Modelling Prenatal Care Pathways at a Central Hospital in Zimbabwe

Abstract

Background: Maternal mortality remains a problem in low-income countries (LICs). In Zimbabwe, there has been an unprecedented increase in maternal mortality in the last 2.5 decades. Effective prenatal care delivery, particularly early visits, appropriate number of visits, and receiving recommended care is viewed as key to reducing fatal care outcomes. Aims: This study sought to model and identify gaps requiring service and care delivery improvement in prenatal care pathways for pregnant women visiting Mpilo Central Hospital in Bulawayo, Zimbabwe. Methods: This was a case study of the services offered by an antenatal care department at Mpilo Central Hospital in Bulawayo, Zimbabwe. Evidence from literature in low-income countries was used to develop prenatal care pathway guidelines as a tool to guide care delivery and identify gaps in care and service delivery. One hundred cases of prenatal care records were reviewed to determine the prenatal care pathway and care delivered to pregnant women. This data was complemented by interviews with 20 maternity care clinicians. Results: In 100 maternity case records studied, 53% booked for prenatal care. Of the 53% (n = 53) pregnant women who booked, their first visit on their pregnancy was late at an average gestational age of 27.1 weeks with extremes of 30 to 40 weeks in 38% (n = 20) cases. Missing scheduled prenatal care appointments was prevalent, with only 11% (n = 6) having attended all the expected 5 visits, whilst 60% (n = 32) missed 3 or more. There were inadequacies in the care delivered to women in each visit compared to that expected in such areas as obstetrics, physical examinations and haematological tests. Maternity care clinicians attributed the cost of prenatal booking fees in the background of poverty and poor family support systems as key factors hindering women’s access to prenatal services. Conclusions: The current prenatal care pathway at MCH requires improvement in the areas of referral, adherence to appointment by pregnant women and visiting prenatal care early. Clinicians also need to adhere to standard clinical tests recommended for each specific pregnant woman’s visit. In the Zimbabwean setting with limited resources, where the number of visits is already low, pathways with reduced visits may not be appropriate. An investment into prenatal care by the government is recommended to enable the utilisation of interventions such as e-health technologies that may improve care delivery as well as adherence to best practices. E-health and mobile health technologies involving e-referrals, e-booking, decision support, and reminder systems are recommended for clinicians to manage and deliver appropriate care to patients as well as pregnant women to adhere to scheduled visits.