Ten Years After the Focused ANC Guideline: Utilization Patterns and Quality of Care Provided in Jimma, Ethiopia, From User and Provider Perspectives

Background Since WHO released guidelines for Focused Antenatal Care in 2002 little focus have been on the content and quality of Antenatal Care (ANC) in low income settings. This study was conducted as a need assessment in order to guide development of a future intervention for improved ANC. We assessed the utilization and quality of ANC in health facilities in Jimma, Ethiopia. Methods 1354 mothers, who resided and gave birth in Jimma, Ethiopia, between June 2008-2009, were included in a questionnaire survey. Logistic regression was used to identify predictors of non-attendance of ANC and low satisfaction with ANC. Additionally, in-depth interviews with nine ANC attendants, four non-attendants, and two focus group discussions were conducted to understand perceptions of pregnancy and ANC. Results Eighty-three percent of pregnant women attended ANC, and 75% had four or more visits. There was no guideline for ANC and the service differed considerably between facilities. Mothers aged less than 20 years were less likely to attend ANC (OR 2, 95% CI: 1.3;3.0) than mothers aged 20-30 years. Mothers with parity four or more were less likely to attend (OR 2.3, 95% CI: 1.4;3.9) than parity 1 mothers. Mothers with no formal education were less likely to attend (OR 5.9, 95% CI: 3.7;9.6) than women with secondary or higher education. Qualitative data showed that non-attending mothers had poor social networks and little awareness of the programme. Lack of laboratory testing, health education, poor conduct of health staff, cleanliness and privacy issues were associated with lower satisfaction with the service. Conclusion Focused ANC was not fully implemented in Jimma, Ethiopia. Improvements are needed on guideline development and implementation, laboratory facilities, health education, privacy and training of health staff. Based on these findings, we suggest structured and supportive supervision from managers and scaling up priority of ANC. 1