Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study

Akashi Andrew Rurangirwa,Ingrid Mogren,Gunilla Krantz,Laetitia Nyirazinyoye,Joseph Ntaganira

doi:10.1186/s12884-017-1328-2

Akashi Andrew Rurangirwa, Ingrid Mogren + Show 3 more

Open Access

https://doi.org/10.1186/s12884-017-1328-2

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Abstract

BackgroundIn Rwanda, a majority of pregnant women visit antenatal care (ANC) services, however not to the extent that is recommended. Association between socio-demographic or psychosocial factors and poor utilization of antenatal care services (≤2 visits during the course of pregnancy irrespective of the timing) among recently pregnant women in Rwanda were investigated.MethodsThis population-based, cross sectional study included 921 women who gave birth within the past 13 months. Data was obtained using an interviewer-administered questionnaire. For the analyses, bi-and multivariable logistic regression was used and odds ratios were presented with their 95% confidence intervals.ResultsAbout 54% of pregnant women did not make the recommended four visits to ANC during pregnancy. The risk of poor utilization of ANC services was higher among women aged 31 years or older (AOR, 1.78; 95% CI: 1.14, 2.78), among single women (AOR, 2.99; 95% CI: 1.83, 4.75) and women with poor social support (AOR, 1.71; 95% CI: 1.09, 2.67). No significant associations were found for school attendance or household assets (proxy for socio-economic status) with poor utilization of ANC services.ConclusionOlder age, being single, divorced or widowed and poor social support were associated with poor utilization of ANC services. General awareness in communities should be raised on the importance of the number and timing of ANC visits. ANC clinics should further be easier to access, transport should be available, costs minimized and opening hours may be extended to facilitate visits for pregnant women.

Highlights

In Rwanda, a majority of pregnant women visit antenatal care (ANC) services, not to the extent that is recommended
81.6% (n = 746) of the cases, the husband accompanied the pregnant woman to the first Antenatal care (ANC) visit but 104 (11.4%) women walked to the health facility alone (Table 2)
We further found that women, who were single, divorced or widowed and women who had no support from family, relative or friend were at a high risk of poor utilization of ANC services

Summary

Introduction

In Rwanda, a majority of pregnant women visit antenatal care (ANC) services, not to the extent that is recommended. ANC attendance among pregnant adolescents is important as complications during pregnancy and childbirth have been shown to be a major cause of death among girls aged 15–19 in low- and middle-income countries.[2] Rwanda is a small country in the center of the African continent with approximately 11 million inhabitants. Following the 1994 genocide against the Tutsi in Rwanda, the rates of maternal mortality increased, but gradually declined to 340 deaths per 100,000 live births in 2012 [2, 7] This improvement in maternal health may be related to increase in attendance at ANC services resulting from intensive sensitization of pregnant women by local government authorities and community health workers [6, 8,9,10]. This raises concerns regarding the adoption and implementation of the WHO new guidelines, which recommend that the number of contacts a pregnant woman has with a health provider throughout her pregnancy should increase from four to eight [16]

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