Gynecology 2027

Background: Nigeria accounted for an estimated 28.7% of global maternal deaths in 2023, and antenatal care (ANC) can reduce this burden only if primary health centers (PHCs) are ready to deliver it. Evidence on facility readiness in rural northwest Nigeria is scarce. This study assessed client- and provider-reported readiness of rural PHCs to deliver essential ANC in Kebbi State.

Methods: We conducted a cross-sectional survey of 420 respondents (pregnant women, women with a child aged five years or younger, and ANC providers) in rural PHC catchments in Argungu, Birnin Kebbi and Yauri Local Government Areas, selected by multistage sampling. Interviewer-administered questionnaires captured indicators mapped to the WHO health-system building blocks (service delivery, workforce, medicines and commodities, equipment, and referral linkage) and to access. Data were analyzed with descriptive statistics and generalized linear models.

Results: Basic clinical services were widely reported, including physical examination (97.9%), blood pressure measurement (96.7%), and malaria preventive treatment (92.9%). Commodity-dependent services lagged: iron supplementation (59.0%) and deworming (52.9%) were reported far less often, and only one respondent reported three tetanus doses. Mean reported coverage was 95.4% for clinical assessment services versus 76.1% for commodity-dependent services. Community Health Extension Workers alone provided ANC to 68.3% of respondents, and only 25.9% began ANC within 12 weeks. Of 83 women whose complications were detected, 16 (19.3%) were referred; unavailable drugs (33.5%), unavailable equipment or supplies (26.8%) and lack of transport (17.9%) were the main reasons emergency care was not obtained. Only 57.5% of women with a previous birth delivered in a health facility. Charges for services, perceived long waits, travel time and waiting time were associated with the number of ANC visits (p < 0.05).

Conclusions: Rural PHCs in Kebbi State deliver low-cost, protocol-driven ANC components well, but readiness weakens where care depends on skilled staff, commodities and referral. Because the findings rest on client and provider reports rather than a facility audit, they should be confirmed with facility inventories. Priorities include midwife deployment, commodity security, emergency transport and referral pathways, and reducing charges at the point of care.

Afamefuna Cyril Egbo is a medical and public health professional with over 15 years of experience in health systems strengthening, maternal and reproductive health, gender equity, community health, and emergency and disaster management. He holds a medical degree, a Master of Public Health (MPH), and a Master of Arts (MA) in Gender Studies, and is currently pursuing doctoral research focused on public health, gender, climate vulnerability, displacement, and disaster-related health risks. His scholarly interests include resilient health systems, maternal and child health, healthcare access and utilization, gender and health inequities, and humanitarian public health. He has authored and co-authored approximately 10 scholarly papers and is actively engaged in interdisciplinary research aimed at strengthening equitable and resilient health systems.