Pattern of Obstetric Clinic Attendance, Deliveries and Neonatal Outcome at a Tertiary Hospital during and after a Free Medical Care Programme

Abstract

Background: Policies and programs aimed at giving access to healthcare free of charge for some segments of the population are increasingly being put in place by low and middle-income countries. The impact of such policies has so far been rather mixed. Objective: This study sought to determine the pattern of obstetrics clinic attendance, deliveries and neonatal outcome during and after a Free Medical Care (FMC) Programme. Was there any significant difference during and after the FMC programme?  Methodology: This was a retrospective population-based study involving the three years of a free medical care programme (2012-2014) and the three years after the programme (2015-2017). Data on antenatal/postnatal clinic attendance, method of deliveries and neonatal outcome were retrieved from the hospital records. The Epi-Info 7 statistical software was used for analysis and statistical significance was set at p<0.05. Results: Mean antenatal attendance was 20763.67±6085.71 and 14269.00±1932.71 during and after the programme respectively, but this difference was not significant (P = 0.143). The mean postnatal attendance of 1457.7±447.69 during and 1025.7±193.52 after was not significant (P=0.200). There was more total number of deliveries during (8596) than after (5989) but this was not significant (P=0.171). There were more operative deliveries during (51.9%) than after (39.3%) and this was significant (P=0.0001). The CS rate was 43.1% with previous CS and CPD both responsible for over 40%. Livebirths were 8,272 (58.8%) during and 5,796 (41.2%) after, which was significant (P=0.0001). There was significant difference (P=0.006) in the macerated stillborn (MSB) rate during (44.2%) and after (55.8%). The stillborn rate was 66.9 during and 98.2 after the programme. Conclusion: There were more clinic attendance and deliveries during the programme, but it was not statistically significant. There was however statistically significant increase in operative delivery, total births and livebirths, and reduced MSB rate during the programme.