Abstract
BackgroundMaternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda.MethodsThis study is cross-sectional using secondary data from the 2014–15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15–49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.ResultsOf 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results.ConclusionThe study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.
Highlights
Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue
This study considered only distance to a health facility as a barrier to health care; the authors did not consider other substantial barriers to care such as treatment cost, time and ability to go alone to a health facility [16, 22]
The study showed that women who perceived to have barriers to accessing care were more likely to have a delayed first antenatal care (ANC) visit and not complete at least four recommended visits; the association was borderline statistically significant
Summary
Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Maternal and neonatal mortality remain a global health concern despite different interventions that have been implemented to address this issue [1]. A study conducted in Zimbabwe found a 42 and 29% decrease in neonatal and under-five mortality respectively as a result of utilization and quality improvement of ANC services [7]. The new WHO ANC guidelines recommend at least eight ANC visits including one visit in the first trimester, two visits in the second trimester and five visits in the third trimester [9] This study used the former guidelines since DHS was conducted before the development of the new guidelines. WHO developed these guidelines to improve ANC in developing countries; the available evidence shows poor utilization of ANC in low-and-middle income countries [8, 10,11,12]
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