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Health system-level interventions to improve the utilization and quality of ANC

It is recommended that each pregnant woman carries her own case notes during pregnancy to improve continuity, quality of care, and pregnancy experience.
Task shifting the promotion of health-related behaviours for maternal and newborn health to a broad range of cadres, including Community health workers, nurses, midwives, and doctors is recommended.
Task shifting the distribution of recommended nutritional supplements and intermittent preventive treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including CHEW, nurses, midwives, and doctors is recommended.
ANC models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care

3.3 Procedures carried out in General ANC Clinics.

Health Education
History Taking
Physical Examination from head to toe
Taking foetal heart sound
Taking mothers vital signs
Laboratory Investigations

7. Weighing

8. Tetanus Toxoid Immunization

9. Treatment of minor ailment/referral of more serious conditions.

10. HIV counseling and testing

A TABLE SHOWING THE NUMBER OF ANC VISITS FOR FANC & 2016 ANC MODEL

Adopted from WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience: Summary; 2018

3.4 ANC CONTACTS AND WHAT THEY ENTAIL

FIRST TRIMESTER (UP TO 12 WEEKS, FIRST CONTACT)

1. Establish a friendly atmosphere

2. Obtain a comprehensive history on;

Personal Information:
Medical History:
Obstetric History:
Last Menstrual Period and Contraceptive Plans:

LMP + 7 days – 3months = EDD.

Present Pregnancy

3. Performa “Head-to-Toe” Physical Examination.

General Wellbeing: Girt, posture, facial expression, skin and conjunctiva for pallor or jaundice, oedema, condition of hair
Blood Pressure Measurement.
Breast Inspection.
Abdominal Examination: Surface of abdomen, fundal height.
Genital Examination: Skin, Labia, Bartholin’s Glands, Purulent discharge (Pus-like)

4. Request Relevant Laboratory Investigations which includes;

Urinanalysis
Haemoglobin (Hb) or Pack Cell Volume (PCV) estimation
Veneral Disease Research Laboratory (VDRL) or Rapid Plasma Reagen (PRP) test
Blood Grouping/Rhesus Factor
HIV Testing (After VCT)
Other Appropriate Investigations as indicated by patient’s history e.g. HBs Ag, Widal, MP, Sickling, FBS etc.

5. Provide Iron and Folate According to Guideline i.e. Folic acid 5mg daily, ferrous sulphate 200mg three times a day (All pregnant women should have iron/folate supplements for 6 months during pregnancy).

6. Provide 1st dose of T.T. vaccine (if not immunized)

7. Provide Long Lasting Insecticide Treated Net (LLITN) if available

8. Educate and counsel client on any topic appropriate to her condition.

9. Initiate discussion on birth and emergency planning

10. Give appointment for the second visit, ensure all records are complete.

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