Quality of antenatal care services in Sudan public health facilities: a cross-sectional study

To understand pregnant women's perception of the quality of antenatal care (ANC) services in terms of service provision and experience in Sudan, a country with one of the highest rates of maternal deaths worldwide.

A cross-sectional facility-based study.

Public primary healthcare centres in Khartoum state, Sudan.

473 pregnant women attending ANC visits. Data were collected through face-to-face interviews using a standardised questionnaire.

The perceived quality of ANC services assessed across two continuous domains: service provision score and care experience score.

The mean score for service provision was 19.96±3.03 out of 56. The great majority of the participants did not have their height or weight measured at any ANC visits 85% and 64.5%, respectively. About 87.1% and 82.5% of the participants, respectively, had blood and urine tests during each ANC visit. However, only 52.6% of the women reported receiving tetanus injections. The percentage of women receiving ultrasound examination at each visit was 88.4%. The mean score of care experience was 58.68±8.22 out of 84. Three-quarters of the women (74%) understood the purpose of the tests performed. The majority felt free to ask questions (87.3%). But only half and a third of the women were told about the signs of pregnancy complications and where to go in case any complications occurred, respectively. In linear regression, being married and older age had significant positive effects on women's perception of care provision (p=0.004 and p=0.003, respectively). Regarding the experience of care, older age affected care experience positively (p=0.038), while rural residency (p=0.044), being illiterate (p<0.001), having only primary education (p=0.002) and nulliparity (p=0.019) all had a significant negative effect on care experience.

Women's perception of the quality of ANC in terms of service provision and care experience was below average. Several factors were associated with their negative perceptions. These factors need to be further investigated and addressed to improve the quality of ANC provided.