How good is the quality of antenatal care in the Colombo district of Sri Lanka in diagnosing and treating anaemia?

ABSTRACT

BACKGROUND: Sri Lanka has shown relatively good maternal outcome indicators for a developing country. However, high maternal deaths from haemorrhage and anaemia raise questions about the quality of detection and treatment of anaemia at field antenatal clinics, which is the primary care setting for pregnant women. AIM: The aim of the study was to assess the quality of facilities and services and how satisfactory antenatal care is with regard to diagnosis and treatment of anaemia. METHODS: This study was set in field antenatal clinics and conducted in two stages based on the Lot Quality Assurance Sampling method. In the first stage 55 antenatal clinics were selected, and in the second stage 275 pregnant women were recruited from these 55 clinics. Quality of services and quality of facilities were assessed using observation, and an interviewer administered questionnaire was used to measure client satisfaction. The validity of haemoglobin colour scale results was investigated by comparing them with results from a quality assured laboratory. RESULTS: Eleven health areas, other than the seven areas which had the haemoglobin investigated, were unacceptable as regards the quality of services. The quality of facilities was better than the quality of services in the Colombo district. Information and counselling was provided for only 4% of women in the clinics. The sensitivity and the specificity for the haemoglobin colour scale was 62% (95% CI 52.9%-71.1%) and 86% (95% CI 79.6%-93.0%) respectively. CONCLUSION: Urgent steps should be taken to improve the quality of care in the health areas where care is substandard, in order to reduce morbidity and mortality due to anaemia.