WHO Proposes New Model For Provision Of Antenatal Care.(World Health Organization)

2001 JUN 14 - (NewsRx Network) -- A new model for the provision of antenatal care involving fewer clinic visits and potentially reduced healthcare costs - was proposed in the May 19, 2001, issue of The Lancet with the publication of the WHO Antenatal Care Randomized Controlled Trial and an accompanying systematic review.

Antenatal care is one of the most common medical practices, although it has undergone little scientific evaluation. Furthermore, its use in less-developed countries is largely based on antenatalcare models of more-developed settings.

Jose Villar and colleagues from the World Health Organization (WHO) undertook a multicenter randomized controlled trial that compared the standard model of antenatal care with a new model that emphasizes actions known to be effective in improving maternal or neonatal outcomes and has fewer clinic visits. Clinics in Argentina, Cuba, Saudi Arabia, and Thailand were randomly allocated to provide either the new model (27 clinics) or the standard model currently in use (26 clinics). All women presenting for antenatal care at these clinics over an average of 18 months were enrolled.

Women enrolled in clinics offering the new model were classified on the basis of history of obstetric and clinical conditions. Those who did not require further specific assessment or treatment were offered the basic component of the new model, and those deemed at higher risk received the usual care for their conditions; however, all were included in the new-model group for the analyses. The primary outcomes were low birthweight (less than 2500 g), preeclampsia/eclampsia, severe anemia after birth (less than 90 g/L hemoglobin), and treated urinary-tract infection. There was an assessment of quality of care and an economic evaluation.

Over 12,500 women attending clinics assigned the new model had an average of five visits compared with eight visits for around 12,000 women in clinics assigned the standard model. More women in the new model than in the standard model were referred to higher levels of care (13.4% compared with 7.3%), but rates of hospital admission, diagnosis, and length of stay were similar. The groups had similar rates of low birthweight (new model 7.7% compared with standard model 7.1%); anemia after birth (7.6% compared with 8.7%); and urinary-tract infection (5.95% compared with 7+4%). For ...