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  • Title: Health education for pregnancy care in Harare. A survey in seven primary health care clinics.
    Author: Murira N, Munjanja SP, Zhanda I, Lindmark G, Nystrom L.
    Journal: Cent Afr J Med; 1996 Oct; 42(10):297-301. PubMed ID: 9130406.
    Abstract:
    OBJECTIVE: The aim of this study was to evaluate how health education is currently practiced in the antenatal clinics in Harare and to make recommendations for its improvement. DESIGN: This was a descriptive study in which data was collected through subject interviews and by observations of antenatal clinics in progress. SETTINGS: Antenatal sessions at primary care clinics in Harare. SUBJECTS: 100 pregnant women and 65 midwives. MAIN OUTCOME MEASURE: The timing, frequency and methods used in health education and the attitude of the pregnant mothers and staff to health education. RESULTS: The results revealed that health education was given once in pregnancy, on the first visit only. The lecture was the most used teaching method. The lecture was full of distractions which affected the concentration of the audience. Midwives decided on the subject matter for health education without consultation with the expectant women. As a result many women could not follow the practical advice given to them. Midwives overestimated their use of other methods of health education. Both the staff and the pregnant women agreed that there should be greater use of written material for women to read at home with their spouses. CONCLUSION: The lecture is not the most appropriate method of health education during pregnancy and greater use should be made of other methods of communication such as the mass media and pamphlets. An evaluation of prenatal health education in 7 primary care clinics in Harare, Zimbabwe, during 1989-91 indicated a need for more attention to this program aspect. Interviews were conducted with 65 clinic midwives and 100 randomly selected pregnant women who had made 2 or more prenatal visits. In addition, educational sessions were observed. Health education was provided only once during pregnancy, generally at the end of the day of the first visit. The education usually took the form of a group lecture without visual aids or written handouts. The lecture covered nutrition and hygiene recommendations, pregnancy risk factors, and sexually transmitted diseases. Only 33% of pregnant women indicated they would be able to follow the advice given by the midwives. Midwives identified women's cultural and religious beliefs, noise and inattention during the lecture, the lack of questions from mothers, and women's skepticism about the information imparted as the main obstacles to effective health education. The pregnant women cited the inconvenient time of day the lectures were scheduled, their hurried nature, and the failure of midwives to solicit topics of interest to clients as the main obstacles. Optimally, prenatal education should increase pregnant women's knowledge, correct misconceptions, strengthen confidence, and offer women an opportunity to express their fears and concerns. It is unlikely that a single lecture without written materials to take home can impart any meaningful new knowledge or produce behavioral change. Among this study's recommendations are training of midwives in communication skills, production of a small pamphlet containing answers to the questions most frequently asked during pregnancy, and individualized health education throughout pregnancy.
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