Quality assessment of the antenatal program for anaemia in rural Tanzania

OBJECTIVE: To assess the quality of antenatal care with respect to anaemia, a common health problem, in a developing country. DESIGN: Cross-sectional study. SETTING: Rufiji rural district, coastal Tanzania. STUDY PARTICIPANTS: Three hundred and seventy-nine consecutively enrolled pregnant women from 16 randomly selected antenatal clinics, including 10 dispensaries, four rural health centres and two hospitals. METHODS: We noted availability of infrastructure for management of anaemia, observed provider-client interaction, and interviewed women who attended antenatal clinics. An observer and health workers measured haemoglobin levels and their measurements were compared. MAIN OUTCOME MEASURES: Quality of antenatal care, anaemia in pregnancy, and maternal satisfaction. RESULTS: Half of the rural health clinics had no instrument to measure haemoglobin. The majority (58%) of pregnant women were not checked for anaemia at all, 10% were clinically examined, and 37% had haemoglobin assessed. The agreement between health workers' (using Tallqvist) and the observers' (using HemoCue) measurements of haemoglobin was poor to fair. The prevalence of anaemia (Hb < 10.5 g/dl) and severe anaemia (< 7.0 g/dl) was 58% and 6.2%, respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. CONCLUSION: Deficiencies in quality of screening, diagnostic information, and individual counselling need to be addressed before any impact of the antenatal care programme on anaemia can be expected.