Sp. Munjanja et al., RANDOMIZED CONTROLLED TRIAL OF A REDUCED-VISITS PROGRAM OF ANTENATAL CARE IN HARARE, ZIMBABWE, Lancet, 348(9024), 1996, pp. 364-369
Background Many of the individual components of antenatal care have be
en studied in randomised controlled trials, but few studies have compa
red whole programmes of antenatal care. Our aim was to test the hypoth
esis that a new programme of antenatal care with fewer goal-oriented v
isits would give an equivalent or better result in the outcomes associ
ated with pregnancy and delivery. Methods In a randomised clinical tri
al in Harare, Zimbabwe, we compared a new programme of antenatal care
with the standard programme. The new programme consisted of fewer but
more objectively oriented procedures per visit. Seven primary randomly
assigned to the two programmes-three to the standard programme and fo
ur to the new programme. Findings Over a 2-year period, 15 994 women w
ere recruited into the study at the time they booked antenatal cave, 9
7% of the women were followed up, 9394 who had followed the new progra
mme, and 6138 from clinics with the standard one, Women allocated to t
he new programme made, as planned, fewer visits than those in the stan
dard programme (median 4 vs 6 visits, respectively). The proportion of
antenatal referrals was also lower (13.6 vs 15.3%: odds ratio 0.87 [9
5% CI 0.79-0.95]) because of fewer referrals for pregnancy-induced (2.
5 vs 3.8%; 0.66 [0.55-0.79]). Nevertheless, there were significantly f
ewer labour referrals for severe hypertension or eclampsia (2.1 vs 2.6
%; 0.81 [0.66-1.00]). The risk for preterm (<37 weeks) delivery was si
gnificantly lower for women on the new programme (10.1 vs 11.5%: 0.86
[0.78-0.96]). There were no other significant differences between the
programmes in other major indices of pregnancy outcome, including ante
natal referrals for other causes, labour referrals, obstetric interven
tions, low birthweight, and perinatal and maternal mortality and morbi
dity. Interpretation An antenatal care programme with fewer more objec
tively oriented visits can be introduced without adverse effects on th
e main intermediate outcome pregnancy variables.