Comparison of pregnancy outcome between booked and unbooked mothers at Van Velden Hospital in the Limpopo Province
Date
2012-01-10
Authors
Madike, Ellen Lopang
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Abstract
BACKGROUND: The World Health Organization (WHO) has acknowledged
the importance of maternal care and listed it as part of its Millennium
Development Goals (MDGs). South Africa has aligned itself with these MDGs.
The 5th goal is focused on improving maternal health by reducing the maternal
mortality rate by 75% by 2015. There are a number of interventions in place to
try and to achieve this goal; the provision of antenatal care is one of these
interventions. Antenatal care provides the expectant mother early ongoing
monitoring and risk assessment of her pregnancy. It is commonly considered
fact that antenatal care improves maternal and perinatal outcomes. In spite of
the provision of free maternal health services in South Africa, there are still a
significant number of mothers who do not attend antenatal clinics before
delivery. No formal study has been done to understand the magnitude of this
problem in the Limpopo Province. In view of this, it was decided to conduct
this study at the Van Velden Hospital (a rural district hospital in the Mopani
District in the Limpopo Province) which has been admitting a significant
number of unbooked mothers even after the introduction of free maternal
health services in South Africa sixteen years ago.
AIM: To compare the pregnancy outcomes (maternal and perinatal) between
booked and unbooked mothers who delivered at Van Velden Hospital, a
district hospital in the Limpopo Province in South Africa.
METHODOLOGY: The setting of this study is the Maternity Unit at the Van
Velden Hospital. A cross sectional study design was used. A retrospective
record review was done and information for one year (2008/09) will be
extracted from the records captured in the District Health Information System.
No primary data was collected for this study.
RESULTS: This is the first study that looked at broad issues pertaining to the
influence of booking status on pregnancy outcomes (maternal and neonatal)
at a district hospital in a rural district in the Limpopo Province and probably in
South Africa. The study found a prevalence of 15.7% (range: 2.7% to 32.3%)
among the study population during the 12 month study period. There were no
significant differences in age, marital and employment status of the subjects.
However, there were a significant number of teenage pregnancies (13.2%) among the study population, which is of concern. Interestingly, more white
women were found not to book in comparison to the black women. There
were no significant differences in parity, gravidity and miscarriages between
the two groups. Overall, unbooked mothers were more likely to have a
preterm baby. This implies antenatal booking can probably prevent preterm
deliveries. This study also found unbooked mothers were more likely to have
C/S than booked mothers. However, there was no significant difference
between booked and unbooked mothers in terms of delivery complications.
There was no significant difference between booked and unbooked mothers in
terms of birth weight. Although, the babies of unbooked mothers had a
significantly lower Apgar score (1 minute) than booked mothers, the difference
became insignificant at 10 minutes. There was no maternal mortality during
this period. All mothers were discharged home. Overall, perinatal mortality
among the study population was 44/ 1000 births. This study found a
significant risk of perinatal morbidity (preterm delivery and low Apgar score)
among the unbooked mothers.
CONCLUSION: This research was undertaken to develop a model that could
be used by both the provincial and national governments to evaluate the
prevalence and impact of booking status of pregnant women in rural district
hospitals in South Africa.