title: CenteringPregnancy-Africa: a pilot of group antenatal care to address Millennium Development Goals.
abstract: BACKGROUND
  severe health worker shortages and resource limitations negatively affect quality of antenatal care (ANC) throughout sub-Saharan Africa. Group ANC, specifically CenteringPregnancy (CP), may offer an innovative approach to enable midwives to offer higher quality ANC.
  
  
  OBJECTIVE
  our overarching goal was to prepare to conduct a clinical trial of CenteringPregnancy-Africa (CP-Africa) in Malawi and Tanzania. In Phase 1, our goal was to determine the acceptability of CP as a model for ANC in both countries. In Phase 2, our objective was to develop CP-Africa session content consistent with the Essential Elements of CP model and with national standards in both Malawi and Tanzania. In Phase 3, our objective was to pilot CP-Africa in Malawi to determine whether sessions could be conducted with fidelity to the Centering process.
  
  
  METHODS
  Phases 1 and 2 took place in Malawi and Tanzania. Phase 3, the piloting of two sessions of CP-Africa, occurred at two sites in Malawi: a district hospital and a small clinic.
  
  
  METHODS
  we used an Action Research approach to promote partnerships among university researchers, the Centering Healthcare Institute, health care administrators, health professionals and women attending ANC to develop CP-Africa session content and pilot this model of group ANC.
  
  
  METHODS
  for Phases 1 and 2, members of the Ministries of Health, health professionals and pregnant women in Malawi and Tanzania were introduced to and interviewed about CP. In Phase 2, we finalised CP-Africa content and trained 13 health professionals in the Centering Healthcare model. In Phase 3, we conducted a small pilot with 24 pregnant women (12 at each site).
  
  
  RESULTS
  participants enthusiastically embraced CP-Africa as an acceptable model of ANC health care delivery. The CP-Africa content met both CP and national standards. The pilot established that the CP model could be implemented with process fidelity to the 13 Essential Elements. Several implementation challenges and strategies to address these challenges were identified.
  
  
  CONCLUSIONS
  preliminary data suggest that CP-Africa is feasible in resource-constrained, low-literacy, high-HIV settings in sub-Saharan Africa. By improving the quality of ANC delivery, midwives have an opportunity to make a contribution towards Millennium Development Goals (MDG) targeting improvements in child, maternal and HIV-related health outcomes (MDGs 4, 5 and 6). A clinical trial is needed to establish efficacy.
  
  
  CONCLUSIONS
  CP-Africa also has the potential to reduce job-related stress and enhance job satisfaction for midwives in low income countries. If CP can be transferred with fidelity to process in sub-Saharan Africa and retain similar results to those reported in clinical trials, it has the potential to benefit pregnant women and their infants and could make a positive contribution to MGDs 4, 5 and 6.
authors.affiliation: University of Illinois at Chicago, Department of Anthropology, 1007 W. Harrison St (MC 027), Chicago, IL 60607, USA. Electronic address: cpatil@uic.edu.
authors.forename: Crystal L
authors.initials: CL
authors.lastname: Patil
authors.forename: Elizabeth T
authors.initials: ET
authors.lastname: Abrams
authors.forename: Carrie
authors.initials: C
authors.lastname: Klima
authors.forename: Chrissie P N
authors.initials: CP
authors.lastname: Kaponda
authors.forename: Sebalda C
authors.initials: SC
authors.lastname: Leshabari
authors.forename: Susan C
authors.initials: SC
authors.lastname: Vonderheid
authors.forename: Martha
authors.initials: M
authors.lastname: Kamanga
authors.forename: Kathleen F
authors.initials: KF
authors.lastname: Norr
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000628:therapy; D006297:Health Services Accessibility / Q000458:organization & administration; D006302:Health Services Research; D006801:Humans; D008295:Malawi; D008507:Medically Underserved Area; D017146:Models, Organizational; D009937:Organizational Objectives; D010342:Patient Acceptance of Health Care; D063868:Patient Outcome Assessment; D018802:Patient-Centered Care / Q000379:methods / Q000458:organization & administration; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000628:therapy; D011295:Prenatal Care / Q000379:methods / Q000458:organization & administration; D058996:Quality Improvement; D013636:Tanzania
keywords: Antenatal care; Group care; Millennium Development Goals; Sub-Saharan Africa