Health Policy and Planning, Vol 13, 94-102, Copyright © 1998 by Oxford University Press
R Nydomugyenyi, S Neema and P Magnussen
The study aimed to analyze reasons for the use or non-use of antenatal care
services and malaria treatment among pregnant women living in rural areas
in Uganda. Focus group discussions with pregnant women, in-depth interviews
with key informants (Traditional Birth Attendants (TBAs) and health
workers) and a structured questionnaire administered to pregnant women were
used to collect the relevant information. Antenatal care attendance was
irregular and few women knew that the purpose of attending antenatal care
was to monitor both the growth of the baby and the health status of the
woman. Parity significantly influenced antenatal care attendance, but level
of education, religion and marital status did not. Fifty-five per cent of
the women stated that they had delivered outside the formal health delivery
system despite antenatal care attendance. All women in their second
pregnancy had delivered their first child in the village, despite TBA
training to the contrary.Malaria as perceived by pregnant women is common
and multiple health service providers are used for its treatment. About 66%
of the mothers reported having suffered from malaria during the current
pregnancy; of these more than half had received treatment outside the
formal health delivery system. Self-treatment with drugs bought from
ordinary shops was commonly reported. Nearly all women (93.3%) knew about
the antimalarial drug chloroquine and 83% thought that it was used for the
treatment of malaria, not for its prevention. Some women believed that the
drug could cause abortion.Health seeking behaviour was influenced by
several factors, including the perceived high cost of antenatal care
services, or conducting a delivery and treatment, and perceived inadequacy
of services provided by the formal health system. Inadequacy of formal
health services was perceived by users to be partly due to understaffing
and to irregular supply of essential drugs.Intensive health education to
pregnant women on the safety of chloroquine use in pregnancy, the
importance and the need for regular antenatal care attendance are
recommended. In addition, training of more TBAs and continued educational
efforts to upgrade their knowledge, regular and adequate supply of
essential drugs, and free health services for high-risk groups such as
pregnant women are recommended to improve antenatal care services and drug
prophylaxis use in pregnancy.
ARTICLES
Research report. The use of formal and informal services for antenatal care and malaria treatment in rural Uganda
Vector Control Division, Kampala, Uganda; Makerere Institute of Social Research, Makerere University, Uganda; Danish Bilharziasis Laboratory, Charlottenlund, Denmark
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