An observational checklist (see Additional file 3 ) for routine antenatal care visits was developed. It captured eight recommendations in the National Guidelines in Reproductive Health Care [38 ] and included 81 items (see Table 2 ). Assessments were made using a scale with the options yes/no/don’t know/cannot observe. Midwifery teachers were trained to undertake structured and non-participatory observations of four women’s antenatal care visits in each commune health centre at the beginning and the end of the PeriKIP project.
Domains covered in the observational checklist
| 1. Asking questions about the pregnant woman’s health and reproductive health history |
| 2. General examination of the pregnant woman |
| 3. Performing different tests |
| 4. Tetanus vaccination (counselling and provision of vaccines) |
| 5. Provision of essential drugs |
| 6. Health education for pregnant women |
| 7. Recording patient information |
| 8. Danger signs during pregnancy, birth preparedness and feedback on examinations |
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