Abstract
In rural Uganda pregnant women often lack access to health services, do not attend antenatal care, and tend to utilize traditional healers/birth attendants. We hypothesized that receiving a message advertising that “you will be able to see your baby by ultrasound” would motivate rural Ugandan women who otherwise might use a traditional birth attendant to attend antenatal care, and that those women would subsequently be more satisfied with care. A cluster randomized trial was conducted across eight rural sub-counties in southwestern Uganda. Sub-counties were randomized to a control arm, with advertisement of antenatal care with no mention of portable obstetric ultrasound (four communities, n = 59), or an intervention arm, with advertisement of portable obstetric ultrasound. Advertisement of portable obstetric ultrasound was further divided into intervention A) word of mouth advertisement of portable obstetric ultrasound and antenatal care (one communitity, n = 16), B) radio advertisement of only antenatal care and word of mouth advertisement of antenatal care and portable obstetric ultrasound (one community, n = 7), or C) word of mouth + radio advertisement of both antenatal care and portable obstetric ultrasound (two communities, n = 75). The primary outcome was attendance to antenatal care. 159 women presented to antenatal care across eight sub-counties. The rate of attendance was 65.1 (per 1000 pregnant women, 95% CI 38.3–110.4) where portable obstetric ultrasound was advertised by radio and word of mouth, as compared to a rate of 11.1 (95% CI 6.1–20.1) in control communities (rate ratio 5.9, 95% CI 2.6–13.0, p<0.0001). Attendance was also improved in women who had previously seen a traditional healer (13.0, 95% CI 5.4–31.2) compared to control (1.5, 95% CI 0.5–5.0, rate ratio 8.7, 95% CI 2.0–38.1, p = 0.004). By advertising antenatal care and portable obstetric ultrasound by radio attendance was significantly improved. This study suggests that women can be motivated to attend antenatal care when offered the concrete incentive of seeing their baby.
Highlights
Improving uptake of antenatal care services ie. getting more mothers to attend professional healthcare visits while pregnant is critical to improving maternal and child health.[1,2,3,4] Low uptake of antenatal care services (ANC) has been demonstrated in many low and middle-income countries.[5]
The benefit of delivering with a skilled birth attendant (SBA) or at a health care facility (HCF) versus homebirth have been clearly defined in the literature in rural regions across the world.[16,17]
Comparing the various intervention arms separately we found that the attendance rate was significantly greater when portable obstetric ultrasound (pOBU) and ANC were advertised by radio and word of mouth (WOM)
Summary
Improving uptake of antenatal care services ie. getting more mothers to attend professional healthcare visits (using nurses, midwives or physicians) while pregnant is critical to improving maternal and child health.[1,2,3,4] Low uptake of antenatal care services (ANC) has been demonstrated in many low and middle-income countries.[5]. Getting more mothers to attend professional healthcare visits (using nurses, midwives or physicians) while pregnant is critical to improving maternal and child health.[1,2,3,4] Low uptake of antenatal care services (ANC) has been demonstrated in many low and middle-income countries.[5] Factors contributing to poor uptake include poor healthcare infrastructure,[6] parental education below primary school,[7,8] difficulty accessing healthcare,[7,9] reluctance to use modern medicine as opposed to traditional medicine,[10,11,12] and viewing ANC as a non-essential service.[3,12] Various methods have previously been trialed aiming to improve uptake of ANC services, such as utilizing community health networks,[13] initiating healthcare insurance,[14] and engaging male partners.[15] While these methods have demonstrated some success, attendance still remains sub-optimal in many areas. The benefit of delivering with a skilled birth attendant (SBA) or at a health care facility (HCF) versus homebirth have been clearly defined in the literature in rural regions across the world.[16,17] In Sub-Saharan Africa, it has been reported that the likelihood of use of a HCF for delivery increased 3.4 times after just one prenatal visit, and by nearly nine times after three ANC visits.[16]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
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 call
