Maternal and Child Health Journal

, Volume 16, Issue 8, pp 1709–1717 | Cite as

Quality of Antenatal Care Services in the Birim North District of Ghana: Contribution of the Community-Based Health Planning and Services Program

  • Sharon Naariyong
  • Krishna C. Poudel
  • Mosuir Rahman
  • Junko Yasuoka
  • Keiko Otsuka
  • Masamine Jimba


To compare the quality of antenatal care (ANC) between Community-based Health Planning and Services (CHPS) and non-CHPS areas in the Birim North District of Ghana. A cross-sectional study was conducted in May, 2010. We collected data from 600 women (300 from CHPS areas and 300 from non-CHPS areas) recruited from six CHPS and six non-CHPS areas, using a structured questionnaire. Participants were aged 15–49 years, had at least one child within 18 months old, and resided in the district for at least 2 years before data collection. Outcomes included: (1) index of ANC utilization (dichotomized as full and partial), (2) receipt of anti-malarial drugs, (3) testing for HIV infection, and (4) index of knowledge about pregnancy danger signs (expressed in tertiles). Descriptive statistics and multivariate logistic regression methods were employed in the analysis. Multivariate analysis revealed that participants in the CHPS areas were 2.7 times (95% CI: 1.66–4.35) more likely to have full utilization score, 4.5 times (95% CI: 2.37–8.51) more likely to receive HIV testing, and 3.7 times (95% CI: 1.72–7.94) more likely to receive anti-malarial prophylaxis during the ANC period. However, scoring high on the index of knowledge was not significantly associated with the CHPS exposure (OR: 1.2; 95% CI: 0.69–2.00). The CHPS intervention might be useful to improve the quality of ANC. Therefore, increasing the CHPS intervention coverage in non-CHPS areas might serve as a basis for improving the quality of ANC in the Birim North and other rural districts of Ghana.


Maternal health Quality Antenatal care Ghana 



We thank all the participants of this study. We also thank Ms. Juliana Sackey, the Birim North District Director of Health Services, Ms. Patience Bekoe, the Birim North District Public Health Nurse, Ms. Irene Nyanuba, the Birim North District Nutrition Technical Officer, and the research assistants.


  1. 1.
    Rani, M., Bonu, S., & Harvey, S. (2008). Differentials in the quality of antenatal care in India. International Journal for Quality in Health Care, 20, 62–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Nations, United. (2010). The Millennium Development Goals Report 2010. New York: United Nations.Google Scholar
  3. 3.
    Hogan, M. C., Foreman, K., Naghavi, M., Ahn, S. Y., Wang, M., Makela, S., et al. (2010). Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet, 375, 1609–1623.PubMedCrossRefGoogle Scholar
  4. 4.
    Donabedian, A. (1988). The quality of care: How is it assessed? Journal of American Medical Association, 260, 1743–1748.CrossRefGoogle Scholar
  5. 5.
    Boller, C., Wyss, K., Mtasiwa, D., & Tanner, M. (2003). Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania. Bulletin of the World Health Organization, 81, 116–122.PubMedGoogle Scholar
  6. 6.
    Pembe, A. B., Carlstedt, A., Urassa, D. P., Lindmark, G., Nystrom, L., & Darj, E. (2010). Quality of antenatal care in rural Tanzania: counseling on pregnancy danger signs. BMC Pregnancy and Childbirth, 10, 35–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Birungi, H. (2008). Adapting focused antenatal care: Lessons from three African countries. FRONTIERS Program Brief No. 11. Washington DC: Population Council.Google Scholar
  8. 8.
    Villar, J., Ba’aqeel, H., Piaggio, G., Lumbiganon, P., Belizan, J. M., & Farnot, U. (2001). WHO antenatal care randomized trial for the evaluation of a new model of routine antenatal care. The Lancet, 357, 1551–1564.CrossRefGoogle Scholar
  9. 9.
    Ghana Statistical Service (GSS), Ghana Health Service (GHS), & ICF Macro. (2009). Ghana demographic and health survey 2008. Accra, Ghana: GSS, GHS, and ICF Macro.Google Scholar
  10. 10.
    Ministry of Health, Ghana. (2008). Pulling together, achieving more. Independent review of health sector program of work 2008. Ghana: Accra.Google Scholar
  11. 11.
    Nyonator, F. K., Awoonor-Williams, J. K., Phillips, J. F., Jones, T. C., & Miller, R. A. (2005). The Ghana community-based health planning and services initiative for scaling up service delivery innovation. Health Policy and Planning, 20, 25–34.PubMedCrossRefGoogle Scholar
  12. 12.
    Phillips, J. F., Bawa, A. A., & Binka, F. N. (2006). Accelerating reproductive and child health program development: the Navrongo initiative in Ghana. Bulletin of the World Health Organization, 84, 949–955.PubMedCrossRefGoogle Scholar
  13. 13.
    Gyapong, J., Garshong, B., Akazili, J., Aikins, M., Agyepong, I., & Nyonator, F. (2007). Critical analysis of Ghana’s health system: with a focus on equity challenges and the national health insurance. Ghana: Shield work package 1 report.Google Scholar
  14. 14.
    Awoonor-Williams, J. K., Feinglass, E. S., Tobey, R., Vaughan-Smith, M. N., Nyonator, F. K., & Jones, T. C. (2004). Bridging the gap between evidence-based innovation and national health-sector reform in Ghana. Studies in Family Planning, 35, 161–177.PubMedCrossRefGoogle Scholar
  15. 15.
    Fawole, A. O., Okunlola, M. A., & Adekunle, A. O. (2008). Clients’ perception of the quality of antenatal care. Journal of the National Medical Association, 100, 1052–1058.PubMedGoogle Scholar
  16. 16.
    Campbell, O. M. R., & Graham, W. J. (2006). On behalf of The Lancet Maternal Survival Series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet, 368, 1284–1299.PubMedCrossRefGoogle Scholar
  17. 17.
    Koblinsky, M., Mtatthews, Z., Hussein, J., Mavalankar, D., Mridha, M. K., Anwar, I., et al. (2006). On behalf of The Lancet Maternal Survival Series steering group. Going to scale with professional skilled care. Lancet, 368, 1377–1386.PubMedCrossRefGoogle Scholar
  18. 18.
    Tei Djangmah, & District Health Management Team (2009). Birim North district annual health report. New Abirim, Ghana.Google Scholar
  19. 19.
    World Health Organization (2008). A profile: Ghana’s expanded program on immunization in Ghana Accra, Ghana.Google Scholar
  20. 20.
    UNICEF (2009). Childinfo: Monitoring the situation of the world. Multiple indicator cluster surveys. New York, USA. (Accessed 01, October, 2009).
  21. 21.
    Mean-Heng, N. G. K., Nakamura, K., Ohnishi, M., Kizuki, M., Suyama, S., & Seino, K. (2007). Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia. Environmental Health and Preventive Medicine, 12, 193–201.CrossRefGoogle Scholar
  22. 22.
    Aiken, L. S., & West, S. G. (1991). Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage.Google Scholar
  23. 23.
    SPSS., SPSS for Windows, Rel. 11.0.1. 2001. Chicago: SPSS Inc.Google Scholar
  24. 24.
    Overbosch, G. B., Nsowah-Nuamah, N. N. N., Van den Boom, G. J. M., & Mamnyag, L. (2004). Determinants of antenatal care use in Ghana. Journal of African Economies, 13, 277–301.Google Scholar
  25. 25.
    Chakraborty, N., Islam, M. A., Chowdhury, R. I., Bari, W., & Akhter, H. H. (2003). Determinants of the use of maternal health services in rural Bangladesh. Health Promotion International, 18, 327–337.PubMedCrossRefGoogle Scholar
  26. 26.
    Stewart, M. A. (1995). Effective physician-patient communication and health outcomes: a review. Canadian Medical Association Journal, 152, 1423–1433.PubMedGoogle Scholar
  27. 27.
    Caldwell, J. C. (1981). Maternal education as a factor in child mortality. World Health Forum, 2, 75–78.Google Scholar
  28. 28.
    Raghupathy, S. (1996). Education and the use of maternal health care in Thailand. Social Science and Medicine, 43, 459–471.PubMedCrossRefGoogle Scholar
  29. 29.
    Celik, Y., & Hotchkiss, D. R. (2000). The socioeconomic determinants of maternal health care utilization in Turkey. Social Science and Medicine, 50, 1797–1806.PubMedCrossRefGoogle Scholar
  30. 30.
    Mubyazi, G. M., Magnussen, P., Goodman, C., Bygbjerg, I. C., Kitua, A. Y., & Olsen, O. E. (2008). Implementing intermittent preventive treatment for malaria in pregnancy: review of prospects, achievements, challenges and agenda for research. The Open Tropical Medicine Journal, 1, 92–100.PubMedCrossRefGoogle Scholar
  31. 31.
    McDonagh, M. (1996). Is ANC effective in reducing maternal morbidity and mortality? Health Policy and Planning, 11, 1–15.PubMedCrossRefGoogle Scholar
  32. 32.
    Simpson, W. M., Johnstone, F. D., Goldberg, D. J., Gormley, S. M., & Hart, G. J. (1999). Antenatal HIV testing: assessment of a routine voluntary approach. British Medical Journal, 318, 1660–1661.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Sharon Naariyong
    • 1
  • Krishna C. Poudel
    • 1
  • Mosuir Rahman
    • 1
  • Junko Yasuoka
    • 1
  • Keiko Otsuka
    • 1
  • Masamine Jimba
    • 1
  1. 1.Department of Community and Global Health, School of International HealthGraduate School of Medicine, The University of TokyoTokyoJapan

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