Quality of Antenatal Care in Colombia. Evaluation of Clinical Records in 20 Provinces and Three Districts, 2009-2011

Session: Quality of Antenatal Care in Colombia. Evaluation of Clinical Records in 20 Provinces and Three Districts, 2009-2011

Presenter: Pablo Montoya, Sinergias Alianzas Estratégicas para la Salud y el Desarrollo Social
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Background: Despite more than 90% of antenatal care (ANC) visits and deliveries in Colombia are attended by physicians, maternal mortality and mother-to-child transmission of HIV remain far from MDG targets. At least 60% of child mortality in the country is neonatal. Timely and quality obstetric care can prevent deaths and HIV infections.

Methodology: Between 03/2011-02/2012 we conducted a descriptive, retrospective study reviewing 2,651 obstetric clinical records (CR), from 142 municipalities in 20 of the 32 Colombian departments, assessing compliance to ANC guidelines emphasizing on evidence-based medicine supported interventions. Municipalities, health care facilities and CR sampled were randomly selected.

Results: Median gestational age at the first ANC visit was 12 weeks (IQR =10). Complete physical examination procedures were found in 40% of the records [95% Confidence Interval-38%, 42%]. Evidence of complete ANC laboratory test as required by national guidelines was found in 19% [17%,21%] of the CR. Syphilis, HIV and hepatitis B screening coverage was 88% [86%,89%], 78% [76%,79%], and 59% [57%,61%] respectively. Multivariate logistic regression showed important screening coverage differences among regions, health insurance systems and ethnicity. Key educational activities including obstetric alarm signs, newborn care, breastfeeding and contraceptive information were found in 91% [89%,93%], 24% [22%,26%], 42% [40%,44%] and 30% [28%,32%] of CR respectively. Key ANC evidence-based medicine supported interventions were found in 21% [19%, 22%] and complete implementation of ANC guidelines in only 1% [1%,2%] of all CR reviewed.

Conclusion: This, one of the largest ANC performance evaluations in Colombia so far, shows that ANC is rather deficient and with profound inequities. Poor ANC quality could explain high maternal and neonatal death figures. Improving ANC and reducing inequities is necessary to improve perinatal and maternal and neonatal mortality and morbidity. Use of standardized techniques to measure adherence to ANC guidelines across the country is key to improving quality.