Development and Implementation of an Antenatal Care Follow-Up Passport at Almanagil Teaching Hospital: A Departmental Initiative in Obstetrics and Gynecology.

BACKGROUND

Maternal healthcare continuity depends on the accurate documentation, effective communication, and active participation of women in their own care. Patient-held health records, including pregnancy passports, have been proven internationally to enhance information sharing and record completeness. Nonetheless, antenatal care (ANC) documentation lapses remain a significant issue in low- and middle-income countries (LMICs) such as Sudan.

AIM: This project, developed by the Department of Obstetrics and Gynecology at Almanagil Teaching Hospital, aimed to improve the completeness of ANC documentation through the introduction of a patient-held ANC passport.

METHODS

A two-cycle quality improvement project (QIP) audit was conducted during August 3-13, 2025. Cycle 1 (baseline; n=54) involved consecutive ANC records reviewed against departmental standards. This was followed by the introduction of the ANC passport, with structured staff training and patient orientation. Cycle 2 (post-intervention; n=26) again included all consecutive eligible records during the audit window. The unequal numbers between cycles reflected actual clinic attendance rather than sampling. Data were extracted using a structured checklist, and comparisons were performed using chi-squared (χ²) tests. To control for multiple comparisons, Bonferroni adjustments were applied. Analyses were conducted using IBM SPSS Statistics for Windows, Version 25.0 (Released 2019; IBM Corp., Armonk, New York, United States). Improvements were categorized as highest (≥75%), significant (50-74%), moderate (25-49%), or mild (<25%).

FINDINGS: Baseline audit revealed major deficiencies, with many parameters undocumented (address, body mass index (BMI), bleeding history, drug and allergy history, partner name, and social history: all 0%). Post-intervention, these domains achieved 100% completeness. Significant gains were also observed for parity (0% → 96.2%), blood group (24.1% → 100%), and first-visit investigations (40.7% → 100%). Documentation of post-obstetric history improved from 0% to >50%. Most improvements were statistically significant (p<0.001).

CONCLUSION

Implementation of the ANC passport led to substantial improvements in the completeness of ANC documentation across nearly all parameters. This audit demonstrates that audit-driven, structured, patient-held records can enhance the accountability, continuity, and quality of ANC in resource-constrained settings. Clinical outcomes were not assessed and should be explored in future studies.