Quality assessment of the antenatal program for anaemia in rural Tanzania

Objective. To assess the quality of antenatal care with respect to anaemia, a common health problem, in a developing country. Design. Cross-sectional study. Setting. Rufiji rural district, coastal Tanzania. Study participants. Three hundred and seventy-nine consecutively enrolled pregnant women from 16 randomly selected antenatal clinics, including 10 dispensaries, four rural health centres and two hospitals. Methods. We noted availability of infrastructure for management of anaemia, observed provider-client interaction, and interviewed women who attended antenatal clinics. An observer and health workers measured haemoglobin levels and their measurements were compared. Main outcome measures. Quality of antenatal care, anaemia in pregnancy, and maternal satisfaction. Results. Half of the rural health clinics had no instrument to measure haemoglobin. The majority (58%) of pregnant women were not checked for anaemia at all, 10% were clinically examined, and 37% had haemoglobin assessed. The agreement between health workers' (using Tallqvist) and the observers' (using HemoCue) measurements of haemoglobin was poor to fair. The prevalence of anaemia (Hb <10.5 g/dl) and severe anaemia (<7.0 g/dl) was 58% and 6.2%, respectively, but overall only 4% of the anaemic pregnant women had specific action taken within the antenatal care program. Conclusion. Deficiencies in quality of screening, diagnostic information, and individual counselling need to be addressed before any impact of the antenatal care programme on anaemia can be expected.