Development and Implementation of an Antenatal Care Follow-Up Passport at Almanagil Teaching Hospital: A Departmental Initiative in Obstetrics and Gynecology

Maternal healthcare continuity depends on the accurate documentation, effective communication, and active participation of women in their own care. Patient-held health records, including pregnancy passports, have been proven internationally to enhance information sharing and record completeness. Nonetheless, antenatal care (ANC) documentation lapses remain a significant issue in low- and middle-income countries (LMICs) such as Sudan.

This project, developed by the Department of Obstetrics and Gynecology at Almanagil Teaching Hospital, aimed to improve the completeness of ANC documentation through the introduction of a patient-held ANC passport.

A two-cycle quality improvement project (QIP) audit was conducted during August 3-13, 2025. Cycle 1 (baseline; n=54) involved consecutive ANC records reviewed against departmental standards. This was followed by the introduction of the ANC passport, with structured staff training and patient orientation. Cycle 2 (post-intervention; n=26) again included all consecutive eligible records during the audit window. The unequal numbers between cycles reflected actual clinic attendance rather than sampling. Data were extracted using a structured checklist, and comparisons were performed using chi-squared (χ²) tests. To control for multiple comparisons, Bonferroni adjustments were applied. Analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (Released 2019; IBM Corp., Armonk, New York, United States). Improvements were categorized as highest (≥75%), significant (50-74%), moderate (25-49%), or mild (<25%).

Baseline audit revealed major deficiencies, with many parameters undocumented (address, body mass index (BMI), bleeding history, drug and allergy history, partner name, and social history: all 0%). Post-intervention, these domains achieved 100% completeness. Significant gains were also observed for parity (0% → 96.2%), blood group (24.1% → 100%), and first-visit investigations (40.7% → 100%). Documentation of post-obstetric history improved from 0% to >50%. Most improvements were statistically significant (p<0.001).

Implementation of the ANC passport led to substantial improvements in the completeness of ANC documentation across nearly all parameters. This audit demonstrates that audit-driven, structured, patient-held records can enhance the accountability, continuity, and quality of ANC in resource-constrained settings. Clinical outcomes were not assessed and should be explored in future studies.