Antenatal care is an acknowledged measure for the reduction of maternal and perinatal mortality. In the rural village of Ilula, Tanzania, the possible impact of antenatal care on mortality was studied longitudinally on the basis of the 707 women delivered in the study period. Ninety-five percent of the antenatal records were available. Anemia, malaria and anticipated obstetric problems were the most frequent reasons for interventions. Among the women from the area who were delivered in hospital, 90% had been referred there. No relationship was found between the number of antenatal visits and the pregnancy outcome, but perinatal mortality was correlated to a low birth weight. Even with a mean attendance rate of six visits and full coverage by antenatal care maternal and perinatal mortality remains high.
PIP: An area-based, prospective study was undertaken in the rural village of Ilula, Tanzania on the possible impact of antenatal care on maternal and perinatal mortality. Between June 1, 1983 and November 30, 1985 683 women were studied. The number of visits averaged 6.4, with a range from 1 to 14. At these antenatal visits, 292 complaints were noted. Fever, rupture of membranes, anemia, twins, and breech presentations were among the most common complications. Interventions were most commonly medication for malaria and anemia. Referrals were made for blood transfusion, consultation of doctor, hospital admission, and hospital delivery. Of the 16 women with twin pregnancies diagnosed before birth, 6 delivered at home; 5 were sent to the referral hospital. Breech presentation was correctly diagnosed in 8 of 17 cases. No relationship was found between number of visits and pregnancy outcome, but perinatal mortality was correlated to a low birth weight. There were 4 maternal deaths; all of which occurred in term deliveries around the time of delivery. In no case could the outcome be linked to insufficient antenatal care. This study suggests that more emphasis should be placed on preventive medical and social measures. Strengthening of the referral mechanism is also necessary.