RANDOMIZED CONTROLLED TRIAL OF A REDUCED-VISITS PROGRAM OF ANTENATAL CARE IN HARARE, ZIMBABWE

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.