Local professional societies may play important roles in this process and an all-inclusive and participatory process should be encouraged. Dr. Poly Begum Assistant Professor Diabetic Association Medical College, Faridpur. Based on this RR, the illustrative impact on perinatal mortality rates are shown in Box 4. The DECIDE (Developing and Evaluating Communication Strategies to support Informed Decisions and Practice based on Evidence) (6) framework, an evidence-to-decision tool that includes intervention effects, values, resources, equity, acceptability and feasibility criteria, was used to guide the formulation and approval of recommendations by the Guideline Development Group (GDG) – an international group of experts assembled for the purpose of developing this guideline – at three Technical Consultations between October 2015 and March 2016. WHO envisions a … 2015;(7):CD000934, WHO handbook for guideline development, 2nd edition. This evidence was not formally graded due to insufficient data. The decision regarding the number of contacts with a health system was also influenced by the following: Should alternative models of ANC with four visits (FANC) be recommended instead of standard care of eight visits for the ANC of healthy pregnant women? The ANC recommendations are intended to inform the development of relevant health-care policies and clinical protocols. Furthermore, evidence suggests that more ANC visits, irrespective of the resource setting, is probably associated with greater maternal satisfaction than less ANC visits. Moderate-certainty evidence indicates that FANC probably has little or no effect on preterm birth (3 trials, 47 094 women; RR: 0.99, 95% CI: 0.91–1.08) and low birth weight (3 trials, 46 220 women; RR: 1.04, 95% CI: 0.97–1.12) compared with “standard” ANC. GUIDELINES FOR MATERNITY CARE IN SOUTH AFRICA GUIDELINES FOR MATERNITY CARE IN SOUTH AFRICA Fourth Edition 2016 3 GUIDELINES FOR MATERNITY CARE IN SOUTH AFRICA GUIDELINES … Emotional and psychosocial needs are variable and the needs of vulnerable groups (including adolescent girls, displaced and war-affected women, women with disabilities, women with mental health concerns, women living with HIV, sex workers, ethnic and racial minorities, among others) can be greater than for other women. Implications for the introduction of the focused antenatal care model in Tanzania. To ensure that each recommendation is correctly understood and applied in practice, the context of all context-specific recommendations is clearly stated within each recommendation, and the contributing experts provided additional remarks where needed. Cochrane Database Syst Rev. With the FANC model, the first ANC visit occurs before 12 weeks of pregnancy, the second around 26 weeks, the third around 32 weeks, and the fourth between 36 and 38 weeks of gestation. Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO Antenatal Care Trial. Factors that influence the use of routine antenatal services by pregnant women: a qualitative evidence synthesis. Up-to-date systematic reviews were used to prepare evidence profiles for priority questions. 2013;10:19. doi:10.1186/1742-4755-10-19. iv Antenatal care 6 Management of common symptoms of pregnancy 106 6.1 Nausea and vomiting in early pregnancy 106 6.2 Heartburn 108 6.3 Constipation 109 6.4 … Adoption and implementation of ANC guidelines at large scale. Lancet. To screen the high risk cases. Aims 1. An enabling environment should be created for the use of this recommendation, including changes in the behaviour of health care practitioners to enable the use of evidence-based practices. Trop Med Int Health. 2. Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures? Presentation Summary : Providing respectful care that takes into account woman’s views. In addition, low-certainty evidence suggests that FANC probably makes little or no difference to SGA (3 trials, 43 094 women; RR: 1.01, 95% CI: 0.88–1.17). WHO antenatal care randomised trial for the evaluation of a new model of routine antenatal care. However, the reduced visit schedule may be appreciated by some women in a range of LMIC settings because of the potential for cost savings, e.g. For the purpose of developing this new ANC model, the ANC recommendations were mapped to the eight contacts based on the evidence supporting each recommendation and the optimal timing of delivery of the recommended interventions to achieve maximal impact. In addition, in low-resource settings, when the target is set at four ANC visits, due to the various barriers to ANC use, far fewer than four visits may actually be achieved. However, up-to-date evidence shows that the FANC model, which was developed in the 1990s, is probably associated with more perinatal deaths than models that comprise at least eight ANC visits. WHO recommendation on group antenatal care. Nyarko P, Birungi H, Armar-Klamesu M, Arhinful D, Degarnus S, Odoi-Agyarko H, Brew G. Acceptability and feasibility of introducing the WHO focused antenatal care package in Ghana. Provider compliance was noted to be problematic in some settings, as were shortages of equipment, supplies and staff. Antenatal care in developing countries: 2 prioritize the need for skilled care during delivery, including emergency obstetric care, rather than ensuring that all women receive antenatal care.1 Nonetheless, there are potential benefits to The GDG also considered existing recommendations from other WHO guidelines on task shifting and recruitment and retention of staff in rural areas. The audit from September 2013 to August 2015 comprised data of 149 308 births of neonates weighing more than 1000 g, among which there were 3893 perinatal deaths (giving a PMR of 24.8 per 1000 births). Programme reports from Ghana and Kenya stress that inadequate equipment, supplies, infrastructure and training may hamper implementation (12, 13). Reprod Health. Systemic supervision (examination and advice) of a women during pregnancy is called ANC. The World Health Organization has issued a new series of recommendations to improve quality of antenatal care to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. Geneva: World Health Organization; 2014 (, GRADE [website]. Outline. The number of visits in this model is considerably fewer than in ANC models used in HICs. Therefore, the number and content of visits should be adaptable to local context and to the individual woman. High-certainty evidence shows that FANC had little or no effect on caesarean section rates (1 trial, 24 526 women; RR: 1.00, 95% CI: 0.89–1.11), and low-certainty evidence suggests that it may make little or no difference to maternal mortality (3 trials, 51 504 women; RR: 1.13, 95% CI: 0.5–2.57). Presentation at ANC guideline development group meeting (21– 23 March). The WHO Reproductive Health Library; Geneva: World Health Organization. Antenatal care models with a minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care. Recommendations. The World Health Organization has issued a new series of recommendations to improve quality of antenatal care to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. Findings on provider compliance from these case studies are consistent with published findings from rural Burkina Faso, Uganda and the United Republic of Tanzania (11). Geneva: World Health Organization; 2002 (, Dowswell T, Carroli G, Duley L, Gates S, Gülmezoglu AM, Khan-Neelofur D, Piaggio G. Alternative versus standard packages of antenatal care for low-risk pregnancy. When these data were compared with stillbirth data from another South Africa province, which uses a model of ANC that includes fortnightly ANC visits from 28 weeks of gestation, the latter showed a gradual rise in the overall stillbirth risk from 28 weeks, with a single (and lower) peak at 40 weeks or more, i.e. In the United Kingdom trial, there was an increase in costs related to neonatal intensive care unit stays in the reduced visit model. These recommendations were developed in accordance with the methods described in the WHO handbook for guideline development (3). Pregnant women must be able to access the right care at the right time, says WHO WHO news release, 7 November 2016 New guidelines on antenatal care for a positive pregnancy experience Decreasing deaths during pregnancy The GRADE Working Group; 2016 (, GRADE-CERQual [website]. Factors that influence the provision of good quality routine antenatal care services by health staff: a qualitative evidence synthesis. WHO Guideline on Antenatal Care (2016)Overview. Health-care providers in this study were found to variably omit certain practices from the FANC model, including blood pressure measurement and provision of information on danger signs, and to spend less than 15 minutes per ANC visit. antenatal care. Implementation, research and monitoring & evaluation (M&E) BACKGROUND. What's new. loss of domestic income from extra clinic attendance and/or associated travel costs (low confidence in the evidence). In a survey conducted among a subset of WHO recommendations on antenatal care for a positive pregnancy experience 102 women participating in the WHO trial, fewer women were satisfied with the frequency of visits in the FANC model than in the standard model (77.4% versus 87.2%) and women in the FANC model were less likely to be satisfied with the spacing between visits compared with the standard model (72.7% versus 81%).

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