Service Provision and Implications for PMTCT.” TROPICAL MEDICINE & INTERNATIONAL HEALTH 15.5 (2010): 584–591. Print.
@article{939640,
  abstract     = {Objectives : To investigate uptake and provision of antenatal care (ANC) services in the Uzazi Bora project: a demonstration-intervention project for Safe Motherhood and prevention of mother-to-child transmission of HIV in Kenya.
Methods : Data were extracted from antenatal clinic, laboratory and maternity ward registers of all pregnant women attending ANC from January 2004 until September 2006 at three antenatal clinics in Mombasa and two in rural Kwale district of Coast Province, Kenya (n = 25 364). Multiple logistic and proportional odds logistic regression analyses assessed changes over time, and determinants of the frequency and timing of ANC visits, uptake of HIV testing, and provision of iron sulphate, folate and single-dose nevirapine (sd-NVP).
Results : About half of women in rural and urban settings (52.2\% and 49.2\%, respectively) attended antenatal clinics only once. Lower parity, urban setting, older age and having received iron sulphate and folate supplements during the first ANC visit were independent predictors of more frequent visits. The first ANC visit occurred after 28 weeks of pregnancy for 30\% (5894/19 432) of women. By mid-2006, provision of nevirapine to HIV-positive women had increased from 32.5\% and 11.7\% in rural and urban clinics, to 67.0\% and 74.6\%, respectively. Equally marked improvements were observed in the uptake of HIV testing and the provision of iron sulphate and folate.
Conclusion : Provision of ANC services, including sd-NVP, increased markedly over time. While further improvements in quality are necessary, particular attention is needed to implement evidence-based interventions to alter ANC utilization patterns. Encouragingly, improved provision of basic essential obstetric care may increase attendance.},
  author       = {Delva, Wim and Yard, Elodie and L{\"u}chters, Stanley and Chersich, Matthew and Muigai, Esther and Oyier, Vicky and Temmerman, Marleen},
  issn         = {1360-2276},
  journal      = {TROPICAL MEDICINE \& INTERNATIONAL HEALTH},
  keyword      = {SINGLE-DOSE NEVIRAPINE,CHILD HIV TRANSMISSION,MATERNAL HEALTH-CARE,SUB-SAHARAN AFRICA,PREVENTION,PROGRAM,HIV,Kenya,maternal health services,prenatal care,nevirapine,IMMUNODEFICIENCY-VIRUS TRANSMISSION,IMPLEMENTATION,COUNTRIES,PARTICIPATION},
  language     = {eng},
  number       = {5},
  pages        = {584--591},
  title        = {A Safe Motherhood project in Kenya: assessment of antenatal attendance, service provision and implications for PMTCT},
  url          = {http://dx.doi.org/10.1111/j.1365-3156.2010.02499.x},
  volume       = {15},
  year         = {2010},
}

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