Antenatal Care Quantity or Quality

8/18/2019 Antenatal Care Quantity or Quality

1/38

ANTENATAL CAREANTENATAL CARE

QUANTITY ORQUANTITY OR

QUALITY ?QUALITY ? Dato’ Dr. GhazaliDato’ Dr. Ghazali

IsmailIsmail

HTAA KuantanHTAA Kuantan


2/38

INTRODUCTIONINTRODUCTION

• ost o! th" ant"natal #ar" mo$"lsost o! th" ant"natal #ar" mo$"lsha%" not &""n su&'"#t"$ to ri(orousha%" not &""n su&'"#t"$ to ri(orouss#i"nti)# "%aluation to $"t"rmin" th"irs#i"nti)# "%aluation to $"t"rmin" th"ir

"*"#ti%"n"ss."*"#ti%"n"ss.• La#+ o! ,har$, "%i$"n#" has im-"$"$La#+ o! ,har$, "%i$"n#" has im-"$"$th" i$"nti)#ation o! "*"#ti%"th" i$"nti)#ation o! "*"#ti%"int"r%"ntions an$ thus th" o-timalint"r%"ntions an$ thus th" o-timal

allo#ation o! r"sour#"s.allo#ation o! r"sour#"s.

• Routin"l r"#omm"n$"$ ant"natalRoutin"l r"#omm"n$"$ ant"natal#ar" -ro(ramm"s ar" o!t"n -oorl#ar" -ro(ramm"s ar" o!t"n -oorlim-l"m"nt"$ an$ #lini#al %isits #an &"im-l"m"nt"$ an$ #lini#al %isits #an &"

irr"(ular/ 0ith lon( 0aitin( tim"s an$irr"(ular/ 0ith lon( 0aitin( tim"s an$-oor !""$&a#+ to th" 0om"n.-oor !""$&a#+ to th" 0om"n.


3/38


4/38

Kasongo Project Team studied

3,614 women in an antenatal clinicin Kasongo, Zaire, in 1984, found

71% of te women wo de!elo"edo#structed la#or were not identi$ed

asat ris&,' wile

9(% of women wo were identi$edas

at ris&' did not de!elo" o#structedla#or)


5/38

Comparison of AntenatalComparison of Antenatal

Visits VisitsCountr Countr

R"#omm"n$"$R"#omm"n$"$nos o! %isitsnos o! %isits

A%"ra(" A%"ra("a#tual nos.a#tual nos.

Not r"#"i%in(Not r"#"i%in(an %isit 6an %isit 6

U.Kin($omU.Kin($om 78 9 7:78 9 7: NA NA ;.8;.8

7.77.7

D"nmar+ D"nmar+ 7;7; >> ;.7 ;.7

@ran#"@ran#" B.B. ;.;.

E"l(iumE"l(ium NA NA =.:=.:

LuF"m&uour(LuF"m&uour( BB BB NA NA


6/38

Ar"a Ar"a 7;7; 8;;;8;;; 8;;:8;;: 8;;=8;;= 8;;B8;;B

4"st 4"st

ala ala siasia

=78/:=78/:

:::>/:>/

::8;/>8;/>

==:::/8B:::/8B

BB:8/7::8/7:

/B:7

B7/=>B7/=>

B8/===B8/===

=

TOTALTOTAL B8>/;8B8>/;8

B7/7:B7/7:>>

:>8/:=:>8/:=BB

=8>/=;=8>/=;==

=88/=88/;;

TOTAL ANTENATAL MOTHERS ATTENDINGANTENATAL CARE IN MALAYSIA 1990, 2000,2003-2005

HMIS KKM 2006


7/38

ARAG NUER O@ ANTNATAL ARAG NUER O@ ANTNATAL

I. .7.7 >.=>.= >.=>.=

.8

.8 >.=>.= >.:>.: >.B>.B

TOTALTOTAL .. >.B>.B >.>>.> >.;>.; >.=>.=


8/38

Do"s th"Do"s th"num&"rs o!num&"rs o!

ant"natal %isitsant"natal %isits

im-ro%"im-ro%"

mat"rnal an$mat"rnal an$

-"rinatal-"rinatalout#om" ?out#om" ?


9/38

CID R"-ort 773CID R"-ort 773

7=7= Total ant"natal %isitsTotal ant"natal %isitsamon( mat"rnal $"athamon( mat"rnal $"ath

#as"s stu$i"$ #as"s stu$i"$ – 7;378 6 ha$ no ant"natal7;378 6 ha$ no ant"natal#ar"#ar"

– =B 9 = 6 ha$ > %isits=B 9 = 6 ha$ > %isits

– :: 6 ha$ J > %isits:: 6 ha$ J > %isits


10/38

Trend of Maternal Mortality 1970 - 2002


11/38

*T+-+.T/ 02 P.+0T0 5.T0+T .0T199((( :*+0;


12/38

7>7 7;>7;>

Ina$"5uat"/ina--ro-riat" or $"laIna$"5uat"/ina--ro-riat" or $"latr"atm"nttr"atm"nt

7777

@ailur" to $ia(nos"@ailur" to $ia(nos" =8=8 88D"la !ailur" o! r"!"rralD"la !ailur" o! r"!"rral :8:8 B=B=

@ailur" to $ia(nos"@ailur" to $ia(nos" 8888 :;:;

@ailur" to in!orm s"niors@ailur" to in!orm s"niors 8=8= 8888

@ailur" o! a$h"r"n#" to -roto#ol@ailur" o! a$h"r"n#" to -roto#ol 7B7B 8=8=

Ina--ro-riat" $"l"(ation o!Ina--ro-riat" $"l"(ation o!$uti"s$uti"s

>> 7:7:

@ailur" to in!orm oth"r s-"#ialist@ailur" to in!orm oth"r s-"#ialist 77

@ailur" o! hom" %isits $"!ault"r@ailur" o! hom" %isits $"!ault"rtra#in(tra#in(

BB 7777


13/38

Ho0Ho0

!r"5u"nt!r"5u"ntshoul$ th"shoul$ th"

%isit &" ? %isit &" ?


14/38

inimum #ar" !orinimum #ar" !or

a normala normal

multi(ra%i$asmulti(ra%i$as12 Weeks Histo! "#$ e%"&i#"tio#, '("i)'"tio# o*

+#'et"i#

$"tes,i$e#ti)'"tio# o* isk *"'tos, (oo$ tests,

"$i'e o# $iet,.ok "#$ e%e'ises

1/ 20 (t"so+#$

22 +#$"( ei4t, "se(i#e .ei4t

30 +#$"( ei4t, .ei4t 4"i#, i$e#ti)'"tio# o* isko*

IGR "#$ e e'("&si"

36 +#$"( ei4t, .ei4t 4"i#, i$e#ti)'"tio# o*

&"(ese#t"tio# e4 ee'es, t"#sese,o(i7+e(ie

80 Assess&e#t o* #ee$ *o i#$+'tio#


15/38


16/38


17/38

R"%i"0 lit"ratur" &"t0""n n"0R"%i"0 lit"ratur" &"t0""n n"0

an$ stan$ar$ nos. ant"natalan$ stan$ar$ nos. ant"natal

%isits %isits1; WHO s!ste&"ti' eie. No '(i#i'"( $i?aroli et al ,ancet a> ((1; TI, =ost"t+&"#"e&i" , &"te#"(,

o ei#"t"( &ot"(it!, LW

2; WHO A#te#"t"( C"e

Ti"( No si4#i)'"#t $i ;

3; Co'"#e D"t""se A e$+'tio# i# #os; o* isitsis #ot "?. @illar et al ((1 ; &"te#"( oei#"t"( o+t'o&es

8;e7+e#'! .it (o#4-te& e


18/38

Fistin( #on$ition o!Fistin( #on$ition o!

ourourant"natal sst"m ant"natal sst"m•


19/38

EA


20/38

• It is %ital that th" -att"rn o! ant"natalIt is %ital that th" -att"rn o! ant"natal

#ar" is r"%i"0"$ to &"#om" mor"#ar" is r"%i"0"$ to &"#om" mor""*"#ti%" & !o#usin( on 5ualit an$"*"#ti%" & !o#usin( on 5ualit an$

ass"ssin( 0hat #ar" 0om"n r"#"i%".ass"ssin( 0hat #ar" 0om"n r"#"i%".

• Allo0s 0om"n to ma+" a mor" Allo0s 0om"n to ma+" a mor"in!orm"$ #hoi#" r"(ar$in( th" #ar"in!orm"$ #hoi#" r"(ar$in( th" #ar"

th" r"#"i%".th" r"#"i%".

• Th"r" shoul$ &" a #l"arl $")n"$Th"r" shoul$ &" a #l"arl $")n"$

-ur-os" to "%"r ant"natal-ur-os" to "%"r ant"natal

a--ointm"nt o*"r"$ to 0om"n.a--ointm"nt o*"r"$ to 0om"n.


21/38

Gui$"lin" that outlin"s a mor"Gui$"lin" that outlin"s a mor"

a--ro-riat" -att"rn o! #ar" !or th"a--ro-riat" -att"rn o! #ar" !or th"87st #"ntur an$ on" that is "%i$"n#"387st #"ntur an$ on" that is "%i$"n#"3

&as"$.&as"$.

•@o#us"s on th" 5ualit o! a--ointm"nts/@o#us"s on th" 5ualit o! a--ointm"nts/

rath"r than 5uantit an$ 0ill a%oi$rath"r than 5uantit an$ 0ill a%oi$ 0om"n’s tim" &"in( 0ast"$ & 0om"n’s tim" &"in( 0ast"$ &

unn"#"ssar a--ointm"nts.unn"#"ssar a--ointm"nts.

•@"0"r %isits ma also h"l- im-ro%"@"0"r %isits ma also h"l- im-ro%"

#ontinuit o! #ar" an$ ha%" a &"n")#ial#ontinuit o! #ar" an$ ha%" a &"n")#ialim-a#t on -r"(nan# out#om".,im-a#t on -r"(nan# out#om".,


22/38

at"rnal N"onatalat"rnal N"onatal

H"alth Mro(ramH"alth Mro(ram• Mromot"s an u-$at"$

a--roa#h to ant"natal #ar"• @o#us"$ ant"natal #ar" on

"%i$"n#" &as"$

• m-hasiz"s 5ualit o%"r5uantit o! %isits.• R"#o(niz"s t0o +" r"aliti"s

– @r"5u"nt %isits $o notn"#"ssaril im-ro%" -r"(nan#

out#om"s– an 0om"n 0ho ha%" ris+!a#tors n"%"r $"%"lo-#om-li#ations/ 0hil" 0om"n 0ithout ris+ !a#tors o!t"n $o.


23/38

• 4h"n ant"natal #ar" is -lann"$usin( a ris+ a--roa#h.

–


24/38

• NH Mro(ram ta+"s th" %i"0 that "%"r-r"(nant 0oman is at ris+ !or#om-li#ations

• All 0om"n shoul$ th"r"!or" r"#"i%" th"sam" &asi# #ar" an$ monitorin( !or

#om-li#ations• Do"s not r"#omm"n$ r"lin( on #"rtainm"asur"s an$ ris+ in$i#ators that ar"routin" in tra$itional ant"natal #ar"1"(.mat"rnal h"i(ht/ o"$"ma/li" o! !"tus 2

as th" ha%" not &""n -ro%"n to &" "*"#ti%"in im-ro%in( -r"(nan# out#om"s.


25/38

GOAL DIRCTDGOAL DIRCTD

INTRNTIONINTRNTION• @o#us"s on "%i$"n#"3&as"$ int"r%"ntions

that a$$r"ss th" most -r"%al"nt h"althissu"s that a*"#t moth"rs an$ n"0&orns.

• a#h !o#us"$ ant"natal #ar" %isitin#lu$"s int"r%"ntions that ar"a--ro-riat" to th" 0oman sta(" o!-r"(nan#

• A$$r"ss"s o%"rall h"alth an$ -r"-aration!or &irth an$ #ar" o! th" n"0&orn.


26/38

• arl $"t"#tion an$ tr"atm"nt o! -ro&l"msha%" -ro%"n "*"#ti%" in r"$u#in( mat"rnalan$ n"onatal $"aths

• Th" s+ill"$ -ro%i$"r int"r%i"0s an$

"Famin"s th" 0oman to $"t"#t -ro&l"msthat mi(ht a*"#t th" 0oman -r"(nan#an$ r"5uir" a$$itional #ar".

• arl tr"atm"nt o! th"s" #on$itions #an

m"an th" $i*"r"n#" &"t0""n $"ath an$sur%i%al !or th" 0oman an$ h"r n"0&orn.


27/38

COUN


28/38

• R"st an$ a%oi$an#" o!h"a% -hsi#al 0or+

• @amil -lannin( &"n")tso! #hil$ s-a#in( to moth"ran$ #hil$ o-tions !or!amil -lannin( s"r%i#"s

!ollo0in( th" &a&’s &irth• Er"ast!""$in( h"alth an$-ra#ti#al &"n")ts"F#lusi%" &r"ast!""$in(im-ortan#" o! imm"$iat"

&r"ast!""$in( a!t"r &irth


29/38

• HI an$ oth"r s"Fuall transmitt"$$is"as"s

– th" us" o! #on$oms !or $ual -rot"#tion!rom -r"(nan# an$ $is"as"

– oth"r m"asur"s !or -r"%"ntion– a%aila&ilit an$ &"n")ts o! t"stin(

an$ s-"#i)# issu" r"lat"$ to moth"r3to3#hil$ transmission an$

– li%in( 0ith AID< 1a!t"r a -ositi%" t"str"sult2


30/38

EIRTH MRMARDN


31/38

Th" s+ill"$ -ro%i$"r an$ th" 0oman shoul$ -lan !or th"

!ollo0in(

•


32/38

RCONDATION


33/38

• A s#h"$ul" o! ant"natal

a--ointm"nts shoul$ &"$"t"rmin"$ & th" !un#tion o! th"a--ointm"nts.

•@or a 0oman 0ho is nulli-arous 0ith anun#om-li#at"$ -r"(nan#/ a s#h"$ul" o!t"n a--ointm"nts shoul$ &" a$"5uat".

•@or a 0oman 0ho is -arous 0ith anun#om-li#at"$ -r"(nan#/ a s#h"$ul" o!s"%"n a--ointm"nts shoul$ &" a$"5uat".

Haiya..Everyweek mustcome kah ?

Yes la.. mustdo ! scanto see baby


34/38

• Mr"(nant 0om"n shoul$ &"o*"r"$ an "arl ultrasoun$s#an to $"t"rmin" ("stationala(" an$ to $"t"#t multi-l"-r"(nan#i"s. This 0ill "nsur"

– #onsist"n# o! ("stational a("ass"ssm"nts/

– im-ro%" th" -"r!orman#" o! mi$3trim"st"r s"rum s#r""nin( !orDo0n’s sn$rom" an$

– r"$u#" th" n""$ !or in$u#tion o!la&our a!t"r =7 0""+s.


35/38

• Mr"(nant 0om"n shoul$ &"o*"r"$ s#r""nin( !or Do0n’ssn$rom" 0ith a t"st 0hi#h-ro%i$"s th" #urr"ntstan$ar$ o! a $"t"#tion rat"a&o%" ;6 an$ a !als"3-ositi%" rat" o! l"ss than B6.

• Th" "%i$"n#" $o"s notsu--ort routin" s#r""nin(!or ("stational $ia&"t"sm"llitus an$ th"r"!or" itshoul$ not &" o*"r"$


36/38

CONCLU


37/38

• ,ew te%hnologies need to &e,ew te%hnologies need to &e

implemented %ontin(all &(t olderimplemented %ontin(all &(t older

servi%es need to &e re%onsiderservi%es need to &e re%onsider


38/38

Antenatal Care Quantity or Quality

Documents

Transcript of Antenatal Care Quantity or Quality