Email updates

Keep up to date with the latest news and content from BMC Research Notes and BioMed Central.

Open Access Short Report

Quality of antenatal care in rural southern Tanzania: a reality check

Malabika Sarker1*, Gerhard Schmid2, Elin Larsson3, Sylvia Kirenga4, Manuela De Allegri1, Florian Neuhann1, Theodora Mbunda4, Isaack Lekule4 and Olaf Müller1

Author Affiliations

1 Institute of Public Health, University of Heidelberg, Heidelberg, Germany

2 Swiss Tropical Institute, University of Basel, Basel, Switzerland

3 Division of Global Health, Department of Public Health Sciences, Karolinska Institute, Stockholm, Sweden

4 Ifakara Health Institute, Dar es Salaam, Tanzania

For all author emails, please log on.

BMC Research Notes 2010, 3:209  doi:10.1186/1756-0500-3-209

Published: 27 July 2010



Counselling on the danger signs of unpredictable obstetric complications and the appropriate management of such complications are crucial in reducing maternal mortality. The objectives of this study were to identify gaps in the provision of ANC services and knowledge of danger signs as well as the quality of care women receive in case of complications.


The study took place in the Rufiji District of Tanzania in 2008 and was conducted in seven health facilities. The study used (1) observations from 63 antenatal care (ANC) sessions evaluated with an ANC checklist, (2) self-assessments of 11 Health workers, (3) interviews with 28 pregnant women and (4) follow-up of 12 women hospitalized for pregnancy-related conditions.

Blood pressure measurements and abdominal examinations were common during ANC visits while urine testing for albumin or sugar or haemoglobin levels was rare which was often explained as due to a lack of supplies. The reasons for measuring blood pressure or abdominal examinations were usually not explained to the women. Only 15/28 (54%) women were able to mention at least one obstetric danger sign requiring medical attention. The outcomes of ten complicated cases were five stillbirths and three maternal complications. There was a considerable delay in first contact with a health professional or the start of timely interventions including checking vital signs, using a partograph, and detailed record keeping.


Linking danger signs to clinical and laboratory examination results during ANC with the appropriate follow up and avoiding delays in emergency obstetric care are crucial to the delivery of coordinated, effective care interventions.