Majrooh Muhammad Ashraf, Hasnain Seema, Akram Javaid, Siddiqui Arif, Memon Zahid Ali
Allama Iqbal Medical College, Lahore, Pakistan.
Population Survives International - Greenstar, Karachi, Pakistan.
PLoS One. 2014 Nov 19;9(11):e113390. doi: 10.1371/journal.pone.0113390. eCollection 2014.
Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In 'Pakistan' antenatal services to rural population are being provided through a network of primary health care facilities designated as 'Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to 'Divisions' and 'Districts'. By population 'Punjab' is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in 'Punjab' province of 'Pakistan'.
Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers.
The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage.
The coverage and quality of the antenatal care services in 'Punjab' are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.
产前保健是孕产妇保健服务的一个非常重要的组成部分。它提供了了解与怀孕相关风险的机会，并指导规划分娩地点，从而预防母婴发病和死亡。在巴基斯坦，通过被指定为“基本卫生单位和农村卫生中心”的初级卫生保健设施网络为农村人口提供产前服务。巴基斯坦是一个发展中国家，由四个省和联邦直辖地区组成。每个省在行政上又细分为“专区”和“县”。按人口计算，旁遮普省是巴基斯坦最大的省份，有36个县。本研究旨在评估巴基斯坦旁遮普省初级卫生保健设施中产前保健的覆盖范围和质量。
采用定量和定性方法收集数据。使用多阶段抽样技术，从36个县中选出9个县，并从每个县随机选择19个公共部门的初级卫生保健设施（17个基本卫生单位和2个农村卫生中心）。对服务对象、提供者和卫生管理人员进行了焦点小组讨论和深入访谈。
产前检查的总体登记率为55.9%，后续就诊时的退出率为32.9%。在评估、治疗和咨询方面的服务质量极差。覆盖范围和质量低的原因是设施位置偏远、设施资源不足、工作人员态度冷漠且无法提供服务。此外，服务对象对产前保健重要性的认识不足以及缺乏自我赋权以做出寻求保健的决策，也是覆盖范围低的原因。
旁遮普省产前保健服务的覆盖范围和质量受到极大损害。只有一半的预期怀孕者登记，其中三分之一在后续就诊时退出。
