title: Antenatal care and pregnancy outcomes in a safe motherhood health voucher system in rural Kenya, 2007-2013.
abstract: METHODS
  A rural private health facility, Ruby Medical Centre (RMC), participating in a safe motherhood health voucher system for poor women in Kiambu County, Kenya.
  
  
  OBJECTIVE
  Between 2007 and 2013, to determine 1) the number of women who delivered at the RMC, their characteristics and pregnancy-related outcomes, and 2) the number of women who received an incomplete antenatal care (ANC) package and associated factors.
  
  
  METHODS
  Retrospective cross-sectional study using routine programme data.
  
  
  RESULTS
  During the study period, 2635 women delivered at the RMC: 50% were aged 16-24 years, 60% transferred in from other facilities and 59% started ANC in the third trimester of pregnancy. Of the 2635 women, 1793 (68%) received an incomplete ANC package: 347 (13%) missed essential blood tests, 312 (12%) missed the tetanus toxoid immunisation and 1672 (65%) had fewer than four visits. Presenting late and starting ANC elsewhere were associated with an incomplete package. One pregnancy-related mortality occurred; the stillbirth rate was 10 per 1000 births.
  
  
  CONCLUSIONS
  This first assessment of the health voucher system in rural Kenya showed problems in ANC quality. Despite favourable pregnancy-related outcomes, increased efforts should be made to ensure earlier presentation of pregnant women, comprehensive ANC, and more consistent and accurate monitoring of reproductive indicators and interventions.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ruby Medical Centre, Kiambu West, Kenya.
authors.forename: A-B
authors.initials: AB
authors.lastname: Kihara
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Harries
authors.affiliation: International Union Against Tuberculosis and Lung Disease, Paris, France ; School of Population Health, The University of Auckland, Auckland, New Zealand.
authors.forename: K
authors.initials: K
authors.lastname: Bissell
authors.affiliation: Médecins Sans Frontières (MSF) Belgium, Nairobi, Kenya.
authors.forename: W
authors.initials: W
authors.lastname: Kizito
authors.affiliation: Medical Department, Brussels Operational Center, MSF-Luxembourg, Luxembourg.
authors.forename: R
authors.initials: R
authors.lastname: Van Den Berg
authors.affiliation: Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Ministry of Health, Nairobi, Kenya.
authors.forename: S
authors.initials: S
authors.lastname: Mueke
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: A
authors.initials: A
authors.lastname: Mwangi
authors.affiliation: Moi University School of Medicine, Eldoret, Kenya.
authors.forename: J C
authors.initials: JC
authors.lastname: Sitene
authors.affiliation: Ruby Medical Centre, Kiambu West, Kenya.
authors.forename: D
authors.initials: D
authors.lastname: Gathara
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya.
authors.forename: R J
authors.initials: RJ
authors.lastname: Kosgei
authors.affiliation: Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya ; Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya.
authors.forename: J
authors.initials: J
authors.lastname: Kiarie
authors.affiliation: Kenya Obstetrics and Gynaecology Society, Nairobi, Kenya ; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
authors.forename: P
authors.initials: P
authors.lastname: Gichangi
keywords: SORT IT; complete ANC package; operational research; output-based aid