Pre-pregnancy care (PPC) is a set of interventions used to identify and reduce women’s risks during reproductive age, especially women with chronic illnesses to achieve a healthy pregnancy. It includes optimisation of care, advice on appropriate contraception, and lifestyle modification. Our project aims to increase the PPC registration percentage of women with diabetes and hypertension from 53% to 100%, hence increasing their chances of receiving appropriate PPC intervention.
Both the cards of diabetic and hypertensive clients were reviewed using the PPC assessment form where the percentages of registered clients, completeness of registration, and aspects of interventions were calculated. We developed a new standardised guideline with a refined registration process into our routine Non-Communicable Disease (NCD) Clinic. The new PPC guideline implementation was reassessed every three months for two cycles by our district PPC team.
Post-intervention, the percentages of diabetes and hypertension clients registered with PPC has increased to 79.2%. Furthermore, proper registration helped to increase the percentages of PPC intervention from 86.6% to 95.3%. The implementation analysis showed that the completeness of five registration components had increased significantly from 1.4% to 16.8%. All elements under optimisation of care showed a positive changed, from 65.1% to 85.6% for optimisation of treatment, 48% to 52.6% for contraception advice, and 30.2% to 44% for lifestyle modifications.
We conclude based on the findings of this study that a well-structured PPC guideline with a few modifications that enhanced the process efficiency was able to increase the PPC registration percentages of eligible women with diabetes and hypertension and in turn, increase their chances of getting appropriate intervention. Continuous assessment and periodic PPC courses for healthcare workers are essential to ensure the sustainability of the implementation.