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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2016

Open Access 01-12-2016 | Research article

Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study

Authors: Mary Amoakoh-Coleman, Kerstin Klipstein-Grobusch, Irene Akua Agyepong, Gbenga A. Kayode, Diederick E. Grobbee, Evelyn K. Ansah

Published in: BMC Pregnancy and Childbirth | Issue 1/2016

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Abstract

Background

Guideline utilization aims at improvement in quality of care and better health outcomes. The objective of the current study was to determine the effect of provider complete adherence to the first antenatal care guidelines on the risk of maternal and neonatal complications in a low resource setting.

Methods

Women delivering in 11 health facilities in the Greater Accra region of Ghana were recruited into a cohort study. Their first antenatal visit records were reviewed to assess providers’ adherence to the guidelines, using a thirteen-point checklist. Information on their socio-demographic characteristics and previous pregnancy history was collected. Participants were followed up for 6 weeks post-partum to complete data collection on outcomes. The incidence of maternal and neonatal complications was estimated. The effects of complete adherence on risk of maternal and neonatal complications were estimated and expressed as relative risks (RRs) with their 95% confidence intervals (CI) adjusted for a potential clustering effect of health facilities.

Results

Overall, 926 women were followed up to 6 weeks post-partum. Mean age (SD) of participants was 28.2 (5.4) years. Complete adherence to guidelines pertained to the care of 48.5% of women. Incidence of preterm deliveries, low birth weight, stillbirths and neonatal mortality were 5.3, 6.1, 0.4 and 1.4% respectively. Complete adherence to the guidelines decreased risk of any neonatal complication [0.72 (0.65–0.93); p = 0.01] and delivery complication [0.66 (0.44–0.99), p = 0.04].

Conclusion

Complete provider adherence to antenatal care guidelines at first antenatal visit influences delivery and neonatal outcomes. While there is the need to explore and understand explanatory mechanisms for these observations, programs that promote complete adherence to guidelines will improve the pregnancy outcomes.
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Literature
1.
The World Bank - IBRD-IDA. Millennium Development Goals (Goal 5). 2016. Ref Type: Online Source. Accessed 6 Nov 2016.
2.
Campbell OM, Graham WJ. Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006;368:1284–99.CrossRefPubMed
3.
Ministry of Health (MoH) GoGaUNCTitRoG. Ghana MDG acceleration fremawork and country action plan, maternal health. 2011. Ref Type: Repor. Accessed 8 Nov 2011.
4.
Edmond KM, Zandoh C, Quigley MA, Amenga-Etego S, Owusu-Agyei S, Kirkwood BR. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics. 2006;117:e380–6.CrossRefPubMed
5.
6.
Pell C, Menaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, et al. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One. 2013;8:e53747.CrossRefPubMedPubMedCentral
7.
WHO. Opportunities for Africa’s newborns: Antenatal Care. 2013. Ref Type: Online Source.
8.
Komajda M, Lapuerta P, Hermans N, Gonzalez-Juanatey JR, van Veldhuisen DJ, Erdmann E, et al. Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J. 2005;26:1653–9.CrossRefPubMed
9.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.CrossRefPubMed
10.
Folbert EC, Smit RS, van der Velde D, Regtuijt EM, Klaren MH, Hegeman JH. Geriatric fracture center: a multidisciplinary treatment approach for older patients with a hip fracture improved quality of clinical care and short-term treatment outcomes. Geriatr Orthop Surg Rehabil. 2012;3:59–67.CrossRefPubMedPubMedCentral
11.
Wells K, Sherbourne C, Schoenbaum M, Ettner S, Duan N, Miranda J, et al. Five-year impact of quality improvement for depression: results of a group-level randomized controlled trial. Arch Gen Psychiatry. 2004;61:378–86.CrossRefPubMed
12.
Wells KB, Sherbourne C, Schoenbaum M, Duan N, Meredith L, Unutzer J, et al. Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. JAMA. 2000;283:212–20.CrossRefPubMed
13.
Abrams JA, Kapel RC, Lindberg GM, Saboorian MH, Genta RM, Neugut AI, et al. Adherence to biopsy guidelines for Barrett’s esophagus surveillance in the community setting in the United States. Clin Gastroenterol Hepatol. 2009;7:736–42.CrossRefPubMedPubMedCentral
14.
Adams AS, Soumerai SB, Lomas J, Ross-Degnan D. Evidence of self-report bias in assessing adherence to guidelines. Int J Qual Health Care. 1999;11:187–92.CrossRefPubMed
15.
Laye MR, Dellinger EH. Timing of scheduled cesarean delivery in patients on a teaching versus private service: adherence to American College of Obstetricians and Gynecologists guidelines and neonatal outcomes. Am J Obstet Gynecol. 2006;195:577–82.CrossRefPubMed
16.
Thudi K, Yadav D, Sweeney K, Behari J. Physicians infrequently adhere to hepatitis vaccination guidelines for chronic liver disease. PLoS One. 2013;8:e71124.CrossRefPubMedPubMedCentral
17.
Fritz JM, Cleland JA, Brennan GP. Does adherence to the guideline recommendation for active treatments improve the quality of care for patients with acute low back pain delivered by physical therapists? Med Care. 2007;45:973–80.CrossRefPubMed
18.
Giorda C, Picariello R, Nada E, Tartaglino B, Marafetti L, Costa G, et al. The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes. PLoS One. 2012;7:e33839.CrossRefPubMedPubMedCentral
19.
Johnstone J, Mandell L. Guidelines and quality measures: do they improve outcomes of patients with community-acquired pneumonia? Infect Dis Clin North Am. 2013;27:71–86.CrossRefPubMed
20.
Rice TW, Morris S, Tortella BJ, Wheeler AP, Christensen MC. Deviations from evidence-based clinical management guidelines increase mortality in critically injured trauma patients*. Crit Care Med. 2012;40:778–86.CrossRefPubMed
21.
Sales AE, Tipton EF, Levine DA, Houston TK, Kim Y, Allison J, et al. Are co-morbidities associated with guideline adherence? The MI-Plus study of Medicare patients. J Gen Intern Med. 2009;24:1205–10.CrossRefPubMedPubMedCentral
22.
Lugtenberg M, Burgers JS, Westert GP. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Health Care. 2009;18:385–92.CrossRefPubMed
23.
Okelo SO, Butz AM, Sharma R, Diette GB, Pitts SI, King TM, et al. Interventions To Modify Health Care Provider Adherence to Asthma Guidelines. Comp Eff Rev. 2013;132:517–34.
24.
Vause J. Adherence to evidence-based guidelines is the key to improved health outcomes for general practice patients: YES. J Prim Health Care. 2012;4:156–8.PubMed
25.
Sukums F, Mensah N, Mpembeni R, Massawe S, Duysburgh E, Williams A, et al. Promising adoption of an electronic clinical decision support system for antenatal and intrapartum care in rural primary healthcare facilities in sub-Saharan Africa: The QUALMAT experience. Int J Med Inform. 2015;84(9):647–57.CrossRefPubMed
26.
Velding K, Klis SA, Abass KM, Tuah W, Stienstra Y, van der Werf T. Wound Care in Buruli Ulcer Disease in Ghana and Benin. Am J Trop Med Hyg. 2014;91:313–8.CrossRefPubMedPubMedCentral
27.
Chinbuah MA, Abbey M, Kager PA, Gyapong M, Nonvignon J, Ashitey P, et al. Assessment of the adherence of community health workers to dosing and referral guidelines for the management of fever in children under 5 years: a study in Dangme West District, Ghana. Int Health. 2013;5:148–56.CrossRefPubMed
28.
McKinlay JB, Link CL, Freund KM, Marceau LD, O’Donnell AB, Lutfey KL. Sources of variation in physician adherence with clinical guidelines: results from a factorial experiment. J Gen Intern Med. 2007;22:289–96.CrossRefPubMedPubMedCentral
29.
30.
WHO, UNFPA, UNICEF, World Bank. Pregnancy, Childbirth, Postpartum and Newborn Care: A guide for Essential Practice. Geneva: World Health Organization; 2006.
31.
Cuspidi C, Michev I, Lonati L, Vaccarella A, Cristofari M, Garavelli G, et al. Compliance to hypertension guidelines in clinical practice: a multicentre pilot study in Italy. J Hum Hypertens. 2002;16:699–703.CrossRefPubMed
32.
Advani A, Shahar Y, Musen MA: Medical quality assessment by scoring adherence to guideline intentions. Proc AMIA Symp 2001, 2–6
33.
Van FE, Van Der Wee NJ, Bauer M, Witte CJ, Zitman FG. Assessing adherence to guidelines for common mental disorders in routine clinical practice. Int J Qual Health Care. 2012;24:72–9.CrossRef
34.
Amoakoh-Coleman M, Agyepong IA, Zuithoff NPA, Kayode GA, Grobbee DE, Klipstein-Grobusch K, et al. Client Factors Affect Provider Adherence to Clinical Guidelines during First Antenatal Care. PLoS One. 2016;11:e0157542.CrossRefPubMedPubMedCentral
35.
Neupane S, Nwaru B. Impact of Prenatal Care Utilization on Infant Care Practices in Nepal: a National Representative Cross-sectional Survey. Eur J Pediatr. 2014;173:99–109.CrossRefPubMed
36.
Burstin HR, Conn AF, Setnik GF, Rucker DW FAU, Cleary PD FAU, O'Neil AC, FAU, et al. Benchmarking and quality improvement: the Harvard Emergency Department Quality Study. Am J Med. 1999;107(5):437-49.
37.
Grilli R, Lomas J. Evaluating the Message: The Relationship between Compliance Rate and the Subject of a Practice Guideline. Med Care. 1994;32:202–13.CrossRefPubMed
38.
39.
Baker U, Tomson G, Som M, Kouyat B, Williams J, Mpembeni R, et al. ‘How to know what you need to do’: a cross-country comparison of maternal health guidelines in Burkina Faso, Ghana and Tanzania. Implement Sci. 2012;7:31.CrossRefPubMedPubMedCentral
40.
41.
Duysburgh E, Williams A, Williams J, Loukanova S, Temmerman M. Quality of antenatal and childbirth care in northern Ghana. BJOG. 2014;121:117–26.CrossRefPubMed
42.
Lomas J, Anderson GM, Domnick-Pierre K, Vayda E, Enkin MW, Hannah WJ. Do Practice Guidelines Guide Practice? N Engl J Med. 1989;321:1306–11.CrossRefPubMed
43.
Steinman MA, Fischer MA, Shlipak MG, Bosworth HB, Oddone EZ, Hoffman BB, et al. Clinician awareness of adherence to hypertension guidelines. Am J Med. 2004;117:747–54.CrossRefPubMed
44.
Cheung A, Weir M, Mayhew A, Kozloff N, Brown K, Grimshaw J. Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior. Syst Rev. 2012;1:36.CrossRefPubMedPubMedCentral
45.
Goldstein MK, Lavori PF, Coleman RF, Advani AF, Hoffman BB. Improving adherence to guidelines for hypertension drug prescribing: cluster-randomized controlled trial of general versus patient-specific recommendations. Am J Manag Care. 2005;11(11):677–85.PubMed
46.
Grimshaw JM, Eccles MP, Walker AE, Thomas RE. Changing physicians’ behavior: What works and thoughts on getting more things to work. J Contin Educ Health Prof. 2002;22:237–43.CrossRefPubMed
47.
Young P, Hamilton R, Hodgett S, Moss M, Rigby C, Jones P, et al. Reducing risk by improving standards of intrapartum fetal care. J R Soc Med. 2001;94:226–31.PubMedPubMedCentral
48.
Kardong-Edgren S. Using Evidence-Based Practice to Improve Intrapartum Care. J Obstet Gynecol Neonatal Nurs. 2001;30:371–5.CrossRefPubMed
49.
Degley J. Assessing The Quality Of Antenatal Care Services In The Nkwanta South District, Volta Region, Ghana. Accra: University of Ghana, Legon, Ghana; 2012.
50.
WHO. Standards for Maternal and Neonatal care: Provision of effective antenatal care. 2013. p. 7-7-2014. Ref Type: Online Source.
51.
Belayneh T, Adefris M, Andargie G. Previous Early Antenatal Service Utilization Improves Timely Booking: Cross-Sectional Study at University of Gondar Hospital, Northwest Ethiopia. J Pregnancy. 2014;2014:132494.CrossRefPubMedPubMedCentral
52.
53.
Haddrill R, Jones GL, Mitchell CA, Anumba DO. Understanding delayed access to antenatal care: a qualitative interview study. BMC Pregnancy Childbirth. 2014;14:207.CrossRefPubMedPubMedCentral
54.
Ifenne DI, Utoo BT. Gestational age at booking for antenatal care in a tertiary health facility in north-central, Nigeria. Niger Med J. 2012;53:236–9.CrossRefPubMedPubMedCentral
55.
56.
Asamoah BO, Moussa KM, Stafström M, Musinguzi G. Distribution of causes of maternal mortality among different socio-demographic groups in Ghana; a descriptive study. BMC Public Health. 2011;11:159.CrossRefPubMedPubMedCentral
57.
Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15:1–42.CrossRefPubMed
58.
Pell C, Meñaca A, Chatio S, Hodgson A, Tagbor H, Pool R. The acceptability of intermittent screening and treatment versus intermittent preventive treatment during pregnancy: results from a qualitative study in Northern Ghana. Malar J. 2014;13:432.CrossRefPubMedPubMedCentral
59.
Stephens JK, Ofori MF, Quakyi IA, Wilson ML, Akanmori BD. Prevalence of peripheral blood parasitaemia, anaemia and low birthweight among pregnant women in a suburban area in coastal Ghana. Pan Afr Med J. 2014;17:3.CrossRefPubMedPubMedCentral
60.
61.
WHO: Luz Gibbons JMBJALAPBMMaFA. The global numbers and costs of additionally needed and unnecessary caesarean sections performed per year: overuse as a barrier to universal coverage: World Health Report; 2010. Ref Type: Report. Accessed 23 Oct 2013.
62.
Jasovic-Siveska E, Jasovic VF, Stoilova S. Previous pregnancy history, parity, maternal age and risk of pregnancy induced hypertension.
63.
Whitley E, Doyle P, Roman E, De Stavola B. The effect of reproductive history on future pregnancy outcomes. Hum Reprod. 1999;14:2863–7.CrossRefPubMed
64.
Mamaye! (Derick Adogla). Ghana: 1,012 Institutional Maternal Deaths recorded in 2013. 2014. Ref Type: Online Source. http://​www.​mamaye.​org/​en/​blog/​ghana-1012-institutional-maternal-deaths-recorded-2013.​ Accessed 9 July 2015.
65.
66.
Institute for Health Metrics and Evaluation (IHME). Maternal Mortality Estimates and MDG 5 Attainment by Country 1990–2011. Seattle: Institue for Health Metrics and Evaluation (IHME); 2011. Ref Type: Report.
Metadata
Title
Provider adherence to first antenatal care guidelines and risk of pregnancy complications in public sector facilities: a Ghanaian cohort study
Authors
Mary Amoakoh-Coleman
Kerstin Klipstein-Grobusch
Irene Akua Agyepong
Gbenga A. Kayode
Diederick E. Grobbee
Evelyn K. Ansah
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2016
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-016-1167-6

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