Godelieve Masuy-Stroobant

The development and application of a new tool to assess the adequacy of the content and timing of antenatal care

BackgroundCurrent measures of antenatal care use are limited to initiation of care and number of visits. This study aimed to describe the development and application of a tool to assess the adequacy of the content and timing of antenatal care.MethodsThe Content and Timing of care in Pregnancy (CTP) tool was developed based on clinical relevance for ongoing antenatal care and recommendations in national and international guidelines. The tool reflects minimal care recommended in every pregnancy, regardless of parity or risk status. CTP measures timing of initiation of care, content of care (number of blood pressure readings, blood tests and ultrasound scans) and whether the interventions were received at an appropriate time. Antenatal care trajectories for 333 pregnant women were then described using a standard tool (the APNCU index), that measures the quantity of care only, and the new CTP tool. Both tools categorise care into 4 categories, from Inadequate (both tools) to Adequate plus (APNCU) or Appropriate (CTP). Participants recorded the timing and content of their antenatal care prospectively using diaries. Analysis included an examination of similarities and differences in categorisation of care episodes between the tools.ResultsAccording to the CTP tool, the care trajectory of 10,2% of the women was classified as inadequate, 8,4% as intermediate, 36% as sufficient and 45,3% as appropriate. The assessment of quality of care differed significantly between the two tools. Seventeen care trajectories classified as Adequate or Adequate plus by the APNCU were deemed Inadequate by the CTP. This suggests that, despite a high number of visits, these women did not receive the minimal recommended content and timing of care.ConclusionsThe CTP tool provides a more detailed assessment of the adequacy of antenatal care than the current standard index. However, guidelines for the content of antenatal care vary, and the tool does not at the moment grade over-use of interventions as Inappropriate. Further work needs to be done to refine the content items prior to larger scale testing of the impact of the new measure.

Infant health and mortality indicators. Their accuracy for monitoring the socio-economic developement in the Europe of 1994

The ability of infant mortality and health indicators to monitor health conditions in early infancy, and their broader use as indicators of the general level of socio-economic development are discussed from three points of view. These are: (i) the increasing impact of differences in legal definitions of live and stillbirths on the comparability of the infant mortality figures produced by vital statistics; (ii) the validity of mortality measures to monitor health; (iii) the comparability of social inequalities in infant health and mortality over time and across countries.RésuméLa validité de la mesure de la mortalité infantile comme indicateur de développement économique et social est remise en question dans le contexte de la situation actuelle en Europe. Trois axes de réflexion sont envisagés: limpact croissant de différences dans les critères légaux de définition des naissances viràntes et des naissances denfants mort-nés sur les niveaux de mortalité infantile fournis par les statistiques détat civil; la pertinence de mesures de mortalité comme indicateurs de santé infantile; la comparabilité dans le temps et dans lespace des inégalités sociales de santé et mortalité infantile.