Access to antenatal blood pressure measurement in Malawi: Findings from a national census of health facilities|
Stones, William & Peno, William Wayne
To identify service side factors associated with access to antenatal blood pressure measurement at health facilities in Malawi.
Secondary data analysis of 1499 observations of antenatal consultations undertaken in the Service Provision Assessment survey
2013-14, a census of all formal health facilities in the country.
Differentials in access to antenatal blood pressure measurements by client age or educational status and provider gender or in-service
training did not reach statistical significance although clinically important effects cannot be excluded. There was substantial variation
among districts, ranging from 14% to 100% of observed consultations. Facilities in the Central and Southern regions had lower odds
of providing blood pressure measurement relative to the Northern region (OR 0.17, 95% CI 0.03 to 0.30 and 0.11, 95% 0.04 to 0.31
respectively). Facilities affiliated to the Christian Health Association of Malawi and facilities under private management had higher
odds of provision relative to government facilities (OR 3.24, 95% CI 1.71 to 6.11 and 5.77, 95% CI 1.87 to 17.79 respectively). Where
observed consultations included taking the client’s weight and measuring the symphysis-fundus height, the odds of blood pressure
measurement were significantly increased (OR 6.4, 95% CI 3.32 to 12.34 and 1.71, 95% CI 1.01 to 2.88 respectively).
An indicator for effective coverage, the proportion of antenatal visits that included blood pressure measurement, recorded in health
passports examined at the time of admission for delivery, should be tested for incorporation into the District Health Information
System to enable tracking of quality improvement in antenatal care. Further research is needed to elucidate the reasons for the variations
Pregnancy Hypertension; Pre eclampsia; Antenatal care; Quality of Health Care; Service Provision Assessment