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    The WHO antenatal care model: the defects [letter]

    Ekele BA

    Acta Obstetricia et Gynecologica Scandinavica. 2003 Nov; 82(11):1063-1064.

    In these days of evidence-based medicine, whatever is done to provide evidence in favor or against a procedure, protocol, program, test or intervention is always welcomed. It is in this light that the new World Health Organization (WHO) antenatal care model, now being propagated for general implementation, will be assessed. The focus of the WHO antenatal model was the developing countries because it was rightly assumed that the routinely recommended antenatal care program is often poorly implemented and clinical visits can be irregular, with long waiting times and poor feedback to the women. A multicenter, randomized, control trial was therefore conducted to compare the old, standard "western" model of antenatal care with the new WHO model, which limits the number of visits to the clinic and restricts tests and clinical procedures. But this all-important study did not consider it appropriate to include at least one African country, with all the peculiarities of sub- Saharan Africa. Even then, out of the four chosen countries, Saudi Arabia, for instance, cannot be said to be a classic example of a developing country. The design of the study was therefore suspect from the outset! A closer look at the trial itself revealed more defects and debatable issues. For instance, the primary maternal outcome monitored was a maternal morbidity index, partly defined by eclampsia occurring within 24 h of delivery and severe postpartum anemia (hemoglobin <90 g/L). The issue of excluding eclamptics whose fits occur after 24 h of delivery might not be as controversial as labeling patients with hemoglobin of <90 g/L with severe anemia. Certainly there are many elegant studies that do not support that definition of severity, at least for African mothers. (excerpt)
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