WHO Antenatal Care Guideline Implementation Guide
0.3.0 - CI Build

WHO Antenatal Care Guideline Implementation Guide, published by World Health Organization (WHO). This is not an authorized publication; it is the continuous build for version 0.3.0). This version is based on the current content of https://github.com/WorldHealthOrganization/smart-anc/ and changes regularly. See the Directory of published versions

Documentation

This implementation guide provides computable content based on the Digital Adaptation Kit (DAK) to facilitate the implementation of the WHO Antenatal care guidelines. The following diagram illustrates the components of a Digital Adaptation Kit and how those components are represented in FHIR:

  • Health Interventions: Health interventions describe the highest level guidance and recommendations of the guideline, and are represented using the CPGPathway and CPGStrategy profiles of the PlanDefinition resource.
  • Generic Personas: Generic personas provide a depiction of the end-users, supervisors, and related stakeholders who would be interacting with the digital system or involved in the care pathway. Generic personas are represented using profiles of the various entity resources in FHIR such as Patient, Practitioner, PractitionerRole, and RelatedPerson.
  • User Scenarios: User scenarios are narratives that describe how the different personas may interact with each other, and provide illustrations and examples of typical workflows. These scenarios are represented using example resources and test cases.
  • Processes: A business process is a set of related activities or tasks performed together to achieve the objectives of the health programme area, such as registration, counselling, and referrals. Workflows are a visual representation of activities (tasks, decision points, and interactions) that are performed within the business process. Processes are represented using the CPGStrategy profile of the PlanDefinition, and activities are represented using the CPGActivityDefinition profile. In addition, the CPG-on-FHIR IG describes the types of activities that can be represented, and provides a common process to allow content from different guidelines to establish common entry points and steps across guidelines.
  • Data Elements: The data dictionary provides a description of the data elements required throughout the guideline, as well as a mapping of those data elements to standard terminologies such as ICD, SNOMED CT, and LOINC. Data elements are represented using a combination of the CodeSystem, ValueSet, StructureDefinition (profiles and extensions), and Questionnaire resources.
  • Decision Tables: Decision tables provide decision support logic and algorithms to support appropriate service delivery in accordance with WHO clinical, public health, and data use guidelines. Decision tables are represented using the CPGRecommendationDefinition profile of the PlanDefinition resource, as well as CQL libraries to provide a computable representation of the rule logic.
  • Indicators: Indicators provide a core set of indicators that need to be aggregated for decision-making, performance metrics, and subnational and national reporting. The indicators and metrics are based on data that can feasibly be captured from a routine digital system, rather than survey-based tools. Indicators are represented using the CPGMetric profile of the Measure resource, as well as CQL libraries to provide a computable representation of the indicator criteria.
  • Functional Requirements: Functional and non-functional requirements provide a listing of the core functions and capabilities the system must have to meet the end-users’ needs and achieve tasks within the business process. These requirements can potentially be represented using CapabilityStatement (future work).

Health Interventions

The key interventions for routine antenatal care (ANC) are the following, as defined in the WHO UHC compendium of essential interventions:

Health interventions are represented using strategy and pathway artifacts:

Code Description Artifact
ANC.INT.01 Health education and counselling to promote healthy pregnancy future work
ANC.INT.02 Nutritional supplementation during pregnancy future work
ANC.INT.03 Maternal and fetal assessment and screening during pregnancy future work
ANC.INT.04 Preventive measures and vaccination during pregnancy future work
ANC.INT.05 Treatment for physiological symptoms during pregnancy future work
ANC.INT.06 Antenatal care models with a minimum of eight contacts ANC.S01

Note that although this implementation does not include high-level representations of many of these interventions, the decision support logic included as part of the routine contact provides an implementation of these health interventions.

Generic Personas

A persona is a depiction of a relevant stakeholder, or “end-user”, of the system. Personas are represented with profiles of the appropriate FHIR resource, as depicted in the following table:

Occupational title Description ISCO code Profile
Auxilliary nurse midwife (ANM) Auxiliary nurse midwives (ANMs) assist in the provision of maternal and newborn health care, particularly during childbirth but also in the prenatal and postpartum periods. 3221 (Nursing associate professional)
3222 (Midwifery associate professional)
ANCPractitionerRole
Midwife A person who has been assessed and registered by a state midwifery regulatory authority or similar regulatory authority. 2222 (Midwifery professional) ANCPractitionerRole
Nurse A graduate who has been legally authorized (registered) to practise after examination by a state board of nurse examiners or similar regulatory authority. 2221 (Nursing professional) ANCPractitionerRole
Pregnant woman Pregnant women are the primary clients receiving antenatal care (ANC) services from the targeted health worker personas. N/A ANCPatient
Adolescent client Adolescent clients require additional decision support logic N/A ANCPatient
Lay health worker Any health worker who performs functions related to health-care delivery, was trained in some way in the context of the intervention but has received no formal professional or paraprofessional certificate or tertiary education degree. 3259 (Health associate professionals not elsewhere classified) ANCPractitionerRole
Community health worker Community health workers provide health education, referral and follow-up; case management and basic preventive health care; and home visiting services to specific communities. They provide support and assistance to pregnant women and their families in navigating the health and social services system. 3253 (Community health workers) ANCPractitionerRole

NOTE: There are other personas in the Digital Adaptation Kit (Nurse/Midwife supervisor, Facility Manager) that are not represented here.

See the ANC Personas code system for complete definitions.

User Scenarios

User scenarios are a narrative description of how different personas would interact with each other. The user scenario is provided to help the reader better understand how the system will be used and how it would fit into existing workflows. The following illustrative examples provide scenarios that may be common within ANC. In the subsequent component on workflows, these types of scenarios will be presented in a visual diagram, as opposed to narrative form. Note: these scenarios are not exhaustive and are only intended to contextualize the workflows in Component 4.

User scenarios within this implementation guide are represented with ExampleScenario resources.

User scenario for first antenatal care contact

First Contact Example Scenario

User scenario for second antenatal care contact

Second Contact Example Scenario

User scenario for an adolescent client

Adolescent Example Scenario

Business Processes

Label Process name Process ID Artifact
A Registration ANC.A CPGCommonRegistration
B Routine ANC Contact ANC.B ANC.B Routine Contact
C ANC referral ANC.C future work
D ANC health promotion, follow-up in the community ANC.D future work
E Reporting on aggregate indicators ANC.E future work

NOTE: C, D, and E are not yet specified by this implementation guide

Routine ANC Contact

Each of these steps will have data requirements that are either met/unmet, and a corresponding questionnaire (either explicitly specified, or derived from missing/incomplete data requirements) to be used as an interface for completing the activity. Each of the steps here are mapped to one of the common process codes in CPGCommonProcess:

  1. Rapid assessment and management (RAM)
  2. Danger signs needing referral?
  3. Confirm pregnancy
  4. First contact
  5. Quick check
  6. Profile
  7. Check symptoms and follow-up
  8. Conduct physical exam
  9. Conduct laboratory test and imaging
  10. Counselling, in-facility management and treatment
  11. Urgent referral?
  12. Scheduling
  13. Self-care in the home or community

NOTE: Steps 1 and 2 are expected to be performed as part of the registration process and are not modeled in the routine contact.

Sequence Diagrams

The following sequence diagrams illustrate the processing that occurs in a typical first contact scenario. The actors are:

  • Pregnant Woman: The pregnant woman generic persona, a client that is a pregnant woman seeking antenatal care
  • Clerk: The clerk generic persona, a registration clerk at the clinic
  • Nurse: The nurse generic persona, a clinical professional at the clinic
  • App: The primary application that the users interact with
  • Engine: The engine component of the digital system that implements the business processes and logic of the Antenatal care guideline
  • Server: A central repository of shared patient records. This may be scoped to the local clinic, or it may be a more broadly implemented repository. From the perspective of these sequences, it is a repository that is expected to contain the longitudinal record for patients seen at this clinic.

The First Contact sequence illustrates the overall processing and high-level steps:

The Registration sequence illustrates the process of identifying and potentially creating the patient record, syncing that data with a clinical data repository, and collecting initial information from the pregnant woman:

The Enrollment sequence illustrates the process that a Nurse uses to manually enroll the patient in the Antenatal care pathway, establishing the Care Plan of Record:

The Encounter Processing sequence illustrates the process of starting an encounter and establishing the activities to be performed based on the Routine Contact strategy:

The Activity Processing sequence illustrates the general process of performing activities within the encounter. For each activity, the decision logic associated with that activity provides proposed activities based on the guideline:

Data Elements

Data elements are represented within this implementation guide using FHIR profiles of the appropriate resource as well as libraries of associated calculation logic for calculated, or inferred, data elements.

Note that some “Data elements” from the perspective of the Data Dictionary presented in the DAK are actually rollups. For example, Patient last name is a specific data element within the DAK, but is represented as one of many elements in the ANCPatient profile.

Data Element Processing

The following diagram illustrates the processing used to derive FHIR terminology and profile resources from the data dictionary:

The inputs on the left consist of:

  1. Data elements in the data dictionary, defining a unique label for each, along with other metadata such as definition, data type, and input options.
  2. Terminology mappings for each element to several standard terminologies, including SNOMED, LOINC, and ICD-10 and -11.
  3. FHIR mappings for each element, establishing a path to a FHIR resource type and element, as well as a base profile and establishing contexts for the element

NOTE: The FHIR mappings are not part of the Digital Adaptation Kit, but are introduced as part of this implementation guide. The WHO_ANC.xlsx spreadsheet in the input/l2 folder is the source for these mappings, and was created by copying the WHO_ANC spreadsheet from the Digital Adaptation Kit, and then adding the FHIR mapping columns and providing the individual data element mappings.

The outputs on the right consist of:

  1. CodeSystem: An ANC-specific code system that contains concepts for each element and input option in the data dictionary
  2. ConceptMap: Mappings from each code in the ANC-specific code system to the various standard terminologies
  3. ValueSet: Valuesets for each data element concept and the possible values for that concept
  4. Profile: StructureDefinition resources for the profiles (and any necessary extensions) to represent the data elements as FHIR resources
  5. Questionnaire: Questionnaire resources, one for each activity, with questions for each data element used by the activity
  6. Concepts (cql): A Concepts CQL library with declarations for each value set (each data element concept and the possible values for it)
  7. DataElements (cql): A DataElements CQL library from both the Patient and Encounter perspectives, keyed by the label of each data element.

Separating the Concepts CQL allows the domain-friendly name for each concept and answer set to be referenced by that name within the logic. This pattern also allows implementations to easily vary implementation by providing alternate versions of the Concepts library with their own definitions for the value sets, supporting local adaptation.

Separating the Patient and Encounter perspectives of the DataElements libraries allows the same data elements to be used from different contexts, depending on the use case. For example, when referenced from decision support logic, the Encounter perspective is typically used, whereas from indicator logic, the Patient perspective is typically used.

Data Model

The model for data elements represented within this implementation guide is based on the following profiles. All the data elements defined derive from one of these profiles, and all data used within smart content and related decision support rules and health metrics use these profiles, or profiles that are derived from them:

Profile
ANC Allergy/Intolerance
ANC Appointment
ANC CarePlan
ANC CareTeam
ANC Condition
ANC EpisodeOfCare
ANC Encounter
ANC Group
ANC Immunization
ANC ImmunizationNotDone
ANC Location
ANC MeasureReport
ANC MedicationRequest
ANC MedicationNotRequested
ANC Observation
ANC ObservationNotDone
ANC Organization
ANC Patient
ANC Practitioner
ANC PractitionerRole
ANC Procedure
ANC ProcedureNotDone
ANC RelatedPerson
ANC ServiceRequest
ANC ServiceNotRequested

Data Elements by Activity

The following index lists all data elements, grouped by their activity:

ANC.A. Registration

Data elements for this activity can be collected using the ANCA questionnaire.

Id Label Description Type Profile Path
ANC.A.DE4 Contact date The date and time of the client’s contact dateTime Encounter.period.start
ANC.B5.DE1 Reason for coming to facility Records the reason why the woman came to the health-care facility today CodeableConcept Encounter.reasonCode
ANC.A.DE12 ANC contact number The ANC contact or visit number – recommended minimum is 8 contacts Integer Encounter.contactNumber
ANC.A.DE1 Unique identification Unique identifier generated for new clients or a universal ID, if used in the country string Patient.identifier.value
ANC.A.DE2 First name Client’s first name string Patient.name.given
ANC.A.DE3 Last name Client’s family name or last name string Patient.name.family
ANC.A.DE5 Date of birth The client’s date of birth (DOB), if known dateTime Patient.birthDate
ANC.A.DE7 Address Client’s home address or address that the client is consenting to disclose string Patient.address.line
ANC.A.DE8 Mobile phone number Client’s mobile phone number string Patient.telecom.value
ANC.A.DE10 Alternative contact’s name Name of an alternative contact, which could be next of kin (e.g. partner, mother, sibling); the alternative contact would be used in the case of an emergency situation string Patient.contact.name
ANC.A.DE11 Alternative contact’s phone number Phone number of the alternative contact string Patient.contact.telecom.value
ANC.A.DE9 Woman wants to receive reminders during pregnancy Whether or not the woman wants to receive SMS or other messages regarding her ANC contacts and health status during pregnancy boolean Patient.reminder
ANC.B6.DE1 Highest level of education achieved The highest level of schooling the woman has reached Code Patient.educationLevel
ANC.B6.DE7 Occupation The woman’s occupation (select all that apply) Code Patient.occupation
ANC.A.DE13 Co-habitants Who does the client live with? It is important to know whether client lives with parents, other family members, a partner, friends, etc. CodeableConcept Observation.value[x]

ANC.B4. Confirm pregnancy

Data elements for this activity can be collected using the ANCB4 questionnaire.

Id Label Description Type Profile Path
ANC.B4.DE1 Pregnancy confirmed Pregnancy has been confirmed boolean Observation.value[x]

ANC.B5. Quick check

Data elements for this activity can be collected using the ANCB5 questionnaire.

Id Label Description Type Profile Path
ANC.B5.DE48 Danger signs Before each contact, the health worker should check whether the woman has any of the danger signs listed here – if yes, she should refer to the hospital urgently; if no, she should continue to the normal contact CodeableConcept Observation.value[x]
ANC.B5.DE5 Specific health concern(s) If the woman came to the facility with a specific health concern, select the health concern(s) from the list CodeableConcept Observation.value[x]

ANC.B6. Collect woman’s profile and history

Data elements for this activity can be collected using the ANCB6 questionnaire.

Id Label Description Type Profile Path
ANC.B6.DE100 Tetanus toxoid-containing vaccine (TTCV) immunization history The woman’s history of receiving tetanus toxoid-containing vaccine (TTCV) CodeableConcept Observation.value[x]
ANC.B6.DE105 Flu immunization history Whether or not this year’s seasonal flu vaccine has been provided CodeableConcept Observation.value[x]
ANC.B6.DE109 Current medications Select all of the medications the woman is currently taking CodeableConcept Observation.value[x]
ANC.B6.DE139 Daily caffeine intake Assesses whether the woman consumes more than 300 mg of caffeine per day CodeableConcept Observation.value[x]
ANC.B6.DE14 Last menstrual period (LMP) date The woman’s last menstrual period (LMP) date; this is defined as the first day of her most recent period dateTime Observation.value[x]
ANC.B6.DE145 Clinical enquiry for alcohol and other substance use done Whether or not the health worker has performed a clinical enquiry into alcohol and substance use CodeableConcept Observation.value[x]
ANC.B6.DE146 Current alcohol and/or other substance use Whether or not the woman currently consumes any alcohol or substances CodeableConcept Observation.value[x]
ANC.B6.DE15 Ultrasound done Whether or not the woman has had an ultrasound scan done at any point in this pregnancy boolean Observation.value[x]
ANC.B6.DE153 Tobacco use Whether the woman uses tobacco products boolean Observation.value[x]
ANC.B6.DE154 Recently quit tobacco products Whether the woman has recently quit using any tobacco products boolean Observation.value[x]
ANC.B6.DE155 Exposure to second-hand smoke Anyone in the household smokes tobacco products – whether the woman is exposed to second-hand smoke from anyone in her household boolean Observation.value[x]
ANC.B6.DE156 Partner HIV status (reported) The HIV status of the woman’s partner CodeableConcept Observation.value[x]
ANC.B6.DE160 Contraceptive use of male condoms Whether or not the woman (and her partner) use male condoms during sex boolean Observation.value[x]
ANC.B6.DE161 Contraceptive use of female condoms Whether or not the woman (and her partner) use female condoms during sex boolean Observation.value[x]
ANC.B6.DE17 Gestational age Gestational age in weeks and/or days depending on the source of gestational age Quantity Observation.value[x]
ANC.B6.DE18 Source of gestational age Gestational age can be calculated multiple ways – this data element describes where the gestational age above has been calculated from CodeableConcept Observation.value[x]
ANC.B6.DE22 Expected date of delivery (EDD) Expected date of delivery based on gestational age dateTime Observation.value[x]
ANC.B6.DE24 Number of pregnancies (gravida) Total number of times the woman has been pregnant (including this pregnancy); also referred to as gravida integer Observation.value[x]
ANC.B6.DE25 Number of miscarriages and/or abortions Total number of pregnancies lost/ended due to miscarriages and/or abortions before 22 weeks / 5 months integer Observation.value[x]
ANC.B6.DE26 Number of live births Total number of live births after 22 weeks integer Observation.value[x]
ANC.B6.DE27 Whether last live birth was preterm Was the last live birth preterm? Whether the last live birth was preterm (i.e. less than 37 weeks gestation at the time of delivery) CodeableConcept Observation.value[x]
ANC.B6.DE31 Number of stillbirths Total number of stillbirths after 22 weeks integer Observation.value[x]
ANC.B6.DE32 Parity Calculated parity is the total number of live and stillbirths integer Observation.value[x]
ANC.B6.DE33 Number of caesarian sections Total number of caesarean sections integer Observation.value[x]
ANC.B6.DE34 Past pregnancy complications Mark whether the woman has had any complications or problems in any previous pregnancy CodeableConcept Observation.value[x]
ANC.B6.DE51 Substance use during past pregnancy specification If selected substance use, specify and indicate what type of substances used during past pregnancies CodeableConcept Observation.value[x]
ANC.B6.DE57 Allergies Does the woman have any allergies? CodeableConcept Observation.value[x]
ANC.B6.DE72 Past surgeries Has the woman had any prior surgeries? CodeableConcept Observation.value[x]
ANC.B6.DE83 Existing chronic health conditions Does the woman have any current chronic health conditions or problems? CodeableConcept Observation.value[x]
ANC.B6.DE99 HIV diagnosis date If woman knows she’s HIV+, record the date of her diagnosis CodeableConcept Observation.value[x]
ANC.B6.DE16 Ultrasound date Date that the ultrasound was done dateTime Procedure.performed[x]
ANC.B9.DE3 Ultrasound scan conducted Whether an ultrasound scan was conducted during a specific contact CodeableConcept Procedure.code

ANC.B7. Check symptoms and follow-up

Data elements for this activity can be collected using the ANCB7 questionnaire.

Id Label Description Type Profile Path
ANC.B7.DE1 Medication follow-up Which of the medications(including supplements and vitamins) is the woman taking and any side effects? CodeableConcept Observation.value[x]
ANC.B7.DE18 Persistent physiological symptoms Which of the following physiological symptoms persist? Select which of the following physiological symptoms persist after being reported during last contact CodeableConcept Observation.value[x]
ANC.B7.DE43 Current physiological symptoms The physiological symptoms that the woman is experiencing right now: select “None” if she is experiencing none of these symptoms CodeableConcept Observation.value[x]
ANC.B7.DE71 Presenting signs and symptoms that trigger suspicion of IPV and clinical inquiry Presenting signs and symptoms that trigger clinical enquiry of IPV. The Input Options listed below are based on Health care for women subjected to intimate partner violence or sexual violence – a clinical handbook (3) CodeableConcept Observation.value[x]
ANC.B7.DE97 Woman discloses or is suspected to be subjected to intimate partner violence Woman discloses or is suspected to be subjected to intimate partner violence CodeableConcept Observation.value[x]
ANC.B7.DE98 Fetal movement Whether the woman has felt the baby move or not or if the baby’s movements have decreased CodeableConcept Observation.value[x]
ANC.B7.DED9 Persistent behaviours Which of the following behaviours persist? Select which of the following behaviours persist after being reported during last contact CodeableConcept Observation.value[x]
ANC.B8.DE128 Has the woman been subjected to intimate partner violence Whether the woman has been subjected to intimate partner violence boolean Observation.value[x]

ANC.B8. Conduct physical exam

Data elements for this activity can be collected using the ANCB8 questionnaire.

Id Label Description Type Profile Path
ANC.B8.DE1 Height The woman’s current height in centimetres Quantity Observation.value[x]
ANC.B8.DE10 Expected weight gain Expected weight gain during pregnancy is based on the woman’s weight category CodeableConcept Observation.value[x]
ANC.B8.DE100 Oedema severity Severity of the oedema CodeableConcept Observation.value[x]
ANC.B8.DE105 Symphysis-fundal height (SFH) The symphysis-fundal height (SFH) in centimetres Quantity Observation.value[x]
ANC.B8.DE106 Fetal heartbeat present Whether or not the health worker observes a fetal heartbeat boolean Observation.value[x]
ANC.B8.DE107 Fetal heart rate The fetal heart rate in beats per minute (bpm) Quantity Observation.value[x]
ANC.B8.DE108 Second fetal heart rate The second fetal heart rate reading in beats per minute (bpm) Quantity Observation.value[x]
ANC.B8.DE109 Number of fetuses Indicate the number of fetuses the woman is carrying Quantity Observation.value[x]
ANC.B8.DE110 Number of fetuses unknown Number of fetuses cannot be determined at this time, thus the number of fetuses is unknown Quantity Observation.value[x]
ANC.B8.DE111 Fetal presentation If a single fetus only, indicate the presentation of the fetus in the uterus CodeableConcept Observation.value[x]
ANC.B8.DE117 Presenting signs/conditions for IPV Signs or conditions that are due to or trigger suspicion of intimate partner violence? CodeableConcept Observation.value[x]
ANC.B8.DE121 Clinical enquiry for IPV Whether or not clinical enquiry for IPV was conducted based on presenting signs and symptoms and conditions boolean Observation.value[x]
ANC.B8.DE122 Reason clinical enquiry not done Reason clinical enquiry not done CodeableConcept Observation.value[x]
ANC.B8.DE129 Types of IPV What type(s) of violence has the woman been subjected to? CodeableConcept Observation.value[x]
ANC.B8.DE15 Average weight gain per week Average weight gain per week since last contact (kg); this would only display starting at the 2nd contact Quantity Observation.value[x]
ANC.B8.DE16 Total weight gain (kg) Total weight gain in pregnancy so far (kg) Quantity Observation.value[x]
ANC.B8.DE17 Systolic blood pressure Systolic blood pressure (SBP) in mmHg Quantity Observation.value[x]
ANC.B8.DE19 Diastolic blood pressure Diastolic blood pressure (DBP) in mmHg Quantity Observation.value[x]
ANC.B8.DE2 Pre-gestational weight The woman’s pre-gestational weight in kilograms Quantity Observation.value[x]
ANC.B8.DE20 Repeat systolic blood pressure Repeat measurement of the woman’s systolic blood pressure in mmHg after 10–15 minutes rest Quantity Observation.value[x]
ANC.B8.DE21 Repeat diastolic blood pressure Repeat measurement of the woman’s diastolic blood pressure in mmHg after 10–15 minutes rest Quantity Observation.value[x]
ANC.B8.DE22 Blood pressure cannot be taken If the woman’s blood pressure cannot be taken, this should be indicated here; otherwise, blood pressure should be measured boolean Observation.value[x]
ANC.B8.DE23 Reason blood pressure cannot be taken The reason why the health worker is unable to record the woman’s BP during this contact visit CodeableConcept Observation.value[x]
ANC.B8.DE27 Symptoms of severe pre-eclampsia Check if the woman has any of the following symptoms of severe pre-eclampsia CodeableConcept Observation.value[x]
ANC.B8.DE3 Current weight The woman’s current weight in kilograms Quantity Observation.value[x]
ANC.B8.DE34 Body temperature The woman’s body temperature in degrees Celsius (°C) (first reading) Quantity Observation.value[x]
ANC.B8.DE35 Second body temperature The woman’s body temperature in degrees Celsius (°C) (second reading) Quantity Observation.value[x]
ANC.B8.DE36 Pulse rate The woman’s pulse rate in beats per minute (bpm) Quantity Observation.value[x]
ANC.B8.DE37 Second pulse rate The woman’s second pulse rate in beats per minute (bpm) Quantity Observation.value[x]
ANC.B8.DE38 Pallor present Whether or not the woman has pallor boolean Observation.value[x]
ANC.B8.DE39 Respiratory exam result The woman’s respiratory condition based on respiratory exam CodeableConcept Observation.value[x]
ANC.B8.DE4 BMI Body mass index (BMI): calculated by taking weight in kg divided by the squared height in meters, i.e. kg/(m^2) Quantity Observation.value[x]
ANC.B8.DE49 Oximetry The measure of the oxygen saturation (%) in the woman’s blood: this is usually measured using a pulse oximeter medical device Quantity Observation.value[x]
ANC.B8.DE5 Weight category Weight category is calculated from BMI CodeableConcept Observation.value[x]
ANC.B8.DE50 Cardiac exam result The woman’s cardiac condition CodeableConcept Observation.value[x]
ANC.B8.DE61 Breast exam result Whether or not the result of the breast exam is normal CodeableConcept Observation.value[x]
ANC.B8.DE71 Abdominal exam result Whether or not the result of the abdominal exam is normal CodeableConcept Observation.value[x]
ANC.B8.DE79 Pelvic exam result (visual) Whether or not the result of the pelvic exam is normal CodeableConcept Observation.value[x]
ANC.B8.DE92 Cervical exam conducted Whether or not the health worker performed a cervical exam boolean Observation.value[x]
ANC.B8.DE93 Cervical dilation If a cervical exam was done, how many centimeters is the cervix dilated? Quantity Observation.value[x]
ANC.B8.DE94 Oedema present Whether or not the woman has oedema boolean Observation.value[x]
ANC.B8.DE95 Oedema type Select the type of oedema the woman has CodeableConcept Observation.value[x]

ANC.B9. Conduct laboratory tests and imaging

Data elements for this activity can be collected using the ANCB9 questionnaire.

Id Label Description Type Profile Path
ANC.B9.DE1 Ultrasound required Woman requires an ultrasound scan boolean Observation.value[x]
ANC.B9.DE102 Reason syphilis test not done Select the reason why a syphilis test was not done CodeableConcept Observation.value[x]
ANC.B9.DE107 Syphilis test result Syphilis test result CodeableConcept Observation.value[x]
ANC.B9.DE110 Syphilis diagnosis Calculation for whether woman has syphilis (1) or not (0) CodeableConcept Observation.value[x]
ANC.B9.DE113 Urine test required Urine test is required boolean Observation.value[x]
ANC.B9.DE115 Urine test ordered Urine test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE116 Urine test type Select the type of urine test that was done. Of the three types of tests, the midstream urine culture is the preferred method. If culture is not available, then midstream Gram-staining test is preferred over dipstick. Urine dipstick test is required if need to check urine for protein. CodeableConcept Observation.value[x]
ANC.B9.DE120 Reason urine test not done Select the reason why a urine test was not done at this contact CodeableConcept Procedure.code
ANC.B9.DE124 Midstream urine culture (recommended) Midstream urine culture is the recommended method for diagnosing asymptomatic bacteriuria (ASB) in pregnancy CodeableConcept Observation.value[x]
ANC.B9.DE129 Midstream urine Gram-staining On-site midstream urine Gram-staining is recommended over the use of dipstick tests as the method for diagnosing ASB in pregnancy if midstream culture is not possible CodeableConcept Observation.value[x]
ANC.B9.DE13 Placenta location Location of the placenta detected during the ultrasound CodeableConcept Observation.value[x]
ANC.B9.DE132 Urine dipstick result - nitrites Dipstick test results – nitrites CodeableConcept Observation.value[x]
ANC.B9.DE138 Urine dipstick result - leukocytes Dipstick test results – leukocytes CodeableConcept Observation.value[x]
ANC.B9.DE144 Urine dipstick result - protein Enter the result for the dipstick test – protein CodeableConcept Observation.value[x]
ANC.B9.DE150 Urine dipstick result - glucose Dipstick test results – glucose CodeableConcept Observation.value[x]
ANC.B9.DE156 Asymptomatic bacteriuria (ASB) diagnosis A woman is considered to have ASB if she has one of the following test results:?– Positive culture (> 100,000 bacteria/mL)?– Gram-staining positive?– Urine dipstick test positive (nitrites or leukocytes) CodeableConcept Observation.value[x]
ANC.B9.DE160 Blood glucose test ordered Blood glucose test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE162 Blood glucose test type Select the type of blood glucose test done CodeableConcept Observation.value[x]
ANC.B9.DE163 Fasting plasma glucose Fasting plasma glucose Quantity Observation.value[x]
ANC.B9.DE164 75 g oral glucose tolerance test (OGTT) - fasting glucose 75 g oral glucose tolerance test (OGTT) – fasting glucose Quantity Observation.value[x]
ANC.B9.DE165 75 g oral glucose tolerance test (OGTT) - 1 hour 75 g oral glucose tolerance test (OGTT) – 1 hour Quantity Observation.value[x]
ANC.B9.DE166 75 g oral glucose tolerance test (OGTT) - 2 hours 75 g oral glucose tolerance test (OGTT) – 2 hours Quantity Observation.value[x]
ANC.B9.DE167 Random plasma glucose Random plasma glucose Quantity Observation.value[x]
ANC.B9.DE168 Blood glucose test result Enter the result for the blood glucose test (mg/dl) Quantity Observation.value[x]
ANC.B9.DE169 Gestational diabetes mellitus (GDM) diagnosis Whether the woman has gestational diabetes mellitus (GDM) CodeableConcept Observation.value[x]
ANC.B9.DE172 Diabetes mellitus (DM) during pregnancy diagnosis Whether the woman has developed diabetes mellitus during pregnancy CodeableConcept Observation.value[x]
ANC.B9.DE176 Blood haemoglobin test ordered Whether or not the blood haemoglobin test (Hb test) has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE177 Blood haemoglobin test type Select the type of Hb test that was done CodeableConcept Observation.value[x]
ANC.B9.DE181 Reason blood haemoglobin test not done Select the reason why a Hb test was not done CodeableConcept Procedure.code
ANC.B9.DE186 Blood haemoglobin test result Blood haemoglobin test result in g/dl Quantity Observation.value[x]
ANC.B9.DE187 Anaemia diagnosis Calculated field to determine woman’s anaemia status CodeableConcept Observation.value[x]
ANC.B9.DE190 Hematocrit (Ht) Hematocrit percentage Quantity Observation.value[x]
ANC.B9.DE191 White blood cell (WBC) count Full white blood cells count Quantity Observation.value[x]
ANC.B9.DE192 Platelet count Full platelets count Quantity Observation.value[x]
ANC.B9.DE193 TB screening recommended TB screening is recommended boolean ServiceRequest.code
ANC.B9.DE195 TB screening ordered TB screening has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE196 Reason TB screening not done Select the reason why TB screening was not done CodeableConcept Procedure.code
ANC.B9.DE2 Ultrasound scan ordered An ultrasound scan has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE206 TB screening result Record the result of the TB screening CodeableConcept Observation.value[x]
ANC.B9.DE21 Blood type test ordered Blood type test has been ordered boolean ServiceRequest.code
ANC.B9.DE214 Other test(s) result(s) Input the result from the test(s) CodeableConcept Observation.value[x]
ANC.B9.DE24 Blood type The client’s blood type CodeableConcept Observation.value[x]
ANC.B9.DE29 Rh factor The client’s Rhesus (Rh) factor CodeableConcept Observation.value[x]
ANC.B9.DE33 HIV test required HIV test is required boolean Observation.value[x]
ANC.B9.DE34 HIV test ordered HIV test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE36 Reason HIV test not done Select the reason why an HIV test was not done CodeableConcept Procedure.code
ANC.B9.DE41 HIV test result Select the result of the HIV test CodeableConcept Observation.value[x]
ANC.B9.DE45 HIV status Calculated field for woman’s HIV status CodeableConcept Observation.value[x]
ANC.B9.DE48 Partner HIV test result Select the result of her partner’s HIV test CodeableConcept Observation.value[x]
ANC.B9.DE49 Partner HIV test ordered An HIV test for the woman’s partner has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE5 Reason ultrasound scan not done Select the reason why an ultrasound scan was not done CodeableConcept Procedure.code
ANC.B9.DE55 Partner HIV status (confirmed) Partner’s confirmed HIV status CodeableConcept Observation.value[x]
ANC.B9.DE58 High risk for HIV If the woman lives in a setting with a generalized HIV epidemic, or her partner is HIV positive, or she injects drugs, or she has an employment at increased risk for HIV, then she is at high risk for HIV boolean Observation.value[x]
ANC.B9.DE59 Hepatitis B test required Hepatitis B test is required boolean Observation.value[x]
ANC.B9.DE61 Hepatitis B test ordered Hepatitis B test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE62 Hepatitis B test type Select the type of Hep B test done CodeableConcept Observation.value[x]
ANC.B9.DE66 Hepatitis B test result Select the reason why a Hep B test was not done CodeableConcept Procedure.code
ANC.B9.DE74 Hepatitis B diagnosis This calculates the woman’s Hep B infection status as positive (1) or negative (0), taking into account any of the three methods for Hep B testing CodeableConcept Observation.value[x]
ANC.B9.DE77 Hepatitis C test required Hepatitis C test is required boolean Observation.value[x]
ANC.B9.DE79 Hepatitis C test ordered Hepatitis C test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE80 Hepatitis C test type Select the type of Hep C test that was done CodeableConcept Observation.value[x]
ANC.B9.DE84 Reason Hepatitis C test not done Select the reason why a Hep C test was not done CodeableConcept Procedure.code
ANC.B9.DE89 Hepatitis C test result Hepatitis C test result CodeableConcept Observation.value[x]
ANC.B9.DE9 Amniotic fluid level Amniotic fluid level detected during ultrasound CodeableConcept Observation.value[x]
ANC.B9.DE92 Hepatitis C diagnosis This calculates the woman’s Hep C infection status as positive (1) or negative (0), taking into account any of the three methods for Hep C testing CodeableConcept Observation.value[x]
ANC.B9.DE97 Syphilis test ordered Syphilis test has been ordered CodeableConcept ServiceRequest.code
ANC.B9.DE98 Syphilis test type Select the type of syphilis test that was done CodeableConcept Observation.value[x]
ANC.B9.DE161 Blood glucose test date Select the date of the glucose test dateTime Procedure.performed[x]
ANC.B9.DE175 Blood haemoglobin test conducted A blood haemoglobin test (Hb test) is required for all women multiple times during pregnancy to determine whether she’s anaemic CodeableConcept Procedure.code
ANC.B9.DE185 Blood haemoglobin test date Select the date of the Hb test dateTime Procedure.performed[x]
ANC.B9.DE22 Blood type test conducted Blood type test has been conducted CodeableConcept Procedure.code
ANC.B9.DE23 Blood type test date Date of the blood type test dateTime Procedure.performed[x]
ANC.B9.DE60 Hepatitis B test conducted Select the status of the Hep B test – record result, ordered (pending) or not done CodeableConcept Procedure.code
ANC.B9.DE70 Hepatitis B test date Select the date of the hepatitis B test dateTime Procedure.performed[x]
ANC.B9.DE78 Hepatitis C test conducted In a setting where the proportion of HCV antibody seroprevalence in the general population is ≥ 2% or the woman is HIV positive, injects drugs or is a sex worker, then a Hep C test is required CodeableConcept Procedure.code
ANC.B9.DE88 Hepatitis C test date Select the date of the hepatitis C test dateTime Procedure.performed[x]
ANC.B9.DE106 Syphilis test date Select the date of the syphilis test dateTime Procedure.performed
ANC.B9.DE35 HIV test conducted An HIV test is required for all pregnant women at the first contact in pregnancy and again at the first contact of the 3rd trimester if the HIV prevalence in the pregnant woman population is ≥ 5%. A test is not required if the woman is already confirmed HIV+. CodeableConcept Procedure.code
ANC.B9.DE40 HIV test date Date of the HIV test dateTime Procedure.performed[x]
ANC.B9.DE211 Other tests conducted If the health worker performed other tests on the woman that are not explicitly listed in the application, select “yes” here and fill in the details below CodeableConcept Procedure.code
ANC.B9.DE212 Other test(s) name Input the name of other test(s) that were done String Procedure.code.text
ANC.B9.DE213 Other test(s) date Input the date of other test(s) that were done dateTime Procedure.performed[x]
ANC.B9.DE50 Partner HIV test conducted If the woman does not know the HIV status of her partner(s), offer to test and add results here CodeableConcept Procedure.code
ANC.B9.DE51 Partner HIV test date Select the date of her partner’s HIV test dateTime Procedure.performed[x]
ANC.B9.DE96 Syphilis test conducted A syphilis test is recommended for all pregnant women at the first contact and again at the first contact of 3rd trimester; women who are already confirmed positive for syphilis do not need to be tested CodeableConcept Procedure.code
ANC.B9.DE194 TB screening conducted In settings where the tuberculosis (TB) prevalence in the general population is 100/100,000 population or higher or in settings with subpopulations that have very poor access to health care, or if the woman is HIV positive, TB screening is recommended CodeableConcept Procedure.code
ANC.B9.DE205 TB screening date Record the date of the TB screening dateTime Procedure.performed[x]
ANC.B9.DE114 Urine test conducted A urine test is required at the first contact, last contact in 2nd trimester, and 2nd contact in 3rd trimester OR anytime the woman reports pain during urination (dysuria). A dipstick test is required if the woman has a repeat high BP reading (140/90 or higher). Otherwise, a urine test is optional. The urine test checks for bacterial or other infections that can lead to adverse outcomes for the neonate. The urine dipstick test can check for proteins in the urine, which can be a sign of pre-eclampsia. CodeableConcept Procedure.code
ANC.B9.DE125 Urine test date Select the date of the urine test dateTime Procedure.performed[x]

ANC.B10 Counselling and Treatment

Data elements for this activity can be collected using the ANCB10 questionnaire.

Id Label Description Type Profile Path
ANC.B10.DE1 Counselling conducted on caffeine reduction Whether or not counselling was done on lowering daily caffeine intake CodeableConcept Procedure.code
ANC.B10.DE10 Reason counselling on second-hand smoke was not conducted Select the reason why counselling on second-hand smoke cessation was not done CodeableConcept Procedure.code
ANC.B10.DE13 Counselling conducted on condom use Whether or not counselling was done on condom use CodeableConcept Procedure.code
ANC.B10.DE14 Reason counselling on condom use was not conducted Select the reason why counselling on condom use was not done CodeableConcept Procedure.code
ANC.B10.DE17 Counselling conducted on alcohol / substance use Whether or not counselling was done on alcohol and substance use cessation CodeableConcept Procedure.code
ANC.B10.DE18 Reason counselling on alcohol / substance use was not conducted Select the reason why counselling on alcohol and substance use was not done CodeableConcept Procedure.code
ANC.B10.DE2 Reason counselling on caffeine reduction was not done The reason why the health worker did not counsel on caffeine reduction CodeableConcept Procedure.code
ANC.B10.DE5 Counselling conducted on tobacco cessation Whether or not counselling was done on tobacco cessation CodeableConcept Procedure.code
ANC.B10.DE6 Reason counselling on tobacco cessation was not conducted Select the reason why counselling on tobacco cessation was not done CodeableConcept Procedure.code
ANC.B10.DE9 Counselling conducted on second-hand smoke Whether or not counselling was done on second-hand smoke cessation CodeableConcept Procedure.code
ANC.B10.DE21 Counselling conducted on non-pharma measures to relieve nausea and vomiting Whether or not counselling was conducted on nausea and vomiting CodeableConcept Procedure.code
ANC.B10.DE22 Reason counselling on non-pharma measures to relieve nausea and vomiting was not conducted Select the reason why non-pharma measures to relieve nausea and vomiting counselling was not done CodeableConcept Procedure.code
ANC.B10.DE25 Counselling conducted on pharmacological treatments for nausea and vomiting Whether or not counselling for the repeat symptom “nausea and vomiting” was done CodeableConcept Procedure.code
ANC.B10.DE26 Reason counselling on pharmacological treatments for nausea and vomiting was not conducted Select the reason why counselling on pharmacological treatments to relieve nausea and vomiting was not done CodeableConcept Procedure.code
ANC.B10.DE29 Counselling conducted on diet and lifestyle changes to prevent and relieve heartburn Whether or not counselling for the symptom “heartburn” was done CodeableConcept Procedure.code
ANC.B10.DE30 Reason counselling on diet and lifestyle changes to prevent and relieve heartburn was not conducted Select the reason why counselling for the symptom “Heartburn” was not done CodeableConcept Procedure.code
ANC.B10.DE33 Counselling conducted on antacid preparations to relieve heartburn Whether or not counselling for the repeat symptom “Heartburn” was done CodeableConcept Procedure.code
ANC.B10.DE34 Reason counselling on antacid preparations to relieve heartburn was not conducted Select the reason why counselling for the repeat symptom “Heartburn” was not done CodeableConcept Procedure.code
ANC.B10.DE37 Counselling on non-pharmacological treatment for the relief of leg cramps Whether or not counselling for the symptom “Leg cramps” was done CodeableConcept Procedure.code
ANC.B10.DE38 Reason counselling on non-pharmacological treatment for the relief of leg cramps was not conducted Select the reason why counselling for the symptom “Leg cramps” was not done CodeableConcept Procedure.code
ANC.B10.DE41 Counselling conducted on use of magnesium and calcium to relieve leg cramps Whether or not counselling for the repeat symptom “Leg cramps” was done CodeableConcept Procedure.code
ANC.B10.DE42 Reason counselling on use of magnesium and calcium to relieve leg cramps was not conducted Select the reason why counselling for the repeat symptom “Leg cramps” was not done CodeableConcept Procedure.code
ANC.B10.DE45 Counselling conducted on dietary modifications to relieve constipation Whether or not counselling for the symptom “Constipation” was done CodeableConcept Procedure.code
ANC.B10.DE46 Reason counselling on dietary modifications to relieve constipation was not conducted Select the reason why counselling for the symptom “Constipation” was not done CodeableConcept Procedure.code
ANC.B10.DE49 Counselling conducted on use of wheat bran or other fibre supplements to relieve constipation Whether or not counselling for the repeat symptom “Constipation” was done CodeableConcept Procedure.code
ANC.B10.DE50 Reason counselling on use of wheat bran or other fibre supplements to relieve constipation was not conducted Select the reason why counselling for the repeat symptom “Constipation” was not done CodeableConcept Procedure.code
ANC.B10.DE53 Counselling conducted on regular exercise, physiotherapy, support belts and acupuncture to relieve low back and pelvic pain Whether or not counselling for the symptom “low back and pelvic pain” was done CodeableConcept Procedure.code
ANC.B10.DE54 Reason counselling on regular exercise, physiotherapy, support belts and acupuncture to relieve low back and pelvic pain was not conducted Select the reason why counselling for the symptom “low back and pelvic pain” was not done CodeableConcept Procedure.code
ANC.B10.DE57 Counselling conducted on non-pharmacological options for varicose veins and oedema Whether or not counselling for the symptom “Varicose veins or oedema” was done CodeableConcept Procedure.code
ANC.B10.DE58 Reason counselling on non-pharmacological options for varicose veins and oedema was not conducted Select the reason why counselling for the symptom “Varicose veins or oedema” was not done CodeableConcept Procedure.code
ANC.B10.DE61 Counselling conducted on healthy eating and keeping physically active Whether or not counselling was done on healthy eating and keeping physically active during pregnancy CodeableConcept Procedure.code
ANC.B10.DE62 Reason counselling on healthy eating and keeping physically active was not conducted Select the reason why counselling on healthy eating and exercise during pregnancy was not done CodeableConcept Procedure.code
ANC.B10.DE65 Counselling conducted on increasing daily energy and protein intake Whether or not counselling was done on increasing energy and protein intake CodeableConcept Procedure.code
ANC.B10.DE66 Reason counselling on increasing daily energy and protein intake was not conducted Select the reason why counselling on increasing daily energy intake was not done CodeableConcept Procedure.code
ANC.B10.DE69 Counselling conducted on balanced energy and protein dietary supplementation Whether or not counselling was done on balanced energy and protein dietary supplementation CodeableConcept Procedure.code
ANC.B10.DE70 Reason counselling on balanced energy and protein dietary supplementation was not conducted Select the reason why counselling on balanced energy and protein intake was not done CodeableConcept Procedure.code
ANC.B10.DE73 Hypertension Whether the client has developed hypertension associated with pregnancy CodeableConcept Condition.code
ANC.B10.DE74 Severe hypertension Whether the client has developed severe hypertension associated with pregnancy, as defined in the decision logic (If SBP is 160 mmHg or higher and/or DBP is 110 mmHg or higher) CodeableConcept Condition.code
ANC.B10.DE75 Pre-eclampsia Whether the client has pre-eclampsia CodeableConcept Condition.code
ANC.B10.DE76 Severe pre-eclampsia Whether the client has severe pre-eclampsia as defined by decision logic and reported symptoms CodeableConcept Condition.code
ANC.B10.DE77 Counselling conducted on hypertension Whether counselling was provided to a client who has been diagnosed with hypertension CodeableConcept Procedure.code
ANC.B10.DE78 Counselling conducted on HIV positive Whether counselling was provided to a client who has been diagnosed with HIV CodeableConcept Procedure.code
ANC.B10.DE79 Counselling conducted on hepatitis B positive Whether counselling was provided to a client who has been diagnosed with Hepatitis B CodeableConcept Procedure.code
ANC.B10.DE80 Counselling conducted on hepatitis C positive Whether counselling was provided to a client who has been diagnosed with Hepatitis C CodeableConcept Procedure.code
ANC.B10.DE81 Syphilis counselling and treatment Whether counselling and treatment was provided to a client who has been diagnosed with syphilis CodeableConcept Procedure.code
ANC.B10.DE82 Syphilis counselling, treatment and further testing Whether counselling and treatment was provided to a client who has been diagnosed with syphilis – additional testing (RPR test) recommended CodeableConcept Procedure.code
ANC.B10.DE83 Seven-day antibiotic regimen for asymptomatic bacteriuria (ASB) provided Whether seven-day antibiotic regimen was provided to a client who has been diagnosed with ASB CodeableConcept Procedure.code
ANC.B10.DE84 Reason seven-day antibiotic regimen for asymptomatic bacteriuria (ASB) not provided Please explain why woman was not provided treatment CodeableConcept Procedure.code
ANC.B10.DE87 Counselling conducted on TB screening positive Counselling provided to woman when TB screening result is positive CodeableConcept Procedure.code
ANC.B10.DE88 Counselling conducted on gestational diabetes mellitus (GDM) Whether counselling was provided to a woman who has been diagnosed with GDM CodeableConcept Procedure.code
ANC.B10.DE89 Counselling conducted on diabetes mellitus (DM) Whether counselling was provided to a woman who has been diagnosed with DM during pregnancy CodeableConcept Procedure.code
ANC.B10.DE90 Counselling conducted on anaemia Whether counselling was provided to a woman who has been diagnosed with anaemia null Procedure.code
ANC.B10.DE104 Vitamin A supplementation not provided Select the reason why the supplement was not given CodeableConcept MedicationRequest.medication
ANC.B10.DE107 Amount of daily calcium supplements provided Amount in grams (g) of calcium supplements provided Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE108 Reason calcium not prescribed Select the reason why calcium supplementation was not prescribed CodeableConcept MedicationRequest.medication
ANC.B10.DE95 Amount of daily dose of folic acid prescribed Amount of folic acid supplements prescribed in milligrams for daily intake Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE96 Reason iron and folic acid not prescribed Select the reason why the supplement was not prescribed CodeableConcept MedicationRequest.medication
ANC.B10.DE91 Amount of iron prescribed Amount of iron supplements prescribed in milligrams for intake Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE92 Type of iron supplement dosage provided Whether the amount of iron prescribed is for daily or weekly intake null MedicationRequest.dosageInstruction.timing.repeat.periodUnit
ANC.B10.DE100 Amount of vitamin A supplementation provided Amount of vitamin A supplementation provided in IU Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE101 Type of vitamin A supplement dosage provided Whether the amount of vitamin A prescribed is for daily or weekly intake null MedicationRequest.dosageInstruction.timing.repeat.periodUnit
ANC.B10.DE233 Preventive antihelminthic treatment provided Preventive antihelminthic treatment was provided CodeableConcept Observation.value[x]
ANC.B10.DE237 Reason no preventative treatment provided Select the reason why the treatment was not given CodeableConcept ServiceRequest.code
ANC.B10.DE241 Counselling conducted on malaria prevention Counselling provided on how to prevent malaria CodeableConcept Procedure.code
ANC.B10.DE242 Reason counselling on malaria prevention was not conducted Select the reason why the counselling was not given CodeableConcept Procedure.code
ANC.B10.DE251 Reason malaria prophylaxis not provided Select the reason why the treatment was not given CodeableConcept Immunization.vaccineCode
ANC.B10.DE245 IPTp-SP dose 1 provided Whether or not IPTp-SP dose 1 was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE246 IPTp-SP dose 1 date Date IPTp-SP dose 1 given dateTime Immunization.occurrence[x]
ANC.B10.DE247 IPTp-SP dose 2 provided Whether or not IPTp-SP dose 2 was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE248 IPTp-SP dose 2 date Date IPTp-SP dose 2 given dateTime Immunization.occurrence[x]
ANC.B10.DE249 IPTp-SP dose 3 provided Whether or not IPTp-SP dose 3 was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE250 IPTp-SP dose 3 date Date IPTp-SP dose 3 given dateTime Immunization.occurrence[x]
ANC.B10.DE113 Risk of pre-eclampsia The woman is at risk for developing pre-eclampsia CodeableConcept Condition.code
ANC.B10.DE114 Pre-eclampsia risk counselling provided Whether or not counselling on pre-eclampsia was provided CodeableConcept Procedure.code
ANC.B10.DE115 Amount of daily aspirin prescribed until delivery Amount in milligrams (mg) of aspirin prescribed Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE116 Reason aspirin not prescribed Select the reason why the aspirin was not prescribed CodeableConcept MedicationRequest.medication
ANC.B10.DE121 Risk of gestational diabetes mellitus (GDM) The woman is at risk for developing gestational diabetes mellitus (GDM) CodeableConcept Condition.code
ANC.B10.DE124 Gestational diabetes mellitus (GDM) risk counselling conducted Gestational diabetes mellitus (GDM) risk counselling conducted Code Procedure.code
ANC.B10.DE125 Counselling conducted on HIV risk Whether counselling on HIV risk was conducted for a client who is at a high risk of HIV Code Procedure.code
ANC.B10.DE126 PrEP for HIV prevention provided Whether or not the client has been counselled on use of oral pre-exposure prophylaxis (PrEP) as a means to reduce risk of HIV transmission and provided with oral PrEP Code Procedure.code
ANC.B10.DE127 Reason PrEP for HIV prevention was not provided Why the client was not provided with PrEP CodeableConcept MedicationRequest.medication
ANC.B10.DE132 Amount of oral PrEP provided Amount of oral PrEP provided to the woman Quantity MedicationRequest.dosageInstruction.doseAndRate.dose[x]
ANC.B10.DE133 Counselling conducted on seeking care when danger signs occur Counselling provided on when and how to seek care when danger signs are present CodeableConcept Procedure.code
ANC.B10.DE134 Counsel to immediately go to the hospital if severe danger signs are present Counselling on going immediately to the hospital if severe danger signs CodeableConcept Procedure.code
ANC.B10.DE135 Counselling on ANC contact schedule conducted Counselling on ANC contact schedule conducted CodeableConcept Procedure.code
ANC.B10.DE136 Counselling conducted on birth preparedness and complications readiness Counselling on birth preparedness and complications readiness conducted CodeableConcept Procedure.code
ANC.B10.DE137 Planned birth place Place where woman plans to give birth CodeableConcept Observation.value[x]
ANC.B10.DE142 Counselling conducted on Rh factor negative Counselling conducted on Rh factor negative CodeableConcept Procedure.code
ANC.B10.DE143 Counselling conducted on intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection Counselling conducted on intrapartum antibiotic to prevent early neonatal Group B Streptococcus (GBS) infection CodeableConcept Procedure.code
ANC.B10.DE144 Counselling on postpartum family planning conducted Counselling on postpartum family planning conducted CodeableConcept Procedure.code
ANC.B10.DE145 Family planning method selected Type of postpartum family planning method selected CodeableConcept Observation.value[x]
ANC.B10.DE164 Counselling conducted on breastfeeding Counselling on breastfeeding was conducted CodeableConcept Procedure.code
ANC.B10.DE175 Reason tetanus toxoid (TT) vaccination not provided Select the reason why the TT dose was not given CodeableConcept Immunization.statusReason
ANC.B10.DE181 Counselling conducted on Hep B negative Counselling conducted on Hep B negative CodeableConcept Procedure.code
ANC.B10.DE188 No doses of hepatitis B No dose, or zero doses, of hepatitis B immunization has ever been provided CodeableConcept Observation.value[x]
ANC.B10.DE189 Reason Hep B vaccination not provided Select the reason why the Hep B dose was not given CodeableConcept Immunization.vaccineCode
ANC.B10.DE197 Reason flu vaccine not provided Select the reason why the flu dose was not given CodeableConcept Immunization.statusReason
ANC.B10.DE195 Flu immunization provided Whether or not the seasonal flu immunization was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE196 Date flu immunization was received Date on which this year’s seasonal flu dose has been given dateTime Immunization.occurrence[x]
ANC.B10.DE182 Hepatitis B-1 immunization provided Whether the first dose of hepatitis B immunization was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE183 Date hepatitis B-1 immunization was received Date on which the first dose of hepatitis B immunization was provided dateTime Immunization.occurrence[x]
ANC.B10.DE184 Hepatitis B-2 immunization provided Whether the second dose of hepatitis B immunization was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE185 Date hepatitis B-2 immunization was received Date on which the second dose of hepatitis B immunization was provided dateTime Immunization.occurrence[x]
ANC.B10.DE186 Hepatitis B-3 immunization provided Whether the third dose of hepatitis B immunization was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE187 Date hepatitis B-3 immunization was received Date on which the third dose of hepatitis B immunization was provided dateTime Immunization.occurrence[x]
ANC.B10.DE165 Tetanus toxoid (TT) 1 immunization provided Whether or not the first tetanus toxoid-containing vaccine (TT1) dose was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE166 Date tetanus toxoid 1 immunization was received Date on which TT1 was provided dateTime Immunization.occurrence[x]
ANC.B10.DE167 Tetanus toxoid (TT) 2 immunization provided Whether or not the second tetanus toxoid-containing vaccine (TT2) dose was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE168 Date tetanus toxoid 2 immunization was received Date on which TT2 was provided dateTime Immunization.occurrence[x]
ANC.B10.DE169 Tetanus toxoid (TT) 3 immunization provided Whether or not the third tetanus toxoid-containing vaccine (TT3) dose was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE170 Date tetanus toxoid 3 immunization was received Date on which TT3 was provided dateTime Immunization.occurrence[x]
ANC.B10.DE171 Tetanus toxoid (TT) 4 immunization provided Whether or not the fourth tetanus toxoid-containing vaccine (TT4) dose was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE172 Date tetanus toxoid 4 immunization was received Date on which TT4 was provided dateTime Immunization.occurrence[x]
ANC.B10.DE173 Tetanus toxoid (TT) 5 immunization provided Whether or not the fifth tetanus toxoid-containing vaccine (TT5) dose was provided CodeableConcept Immunization.vaccineCode
ANC.B10.DE174 Date tetanus toxoid 5 immunization was received Date on which TT5 was provided dateTime Immunization.occurrence[x]
ANC.B10.DE203 IPV first-line support provided First-line support includes basic counselling or psychosocial support using LIVES, which involves the following steps: Listen, Inquire, Validate, Enhance safety and Support CodeableConcept Procedure.code
ANC.B10.DE204 Reason IPV first line support not done Reason IPV first line support not done CodeableConcept Procedure.code
ANC.B10.DE210 What additional type of care provided What care was provided for survivor/woman subject to intimate partner violence CodeableConcept Procedure.code
ANC.B10.DE216 Safety assessement Assess immediate risk of violence/danger boolean Observation.value[x]
ANC.B10.DE217 Has the physical violence happened more often or gotten worse over the past 6 months Has the physical violence happened more often or gotten worse over the past 6 months? boolean Observation.value[x]
ANC.B10.DE218 Has he ever used a weapon or threatened you with a weapon Has he ever used a weapon or threatened you with a weapon? boolean Observation.value[x]
ANC.B10.DE219 Has he ever tried to strangle you Has he ever tried to strangle you? boolean Observation.value[x]
ANC.B10.DE220 Has he ever beaten you when you were pregnant Has he ever beaten you when you were pregnant? boolean Observation.value[x]
ANC.B10.DE221 Is he violently and constantly jealous of you Is he violently and constantly jealous of you? boolean Observation.value[x]
ANC.B10.DE222 Do you believe he could kill you Do you believe he could kill you? boolean Observation.value[x]
ANC.B10.DE223 Referrals made as part of first-line support and care Referrals made as part of first-line support and care CodeableConcept ServiceRequest.code
ANC.B10.DE224 Was client referred Whether the client was referred to external services CodeableConcept Observation.value[x]

ANC.B11. Urgent referral needed?

Data elements for this activity can be collected using the ANCB11 questionnaire.

Id Label Description Type Profile Path
ANC.B10.DE256 Referred to hospital Whether or not the health worker referred the woman to a hospital or higher-level facility CodeableConcept ServiceRequest.code
ANC.B10.DE257 Reason referral not done The reason why the health worker did not refer the woman to a hospital or higher-level facility CodeableConcept ServiceRequest.code

ANC.C. Emergency referral?

Data elements for this activity can be collected using the ANCC

Id Label Description Type Profile Path          
ANC.C.DE1 Emergency referral Referral for urgent care CodeableConcept ServiceRequest.code          
ANC.C.DE6 Date of scheduled referral When the referral is scheduled dateTime ServiceRequest.occurrence[x]          
ANC.C.DE7 Location of referral Where the client is being referred to Reference(Location) ServiceRequest.locationReference          
ANC.C.DE8 Date referral was made The date the referral was made dateTime ServiceRequest.authoredOn          
ANC.C.DE9 Provider who made referral The name of the provider who made the referral Reference(Practitioner   PractitionerRole   Organization   Patient   RelatedPerson   Device) ServiceRequest.requester
ANC.C.DE12 Referral notes Any additional relevant details of clinical significance for the referral facility to provide continuity of care Annotation ServiceRequest.note          
ANC.C.DE13 Client history summary With interoperable systems, the provider receiving the referral should be able to access the client’s health record digitally. However, in the absence of this, the referral provider should receive a summary of the client’s health records that includes the client’s history, reported issues and concerns, and any other relevant clinical information the health-care provider had already obtained Reference(Provenance) ServiceRequest.relevantHistory          
ANC.C.DE2 Reason for referral Reason why the client is being referred CodeableConcept ServiceRequest.code          
ANC.C.DE5 Any treatment given before referral If woman was referred, was any treatment provided before referral? boolean Observation.value[x]          
ANC.C.DE10 Provider’s facility Facility client is being referred from Reference(Location) PractitionerRole.location          
ANC.C.DE11 Provider’s telephone number The contact details of the provider making the referral String PractitionerRole.telecom.value          

ANC.End End

Data elements for this activity can be collected using the ANCEnd

Id Label Description Type Profile Path
ANC.End.1 Reason for closing ANC record Select the reason why you are closing the woman’s ANC record CodeableConcept Observation.value[x]
ANC.End.12 Delivery date Date on which the woman delivered dateTime Observation.value[x]
ANC.End.13 Place of delivery Place where the woman delivered CodeableConcept Encounter.location.location
ANC.End.17 Preterm Birth The woman gave birth when the gestational age was less than 37 weeks boolean Observation.value[x]
ANC.End.18 Delivery mode How the woman gave birth/delivered CodeableConcept Observation.value[x]
ANC.End.23 Birth weight Enter the birth weight of the baby in kg Quantity Observation.value[x]
ANC.End.24 Exclusively breastfeeding Specify whether the woman is exclusively breastfeeding boolean Observation.value[x]
ANC.End.25 Delivery complications Any complications that occurred during delivery CodeableConcept Observation.value[x]
ANC.End.38 Date of miscarriage or abortion Date of the miscarriage/abortion dateTime Observation.value[x]
ANC.End.39 Date of death Date that the woman died dateTime Observation.value[x]
ANC.End.40 Cause of death Cause of the woman’s death CodeableConcept Observation.value[x]

Decision-support Logic

Decision tables within this implementation guide are represented with a combination of recommendation definitions and libraries of associated criteria logic.

Decision-table Processing

The following diagram illustrates the processing used to derive decision support rules and logic from the decision tables:

The input on the left consists of decision tables included in the Digital Adaptation Kit.

The output on the right consists of:

  1. PlanDefinition resources conforming to the CPGRecommendationDefinition profile, one for each decision table. Each PlanDefinition contains:
    1. An action for each unique action in the decision table
    2. A definition for the criteria associated with the action
  2. CQL Library files that reference the Concepts and DataElements CQL libraries produced by the data dictionary processing. Each file contains an empty definition for each condition of each action, named with the description of the action, and a comment with the combined pseudo code for the conditions for that action.

Because the pseudo-code for the criteria in the decision table is expressed in terms of the labels for the data elements, a knowledge-engineer can easily take the pseudo-code, and by referencing the expressions from the DataElements libraries, construct the CQL for the condition logic.

Plan Definition Index

Plan Definitions by Decision ID

Decision Table Description
ANC.DT.01 Danger signs Before each contact, during the Quick Check, the health worker should check whether the woman has any of the danger signs listed here – if yes, she should be referred to the hospital urgently; if no, the normal contact should be continued as normal
ANC.DT.02 Adolescent HEADSS assessment If client is an adolescent, conduct Home-Eating-Activity-Drugs-Sexuality-Safety-Suicide (HEADSS) assessment
ANC.DT.03 Check symptoms and follow up Depending on current and/or persistant symptoms, physiological symptoms counselling may be required
ANC.DT.04 Conducting physical exams Depending on the results of some physical exams, additional examinations or repeat measurements are required
ANC.DT.05 Evaluating labour During a cervical exam, if cervical dilation is greater than 2 cm evaluate the possibility of labour
ANC.DT.06 Physical symptoms and exam results requiring referral If the woman has any of the following physical exam results, refer to the hospital
ANC.DT.07 Ultrasound recommendation An ultrasound is recommended for all pregnant women before 24 weeks of gestation (early ultrasound). If there’s no ultrasound available at that health-carte facility, the woman should be referred to another facility in which she can receive an ultrasound.
ANC.DT.08 HIV testing Depending on the population prevalence, and woman’s medical history, conduct HIV testing
ANC.DT.09 Heptatitis B testing Depending on the population prevalence, and woman’s medical history, conduct hepatitis B testing
ANC.DT.10 Hepatitis C testing Depending on the population prevalence, and woman’s medical history, conduct hepatitis C testing
ANC.DT.11 Syphilis testing Depending on the contact schedule, and woman’s syphilis diagnosis, test for syphilis
ANC.DT.12 Urine testing Conditions in which urine testing is required
ANC.DT.13 Tuberculosis screening Conditions in which screening for TB is recommended
ANC.DT.14 Other Additional blood tests
ANC.DT.15 Behaviour counselling required Depending on the woman’s behaviours reported during the first contact and the woman’s reported persistent behaviours, additional counselling may or may not be required
ANC.DT.16 Dietary counselling ALL women should have “Healthy eating and keeping physically active counselling” with guidance on nutrition and exercise. If a woman is classified as “underweight” AND she is part of a population whereby the prevalence of undernourishment is greater than or equal to 20%, then additional dietary counselling is needed.
ANC.DT.17 Pre-eclampsia, severe pre-eclampsia and hypertension diagnosis If the woman presents with any of the following symptoms and/or test results, conduct counselling and referral as needed
ANC.DT.18 HIV diagnosis If the woman tests positive for HIV, provide counselling and referral as needed
ANC.DT.19 Hepatitis B diagnosis If the woman tests positive for hepatitis B, provide counselling and referral as needed
ANC.DT.20 Hepatitis C diagnosis If the woman tests positive for hepatitis C, provide counselling and referral as needed
ANC.DT.21 Syphilis diagnosis If the woman tests positive for syphilis, provide counselling and treatment as needed
ANC.DT.22 Asymptomatic bacteriuria (ASB) diagnosis If the woman tests positive for ASB, provide counselling and treatment as needed.
ANC.DT.23 Gestational diabetes mellitus (GDM) and diabetes mellitus (DM) during pregnancy diagnosis If the woman’s blood glucose test results are as follows, provide the necessary counselling and treatment
ANC.DT.24 TB diagnosis If the woman’s TB screening results are positive for TB, provide the required treatment as per local TB protocols
ANC.DT.25 Anaemia, iron and folic acid supplementation Testing for anaemia is recommended for all pregnant women. Regardless of test results, iron and folic acid supplementation is recommended. The amount of iron and folic acid supplementation will vary depending on anaemia diagnosis, population prevalence of anaemia, and whether the woman has side-effects due to iron and folic acid supplementation
ANC.DT.26 Calcium and vitamin A supplementation Depending on the population, additional calcium and/or vitamin A supplements maybe required
ANC.DT.27 Pre-eclampsia risk counselling If the woman has risk factors for developing pre-eclampsia, provide counselling to reduce risk of developing pre-eclampsia
ANC.DT.29 HIV risk counselling If the woman has risk factors for contracting HIV, provide counselling to reduce risk of contracting HIV
ANC.DT.30 General risk reduction counselling Depending on a variety of risk factors and/or gestational age, provide additional counselling accordingly
ANC.DT.31 Flu immunization If the woman has not yet been immunized with the seasonal flu vaccine, she should be immunized
ANC.DT.32 Tetanus toxoid-containing vaccination If the woman has not yet been fully immunized against tetanus, she should be immunized
ANC.DT.33 Breastfeeding counselling General counselling to be provided/reviewed at every contact
ANC.DT.34 Birth preparedness counselling General counselling to be provided/reviewed at every contact
ANC.DT.35 Family planning counselling General counselling to be provided/reviewed at every contact
ANC.DT.36 Intimate partner violence (IPV) clinical inquiry You may suspect that a woman has been subjected to intimate partner violence if she has any of the following risk factors
ANC.DT.37 Intimate partner violence (IPV) first-line support and treatment Woman has been subjected to IPV
ANC.DT.38 Deworming and malaria prophylaxis If the woman is currently in a malaria-endemic setting, or in an area where there is greater than 20% prevalence of infection with any soil-transmitted helminths, THEN she should receive preventative treatment accordingly

Indicators

This section details indicators and performance metrics that would be aggregated from core data elements identified in Component 5. These indicators are based on the Global ANC monitoring framework (25) and the WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10). These indicators may be aggregated automatically from the digital tracking tool to populate a digital HMIS, such as DHIS2.

Indicator definitions are represented using the FHIR Measure resource (CPGMetric profile).

Indicator ID Title Artifact Reference
ANC.IND.01 Percentage of pregnant women with first ANC contact in the first trimester (before 12 weeks of gestation) ANC.IND.01 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.02 Percentage of pregnant women who received iron and folic acid (IFA) supplements for 90+ days ANC.IND.02 Global ANC monitoring framework (25)
ANC.IND.03 Percentage of pregnant women screened for syphilis during ANC ANC.IND.03 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.04 Percentage of pregnant women with at least four ANC contacts ANC.IND.04 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.05 Percentage of pregnant women with a minimum of eight antenatal care contacts ANC.IND.05 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.06 Pregnant women who received counselling on danger signs (%) during at least one ANC contact ANC.IND.06 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.07 Percentage of pregnant women with at least one blood pressure measure during ANC ANC.IND.07 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.08 Percentage of pregnant women with at least one blood pressure measure in the third trimester during ANC ANC.IND.08 Global ANC monitoring framework (25)
ANC.IND.09 Percentage of pregnant women whose baby’s heartbeat was listened to at least once during ANC ANC.IND.09 Global ANC monitoring framework (25)
ANC.IND.10 Percentage of pregnant women with an ultrasound scan before 24 weeks ANC.IND.10 Global ANC monitoring framework (25)
ANC.IND.11 Percentage of women who received three doses or more of intermittent preventive therapy for malaria (IPTp) during their last pregnancy ANC.IND.11 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.12 Percentage of pregnant women counselled and tested for HIV ANC.IND.12 Global ANC monitoring framework (25)
WHO–UNICEF guidance for RMNCAH programme managers on the analysis and use of health facility data (10)
ANC.IND.13 Percentage of pregnant women who received oral pre-exposure prophylaxis (PrEP) ANC.IND.13 Global ANC monitoring framework (25)

Functional requirements

Functional requirements are specified in the Digital Adaptation Kit. Future work may involve specifying these requirements as CapabilityStatement resources, depending on feedback from the implementation community.