Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

Evelyn Sakeah,Evelyn Ansah,The Ghana Embrace Team The Ghana Embrace Team,Enoch Oti Agyekum,Charlotte Tawiah,Doris Sarpong,Kimiyo Kikuchi,Margaret Gyapong,Akira Shibanuma,Yeetey Enuameh,Junko Yasuoka,Sumiyo Okawa,Cornelius Debpuur,Abraham Oduro ,John E Williams ,Sheila Ofori Addai ,Vida Kukula ,Seth Owusu‐Agyei ,Gloria Quansah Asare,Keiko Nanishi,Masamine Jimba,Kwame Adjei,Francis Yeji,Abraham Hodgson

doi:10.1080/16549716.2017.1291879

Abstract

ABSTRACTBackground: Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance.Objective: This study examined factors associated with ANC attendance in predominantly rural Ghana.Methods: We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women’s sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis.Results: Of the 1497 participants, 86% reported attending ANC at least four times, which was positively associated with possession of national health insurance (AOR 1.64, 95% CI: 1.14–2.38) and having a partner with a high educational level (AOR 1.64, 95% CI: 1.02–2.64) and negatively associated with being single (AOR 0.39, 95% CI: 0.22–0.69) and cohabiting (AOR 0.57, 95% CI: 0.34–0.97). In site-specific analyses, factors associated with ANC attendance included marital status in Navrongo; marital status, possession of national health insurance, partners’ educational level, and wealth in Kintampo; and preferred pregnancy timing in Dodowa. In the youngest, least educated, and poorest women and women whose partners were uneducated, those with health insurance were more likely to report at least four ANC attendances relative to those who did not have insurance.Conclusions: Ghanaian women with low socioeconomic status were less likely to report at least four ANC attendances during pregnancy if they did not possess health insurance. The national health insurance scheme should include a higher number of deprived women in predominantly rural communities.

Highlights

Improving maternal health is a global challenge
Other studies conducted in developing countries, such as Sudan and Ghana, have shown that low Antenatal care (ANC) attendance was associated with low educational levels of spouses [9,35,36]
Ghanaian women who were economically disadvantaged were less likely to have attended ANC at least four times during pregnancy if they were not enrolled in the National Health Insurance Scheme (NHIS)

Summary

Introduction

Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. Few studies have updated current knowledge regarding determinants of ANC attendance. Objective: This study examined factors associated with ANC attendance in predominantly rural Ghana. Data concerning 1497 women’s sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis. Sub-Saharan Africa experienced 201,000 maternal deaths despite a 45% reduction since 1990 [1]. Despite the significant number of maternal deaths in sub-Saharan Africa, limited progress has been made toward achieving Millennium Development Goal 5 [1].

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