Abstract
BackgroundEarly initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda.MethodsThis is a cross-sectional study using data collected during the 2010 Rwanda DHS from 6,325 women age 15–49 that had at least one birth in the last five years. Factors associated with delayed ANC were identified using a multivariable logistic regression model using manual backward stepwise regression. Analysis was conducted in Stata v12 applying survey commands to account for the complex sample design.ResultsSeveral factors were significantly associated with delayed ANC including having many children (4–6 children, OR = 1.42, 95% CI: 1.22, 1.65; or more than six children, OR = 1.57, 95% CI: 1.24, 1.99); feeling that distance to health facility is a problem (OR = 1.20, 95% CI: 1.04, 1.38); and unwanted pregnancy (OR = 1.41, 95% CI: 1.26, 1.58). The following were protective against delayed ANC: having an ANC at a private hospital or clinic (OR = 0.29, 95% CI: 0.15, 0.56); being married (OR = 0.85, 95% CI: 0.75, 0.96), and having public mutuelle health insurance (OR = 0.81, 95% CI: 0.71, 0.92) or another type of insurance (OR = 0.33, 95% CI: 0.23, 0.46).ConclusionThis analysis revealed potential barriers to ANC service utilization. Distance to health facility remains a major constraint which suggests a great need of infrastructure and decentralization of maternal ANC to health posts and dispensaries. Interventions such as universal health insurance coverage, family planning, and community maternal health system are underway and could be part of effective strategies to address delays in ANC.
Highlights
Initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality
Among the 6,211 women who presented to ANC clinics, 3,797 women (61.1%, 95% Confidence interval (CI): 59.3%, 62.7%) had a delayed first visit (Table 1)
The following factors were significantly associated with delayed ANC: number of children (p < 0.001), area of residence (p = 0.018), place of ANC (p < 0.001), marital status (p = 0.012), type of health insurance (p < 0.001), expressed problem with distance to health facility (p = 0.002), unwanted pregnancy (p < 0.001), age (p < 0.001), wealth status (p < 0.001), woman’s education level (p < 0.001), partner’s education level (p < 0.001), woman’s employment status (p < 0.001), partner’s employment status (p < 0.001), and access to TV or radio at least once a week (p = 0.003)
Summary
Initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Leading causes of maternal deaths, including hemorrhaging, anemia, and hypertension during pregnancy [3], could be averted if detected early. Utilization of maternal health services is associated with improved pregnancy outcomes [4], including reduced maternal and perinatal mortality [5,6,7,8]. When mothers receive prenatal care during the first trimester, early signs of pregnancy complications such as anemia, hypertension, hyperemesis gravidarum, polyhydramnios, ante-partum hemorrhage, gestational diabetes, and urinary tract infections can be detected [9,10]. Utilization of antenatal care (ANC) services are often limited or delayed in developing countries due to demographic, education, culture, and economic factors and geographic barriers [11,12,13]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
