Factors Associated with the Low Completion Rate of Pre-natal Consultations in a Health District in Senegal

Abstract

Introduction: Maternal-fetal and child morbidity and mortality is still a major public health problem despite all the progress made. It can be reduced significantly by proper monitoring of pregnancy through the 4 recommended pre-natal consultations (PNC). However, PNC completion rates remain low in sub-Saharan Africa. The Koki health district is no exception to this reality with 39% completion rate. The objective of this study is to determine the factors associated with PNC completion by pregnant women in order to make recommendations which aim to reduce maternal and fetal morbidity and mortality in the Koki health district in Senegal. Methodology: A cross-sectional descriptive study was conducted among 603 women who gave birth between 01/01/2017 and 31/12/2017 in the health district's area of responsibility. Two-stage cluster sampling was conducted. The first stage involved the selection of villages through a simple random draw. The second concerned the selection of concessions chosen by the bottle method. The number of clusters per Health Service Delivery Point (HSDP) was based on the number of expected pregnancies. Thus the survey consisted of 30 clusters of 20 women. All women meeting the criteria were selected from the concession. Data entry and analysis was done using Epi Info version 7.2.3.0. Results: The sample consisted of aged 26.15 years old average women, married, predominantly educated (52.75 per cent), and of Wolof ethnic group (66.6 per cent). More than 2/3 of the women (61.63%) were within 5 km of the health facilities. The majority of women (68%) had their own income. Almost all women were satisfied with the reception (97.5%) in the HSDP. Half of the women (50.61%) had their first PNC in the first trimester of pregnancy. The PNC completion rate calculated with prenatal consultation booklet data is 30%. The main factors having a statistically significant relationship with the low PNC completion rate are: age ≥ 30 years, number of pregnancies >3, number of deliveries > 3, distance between home and HSDP ≥ 5 km, PNC high cost perception and lack of own income. Conclusion: The reasons for the low PNC completion rate are related to the obstetrical situation, geographical accessibility, but also the woman's financial situation. Achieving a satisfactory completion rate require not only a greater awareness and empowerment of women, but also accessibility to health facilities.