An audit of pregnancy outcomes at a private facility in the Johannesburg health district

Abstract

Introduction Neonatal health and morbidity are influenced by events prior to birth. Some of the events include antenatal care and the presence of co-morbid conditions in pregnant mothers. Mothers in South Africa have a choice from the two-tier health system to receive care during pregnancy either from the public health sector or from the private health sector. The choice is usually influenced by ability to pay for antenatal and perinatal services. High levels of antenatal care provision and positive outcomes are perceived in pregnant women who receive antenatal care in private healthcare facilities. However, there is no evidence of prior systematic testing of this perception. The rationale for this research was conceptualised against this background, which explored both maternal and neonatal outcomes and the factors influencing these outcomes such as socio-demographic factors, and co-morbid conditions such as medical conditions. For example, hypertensive disorders and infections including the human immunodeficiency virus (HIV). Objective To describe the profiles and outcomes of pregnant women (who delivered or had termination of pregnancy at a private facility in the Johannesburg Health District) during a three-month study period. Methodology A retrospective record review was done. The sample for this study was drawn from pregnant women who delivered or suffered pregnancy loss at a private facility in Johannesburg Metro District. Ethics approval application was submitted to and approved by the Human Research Ethics Committee (Medical) of the University of Witwatersrand. A three-month period (quarter of a year) was chosen from the 16 quarters in the period 2008 to 2011. The quarters were numbered from 1 to 16, and one quarter was chosen using a random table of numbers, to exclude sampling bias. The data collection tool used was specifically designed for this study, and was prepiloted. Socio-demographic data and data on antenatal attendance, pregnancy comorbidity and foetal outcomes were collected. The latter was measured as Apgar scores, birth weight and need for resuscitation including the need for neonatal intensive care unit (NICU) admission. Data was captured on an MS Excel spreadsheet and analysed using (NCSS) statistical software. Results The findings in this study included a low neonatal mortality rate (NMR), absence of maternal deaths and a high caesarean section rate. Moreover, women of high medical aid type suffered less complications of postpartum haemorrhage than the medium and low-level types. Conclusion This was probably the first study done in a private health facility in South Africa looking at maternal foetal and / or neonatal outcome and to stratify them according to medical aid type (high / medium / low). The demographic characteristics of the study population were representative of the South African population. The findings in this study showed better maternal and neonatal outcomes than public health facilities in South Africa. The study also reported a high caesarean section rate and relatively more frequent postpartum complications in low and medium medical aid holders.