Objectives Providing counseling on danger signs of pregnancy complications as part of visits for antenatal care (ANC) can raise expecting women’s awareness so that if danger signs occur they can seek assistance in time. The study examines the level of agreement in counseling on danger signs between observation of the provider during the ANC visit and the client’s report in the exit interview, and the association of this agreement with the client’s level of knowledge on danger signs. Methods The analysis used data from service provision and assessment (SPA) surveys in Haiti, Malawi, and Senegal. Agreement between the observation and client’s report was measured by Cohen’s kappa and percent agreement. Regressions were performed on the number of danger signs the client knew, with the level of agreement on the counseling on danger signs as the main independent variable. Results The study found little agreement between the observation of counseling and the client’s report that the counseling occurred, despite the fact that the exit interview with the client was performed immediately following the ANC visit with the provider. The level of positive agreement between observation and client’s report was 17% in Haiti, 33% in Malawi, and 23% in Senegal. Clients’ overall knowledge of danger signs was low; in all three countries the mean number of danger signs known was 1.5 or less. The regression analysis found that, in order to show a significant increase in knowledge of danger signs, it was important for the client to report that it took place. Conclusions Ideally, there should be 100% positive agreement that counseling occurred. To achieve this level requires raising both the level of counseling on danger signs of pregnancy complications and its quality. While challenges exist, providing counseling that is more client-centered and focuses on the client’s needs could improve quality and thus could increase the client’s knowledge of danger signs.
Adam, T., Amorim, D. G., Edwards, S. J., Amaral, J., & Evans, D. B. (2005). Capacity constraints to the adoption of new interventions: Consultation time and the Integrated Management of Childhood Illness in Brazil. Health policy and planning, 20(suppl 1), i49–i57. CrossRef
Agence Nationale de la Statistique et de la Démographie - ANSD/Sénégal, & ICF International. (2015). Sénégal Enquête Continue sur la Prestation des Services de Soins de Santé ( ECPSS) 2014. Retrieved from Rockville, Maryland, USA: http://dhsprogram.com/pubs/pdf/SPA21/SPA21.pdf.
Ahmad, M. O., Sughra, U., Kalsoom, U., Imran, M., & Hadi, U. (2012). Effect of antenatal counselling on exclusive breastfeeding. Journal of Ayub Medical College Abbottabad, 24(2), 116–119.
Ali, A. A., Rayis, D. A., Abaker, A. O., & Adam, I. (2010). Awareness of danger signs and nutritional education among pregnant women in Kassala, Eastern Sudan. Sudanese Journal of Public Health, 5(4), 179–181.
Anya, S. E., Hydara, A., & Jaiteh, L. E. (2008). Antenatal care in The Gambia: Missed opportunity for information, education and communication. BMC pregnancy and childbirth, 8(9), 1–7.
Assaf, S., Wang, W., & Mallick, L. (2016). Provider counseling and knowledge transfer in health facilities of Haiti, Malawi, and Senegal. Retrieved from Rockville, Maryland, USA: http://dhsprogram.com/pubs/pdf/AS60/AS60.pdf.
Baqui, A. H., Williams, E. K., Darmstadt, G. L., Kumar, V., Kiran, T. U., Panwar, D., et al. (2007). Newborn care in rural Uttar Pradesh. The Indian Journal of Pediatrics, 74(3), 241–247. CrossRef
Bessinger, R. E., & Bertrand, J. T. (2001). Monitoring quality of care in family planning programs: A comparison of observations and client exit interviews. Int Fam Plan Perspect, 27(2), 63–70. CrossRef
Bruce, J. (1990). Fundamental elements of the quality of care: A simple framework. Studies in family planning, 21(2), 61–91. CrossRef
Chewning, B., & Sleath, B. (1996). Medication decision-making and management: A client-centered model. Social Science & Medicine, 42(3), 389–398. CrossRef
Clift, E. (2001). Information education and communication: lessons from the past; perspectives for the future. Retrieved from Geneva.
Donabedian, A. (1988). The quality of care: How can it be assessed? The Journal of the American Medical Association, 260(12), 1743–1748. CrossRef
Duffield, C., Diers, D., O’Brien-Pallas, L., Aisbett, C., Roche, M., King, M., & Aisbett, K. (2011). Nursing staffing, nursing workload, the work environment and patient outcomes. Applied Nursing Research, 24(4), 244–255. CrossRef
Dunlop, A. L., Logue, K. M., Thorne, C., & Badal, H. J. (2013). Change in women’s knowledge of general and personal preconception health risks following targeted brief counseling in publicly funded primary care settings. American Journal of Health Promotion, 27(sp3), S50–S57. CrossRef
Duysburgh, E., Ye, M., Williams, A., Massawe, S., Sie, A., Williams, J., Mpembeni, R., Lukanova, S., & Temmerman, M. (2013). Counselling on and women’s awareness of pregnancy danger signs in selected rural health facilities in Burkina Faso, Ghana and Tanzania. Tropical Medicine & International Health, 18(12), 1498–1509. CrossRef
Hutchinson, P. L., Do, M., & Agha, S. (2011). Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana. BMC health services research, 11(1), 203. CrossRef
Igumbor, J., Davids, A., Nieuwoudt, C., Lee, J., & Roomaney, R. (2016). Assessment of activities performed by clinical nurse practitioners and implications for staffing and patient care at primary health care level in South Africa. curationis, 39(1), 1–8. CrossRef
Institut Haïtien de l’Enfance - IHE, & ICF International. (2014). Haïti Évaluation de la Prestation des Services de Soins de Santé 2013. Retrieved from Rockville, Maryland, USA: http://dhsprogram.com/pubs/pdf/SPA19/SPA19.pdf.
Jennings, L., Yebadokpo, A. S., Affo, J., & Agbogbe, M. (2010). Antenatal counseling in maternal and newborn care: Use of job aids to improve health worker performance and maternal understanding in Benin. BMC pregnancy and childbirth, 10(75), 1–13.
Kabakyenga, J. K., Ostergren, P., Turyakira, E., & Pettersson, K. O. (2011). Knowledge of obstetric danger signs and birth preparedness practices among women in rural Uganda. Reproductive Health, 8(33), 1–10.
Khan, K. S., Wojdyla, D., Say, L., Gülmezoglu, A. M., & Van Look, P. F. (2006). WHO analysis of causes of maternal death: A systematic review. The lancet, 367(9516), 1066–1074. CrossRef
Magoma, M., Requejo, J., Merialdi, M., Campbell, O. M., Cousens, S., & Filippi, V. (2011). How much time is available for antenatal care consultations? Assessment of the quality of care in rural Tanzania. BMC pregnancy and childbirth, 11(64), 1–9.
Mbalinda, S. N., Nakimuli, A., Kakaire, O., Osinde, M. O., Kakande, N., & Kaye, D. K. (2014). Does knowledge of danger signs of pregnancy predict birth preparedness? A critique of the evidence from women admitted with pregnancy complications. Health Research Policy and Systems, 12(1), 60. CrossRef
McHugh, M. L. (2012). Interrater reliability: the kappa statistic. Biochemia medica, 22(3), 276–282. CrossRef
Ministry of Health - MoH/Malawi, & ICF International. (2014). Malawi Service Provision Assessment 2013- 14. Retrieved from Lilongwe, Malawi: http://dhsprogram.com/pubs/pdf/SPA20/SPA20.pdf.
Mpembeni, R. N., Killewo, J. Z., Leshabari, M. T., Massawe, S. N., Jahn, A., Mushi, D., & Mwakipa, H. (2007). Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: Implications for achievement of MDG-5 targets. BMC pregnancy and childbirth, 7(1), 29. CrossRef
Mutiso, S. M., Qureshi, Z., & Kinuthia, J. (2008). Birth preparedness among antenatal clients. East African Medical Journal, 85(6), 275–283. CrossRef
Nikiéma, B., Beninguisse, G., & Haggerty, J. L. (2009). Providing information on pregnancy complications during antenatal visits: Unmet educational needs in sub-Saharan Africa. Health policy and planning, 24(5), 367–376. CrossRef
Perreira, K. M., Bailey, P. E., de Bocaletti, E., Hurtado, E., de Villagrán, S. R., & Matute, J. (2002). Increasing awareness of danger signs in pregnancy through community-and clinic-based education in Guatemala. Maternal and child health journal, 6(1), 19–28. CrossRef
Ronsmans, C., & Graham, W. J. & The Lancet Maternal Survival Series steering Group, Lancet Maternal Survival Series Steering. (2006). Maternal mortality: Who, when, where, and why. The Lancet, 368(9542), 1189–1200. CrossRef
Roter, D. (2000). The enduring and evolving nature of the patient–physician relationship. Patient Education and Counseling, 39(1), 5–15. CrossRef
Tumlinson, K., Speizer, I. S., Curtis, S. L., & Pence, B. W. (2014). Accuracy of standard measures of family planning service quality: Findings from the simulated client method. Studies in family planning, 45(4), 443–470. https://doi.org/10.1111/j.1728-4465.2014.00007.x. CrossRefPubMedPubMedCentral
Vickers, K. S., Kircher, K. J., Smith, M. D., Petersen, L. R., & Rasmussen, N. H. (2007). Health behavior counseling in primary care: Provider-reported rate and confidence. Family Medicine, 39(10), 730–735. PubMed
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363. PubMed
von Both, C., Fleβa, S., Makuwani, A., Mpembeni, R., & Jahn, A. (2006). How much time do health services spend on antenatal care? Implications for the introduction of the focused antenatal care model in Tanzania. BMC pregnancy and childbirth, 6(22), 1–9.
World Health Organization. (2006). World Health Report 2006: Working together for health. Geneva: World Health Organization. CrossRef
- Counseling and Knowledge of Danger Signs of Pregnancy Complications in Haiti, Malawi, and Senegal
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