Quality of care in six sub-Saharan Africa countries: a provider-based study on adherence to WHO's antenatal care guideline

Int J Qual Health Care. 2019 Feb 1;31(1):43-48. doi: 10.1093/intqhc/mzy105.


Objective: Quality of care may help explain the high burden of disease in maternal, newborn and child health in low- and middle-income countries even as access to care is improved. We explored the determinants of quality of antenatal care (ANC) in sub-Saharan Africa (SSA).

Design: Cross-sectional study. Multilevel Generalized Linear Latent Mixed-Effect models with logit link function were employed to obtain the adjusted odds ratios (AORs) and 95% confidence interval (CI).

Setting: We used Service Provision Assessment data from six countries in SSA, including Kenya, Malawi, Namibia, Rwanda, Tanzania and Uganda.

Participants: Seven thousand, five hundred and seventy seven observed antenatal clients across the six countries.

Main outcome measures: Quality of ANC services, measured using indexes of quality of clinical care and quality of information provided.

Results: Providers in facilities that had ANC guideline (AOR = 1.26; 95% CI, 1.08-1.48), were well-equipped (AOR = 1.65; 95% CI, 1.41-1.92), were classified as upper level facility (AOR = 1.32; 95% CI, 1.05-1.66), had central electricity supply (AOR = 2.19; 95% CI, 1.81-2.65), and piped water (AOR = 1.30; 95% CI, 1.09-1.55) were more likely to provide optimal quality of clinical care. Moreover, those having ANC guideline (AOR = 1.81; 95% CI, 1.43-2.28) and central electricity supply (AOR = 2.67; 95% CI, 2.01-3.44) were more likely to provide optimal information as well. Provider's qualification and experience were also important in information provision and clinical care independently.

Conclusion: The lack of some very basic facility equipment and amenities compromised quality of care in sub-Saharan countries. Policy actions and investment on facility and providers will enable provision of quality services necessary to improve maternal, newborn and child health in SSA.

Keywords: Service Provision Assessmentantenatal care; multilevel analysis; quality of care; sub-Saharan Africa.

MeSH terms

  • Africa South of the Sahara
  • Cross-Sectional Studies
  • Developing Countries
  • Equipment and Supplies / supply & distribution
  • Female
  • Guideline Adherence
  • Health Facilities / statistics & numerical data
  • Humans
  • Maternal Health Services / standards
  • Pregnancy
  • Prenatal Care / organization & administration
  • Prenatal Care / standards*
  • Prenatal Care / statistics & numerical data*
  • Quality of Health Care / standards
  • Quality of Health Care / statistics & numerical data*