To screen the high risk cases. Two trials evaluated cost implications of two models of ANC with reduced visits, one in the United Kingdom and one in two LMICs (Cuba and Thailand). The World Health Organization has issued a new series of recommendations to improve quality of antenatal care to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. The median number of visits achieved in the FANC arms of these trials ranged from four to five visits and the median number of visits achieved in the standard ANC arms ranged from four to eight visits. In terms of the operationalization of this recommendation, “contact” can be adapted to local contexts through community outreach programmes and lay health worker involvement. The DECIDE (Developing and Evaluating Communication Strategies to support Informed Decisions and Practice based on Evidence) (6) framework, an evidence-to-decision tool that includes intervention effects, values, resources, equity, acceptability and feasibility criteria, was used to guide the formulation and approval of recommendations by the Guideline Development Group (GDG) – an international group of experts assembled for the purpose of developing this guideline – at three Technical Consultations between October 2015 and March 2016. An enabling environment should be created for the use of this recommendation, including changes in the behaviour of health care practitioners to enable the use of evidence-based practices. Programme reports from Ghana and Kenya stress that inadequate equipment, supplies, infrastructure and training may hamper implementation (12, 13). In general, however, evidence from these individual studies also suggests that the reduced-visit models may be associated with lower women’s satisfaction. Adoption and implementation of ANC guidelines at large scale. However, the reduced visit schedule may be appreciated by some women in a range of LMIC settings because of the potential for cost savings, e.g. To p[revent or to detect and treat at the earliest any complications. Villar J, Ba’aqeel H, Piaggio G, Lumbiganon P, Miguel Belizan J, Farnot U et al. The ANC recommendations are intended to inform the development of relevant health-care policies and clinical protocols. How much time do health services spend on antenatal care? (Recommended) Publication history. WHO envisions a … Recommendations. Coronavirus disease outbreak (COVID-2019), Coronavirus disease outbreak (COVID-19) », New guidelines on antenatal care for a positive pregnancy experience, WHO recommendations on antenatal care for a positive pregnancy experience, Decreasing deaths during pregnancy in South Africa by improving antenatal care, Pregnant women must be able to access the right care at the right time, says WHO. Low-certainty evidence suggested that the reduced-visit model (with at least eight visits) may be associated with increased preterm birth (3 trials; RR: 1.24, 1.01–1.52), but no other important effects on health outcomes were noted. Assessed as up-to-date: November 2016 Remarks. Modifications to the recommendation, where necessary, should be justified in an explicit and transparent manner. Frontiers in Reproductive Health Program, Population Council; 2006 (. Stillbirth risk was plotted according to gestational age and three peaks in the occurrence of stillbirths were noted, one at around 31 weeks of gestation, another at around 37 weeks, and the third occurring at 40 weeks or more. Moderate-certainty evidence indicates that FANC probably has little or no effect on preterm birth (3 trials, 47 094 women; RR: 0.99, 95% CI: 0.91–1.08) and low birth weight (3 trials, 46 220 women; RR: 1.04, 95% CI: 0.97–1.12) compared with “standard” ANC. Authors : World Health Organization Publication details Number of pages : 262 Publication date : 2009 Languages : English Price : ISBN : 9789241597906 Downloads Overview The WHO guidelines on hand hygiene in health care provide health-care workers (HCWs), hospital administrators and health... Community participation in programme planning, implementation and monitoring is recommended to improve use of skilled care during pregnancy, childbirth and the postnatal period for women and newborns, increase the timely use of facility care for obstetric and newborn complications and improve... Community participation in quality-improvement processes for maternity care services is recommended to improve quality of care from women’s, communities’ and health care providers’ perspectives. This document aims to provide clear guidelines for antenatal care. 2015;(7):CD000934, WHO handbook for guideline development, 2nd edition. The GDG stresses that the four-visit focused ANC (FANC) model does not offer women adequate contact with health-care practitioners and is no longer recommended. The number of visits in this model is considerably fewer than in ANC models used in HICs. In accordance with WHO guideline development standards, these recommendations will be reviewed and updated following the identification of new evidence, with major reviews and updates at least every five years. Reproductive Health and Research (RHR) Nutrition for Health and Development (NHD) Maternal, Newborn, Child and Adolescent Health (MCA) Geneva, Switzerland. For the purpose of developing this new ANC model, the ANC recommendations were mapped to the eight contacts based on the evidence supporting each recommendation and the optimal timing of delivery of the recommended interventions to achieve maximal impact. In the United Kingdom trial, there was an increase in costs related to neonatal intensive care unit stays in the reduced visit model. Indirect evidence also suggests that women are much more likely to engage with antenatal services if care is provided by knowledgeable, kind health-care professionals who have the time and resources to deliver genuine woman-centred care, regardless of the number of WHO recommendations on antenatal care for a positive pregnancy experience 104 visits (high confidence in the evidence). Optimizing service delivery within health systems. … Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures? It is not clear whether the philosophy of the FANC approach, with regard to improving quality of care at each ANC visit, was implemented effectively in the trials. Therefore, the number and content of visits should be adaptable to local context and to the individual woman. With regard to maternal satisfaction, outcomes were reported narratively in the review, as data were sparse. High-certainty evidence shows that FANC had little or no effect on caesarean section rates (1 trial, 24 526 women; RR: 1.00, 95% CI: 0.89–1.11), and low-certainty evidence suggests that it may make little or no difference to maternal mortality (3 trials, 51 504 women; RR: 1.13, 95% CI: 0.5–2.57). The GRADECERQual Project Group; 2016 (. What's new. FRONTIERS final report. loss of domestic income from extra clinic attendance and/or associated travel costs (low confidence in the evidence). 2. I welcome these guidelines, which aim to put women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life. Reprod Health. 3. Antenatal Care Mdg 5, Target 5b, Indicator 5.5 PPT Presentation Summary : The presence of a trained health-care worker during delivery is crucial in reducing maternal deaths. Guidance on each visit includes specific evidence-based interventions for healthy pregnant women (called “goal-oriented”), with appropriate referral of high-risk women and those who develop pregnancy complications. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care. (November 2016). Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care. With the FANC model, the first ANC visit occurs before 12 weeks of pregnancy, the second around 26 weeks, the third around 32 weeks, and the fourth between 36 and 38 weeks of gestation. Conrad P, Schmid G, Tientrebeogo J, Moses A, Kirenga S, Neuhann F et al. Four individual RCTs were conducted in HICs (the United Kingdom and the USA) and three large cluster-RCTs were conducted in LMICs, including one conducted in Argentina, Cuba, Saudi Arabia and Thailand (7), and two conducted in Zimbabwe.
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