Table 1 Attributes of care: structure, process and outcome

Data collection tools (0–3)

Registers for: ANC visits, inpatients and referrals, maternal deaths

Infrastructure (0–6)

Source of clean water, 24 h power for fridge, autoclave/sterilization, lighting, infection prevention buckets, chlorine for processing equipment

PE/E Guidelines (0–5)

Protocols for diagnosis PE/E, managing PE/E, administering MgSO₄

General Equipment (0–11)

Stethoscopes, sphygmomanometers, urine collection containers, dipsticks, patella hammers, self-retaining catheter, urine bag, 20 ml syringe, saline (IV), IV equipment, syringe/needles

Availability of Drugs (0–5)

Availability of magnesium sulfate, calcium gluconate, anti-hypertensives, xylocaine, misoprostol

Referral Mechanisms (0–4)

Transport system/ambulance, 24/7 referral system, facility makes transport arrangements, client is accompanied to referral facility

Capacity for HDP-specific services (0–4)

See pre-eclamptic/eclamptic patients in ANC visits, admit pre-eclamptic patients into labor ward, admit clients with eclampsia to maternity ward

Trainings in past 3 years (0–7)

Any maternal/FP training, emergency obstetric care, ANC, safe delivery, skilled birth attendant, family planning, lab investigations

Signs and Symptoms of HDPs (0–12)

Definition of HDPs, signs of mild PE (Y/N), signs of eclampsia (Y/N), signs of severe PE: high BP, proteinuria, severe headaches, changes in vision, light sensitivity, upper abdominal pain, nausea/vomiting, decreased urine output, edema

Management/Treatment of PE (0–8)

Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, administer anti-hypertensive, refer to nearest doctor/specialist

Management of Severe PE (0–9)

Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, administer anti-hypertensive, administer anti-seizure/magnesium sulfate, refer to nearest doctor/specialist

Management of Eclampsia (0–11)

Admit, start monitoring signs, monitor BP, monitor fetal heart rate, monitor fluid input/output, quantitative monitoring of proteinuria, keep tongue blade ready for possible seizure, administer anti-hypertensive, administer anti-seizure/magnesium sulfate, induce delivery, refer to nearest doctor/specialist

Diagnosis of HDPs (0–3)

Chronic hypertension, PE, eclampsia

Use of MgSO₄ (0–7)

Know total loading dose for MgSO₄, know maintenance dose for MgSO₄, 2 ways to monitor toxicity, drug used to treat toxicity, how to administer drug to treat toxicity, 1 advantage/disadvantage of using MgSO₄, believe that morbidity/mortality will decrease with use of loading dose

Eclampsia Prophylaxis (0–4)

Guidelines on giving prophylaxis to prevent PE, which drug to give to prevent PE, currently use aspirin among women at risk of PE/E, 1 advantage/disadvantage of using prophylaxis to prevent PE

Antihypertensive Drugs (0–5)

Use antihypertensive to control HT in PE patients, use vasodilators to control severe HT in PE/E patients, know correct BP at which anti-hypertensives are administered, know correct BP at which vasodilators are administered, use antihypertensive to treat pregnant women with high BP

History taking (0–9)

Date of last menstrual period, any current medication, general health problems, history of hypertension/high BP, diabetes, asthma, TB, malaria, STI/STD

Previous pregnancy history taking

(0–6)

Type and duration of last delivery, history of miscarriage/abortion, stillbirth, neonatal death, cesarean section

Physical examination (0–9)

Weight, blood pressure, pulse, conjunctiva, body temperature, edema, abdomen palpation, fetal movement/heart rate

Lab tests (0–2)

Urine: glucose, albumin

Health promotion/ disease prevention (0–12)

Provided: malaria prophylaxis, tetanus toxoid injection, iron/folic acid supplements, HIV test; took blood sample, urine sample; gave advice/information on: diet & nutrition, insecticide-treated bed nets, STIs/AIDS, PMTCT of HIV, danger signs of pregnancy, self-care

Encouragement of continuation of care (0–3)

Told when and where to return for follow-up, given written reminder of date for follow-up

Documentation (0–2)

nfo recorded on: client’s ANC card, in registers

Rapport (0–7)

Used client’s name, greeted client in friendly manner, requested client to take a seat, maintained audio & visual privacy, treated client with respect, client felt comfortable asking questions

Communication (0–4)

Used words client could understand, listened to client attentively, inquired for need of other services, answer client’s inquiries

Wait and cost (0–3)

Time spent waiting was reasonable, time with provider was reasonable, amount paid was reasonable

Satisfaction (0–5)

Satisfied with services received, would recommend to a friend, will return: before giving birth, 1 week after birth, 6 weeks after birth

Health comprehension/literacy (0–8)

Opportunity to ask questions, encouraged to return for another visit, discussed progress of pregnancy, provided results from: checkup, blood pressure, urine test; explained results from: blood pressure, urine test

Wait time (average)

Wait before seeing provider

Time spent with provider (average)

Length of consultation

First ANC Visit

Proportion of women attending a first ANC visit in < 10 weeks, 10–19 weeks, 20–29 weeks, or 30+ weeks

Amount willing to pay

Amount client is willing to pay for services (in USD)

Satisfaction

Proportion of women satisfied, somewhat satisfied, or not at all satisfied with services

Knowledge of danger signs

Proportion of women who know none, 1, 2, or 3 danger signs of pregnancy that would make them return to the facility