Perspectives and practices of health workers in selected local government areas of Lagos State regarding focused antenatal care
This study assessed the knowledge of health workers in Lagos Mainland and Mushin Local Government Areas of Lagos State about focused antenatal care (FANC) and the attitude/ beliefs of the health workers toward FANC. It further determined the acceptability and practice of FANC and the correlates of the practice of FANC among health workers in Lagos Mainland and Mushin Local Government Areas of Lagos State. This was with a view to examining the health workers’ perspectives and practices regarding FANC. The study employed both qualitative and quantitative methodologies. The quantitative survey was cross-sectional in design and was carried out with the aid of a semi-structured, self- administered questionnaire applied to 400 health workers at the selected health facilities. The qualitative design consisted of three focus group discussions (FGD) with doctors, nurses and community health workers. Quantitative data were analysed and presented using univariate, bivariate and multivariate statistical methods. Statistical significance was accepted at p< 0.05. Qualitative data were analysed using detailed content analysis and results presented with Z-Y index tables. The results showed that 225 (56.2%) respondents were aware of FANC. Three hundred and forty-six respondents (86.5%) had no protocols on FANC, while 336 (84%) had no educational materials regarding FANC. One hundred and twenty-four (55.1%) of those aware of FANC knew that FANC visits should be carried out four times in normal pregnancy. However, only 38 (16.9%) of them knew that health workers were expected to spend approximately 46 mins with each patient during the first visit, while 46 (20.7%) knew that health workers were expected to spend approximately 27 mins with each patient during revisits. The years of practice as a health worker was significantly and positively associated with the knowledge of FANC (χ2 =21.048; p<0.005). Regarding the gestational age when clients should visit, 140 (62.2%) respondents who were aware of FANC correctly reported that clients should first visit at 10-17 weeks, 143 (63.6%) correctly reported that second visit should be at 24-28 weeks and 29 (12.9%) correctly reported that third visit should be at 32 weeks. Two hundred and six respondents (91.6%) who were aware of FANC indicated that the strategy was acceptable to them. The practice of FANC was generally poor among the respondents; 321(80.25%) were not practicing FANC in their health facilities while only 79 (19.75%) were practicing FANC. Seventy nine percent of the respondents believed that FANC is time consuming, while 76% believe that it is stressful. Overall, 51% of those aware of FANC demonstrated a positive attitude towards the practice of FANC. Respondents that had positive attitude towards FANC were 9 times more likely to practice FANC compared to those with negative attitude (OR= 9.65; p<0.05). Medical doctors were 14 times more likely to have good knowledge about FANC compared to other health workers (OR=14.32; p<0.05). The study concluded that while significant proportions of the health workers had good knowledge of FANC, and were positively predisposed to it, the practice was poor. The major predictor of practice of FANC was the attitude of the health workers to the strategy.