Prevalence and factors associated with antenatal care service access among Indigenous women in the Chittagong Hill Tracts, Bangladesh: A cross-sectional study.

Shahinoor Akter,Jane Louise Rich,Kate Davies,Kerry Jill Inder,Yeetey Akpe Kwesi Enuameh

doi:10.1371/journal.pone.0244640

Abstract

Prevalence of accessing antenatal care (ANC) services among Indigenous women in the Chittagong Hill Tracts (CHT) is unknown. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services. Using a cross-sectional design three Indigenous groups in Khagrachari district, CHT, Bangladesh were surveyed between September 2017 and February 2018. Indigenous women within 36 months of delivery were asked about attending ANC services and the number who attended was used to estimate prevalence. Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI). Of 494 indigenous women who met the inclusion criteria in two upazilas, 438 participated (89% response rate) in the study, 75% were aged 16-29 years. Sixty-nine percent were aware of ANC services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48-0.58). Half (52%; n = 121) attended private facilities. Independent factors associated with knowledge about ANC were age ≥30 years (OR 2.2, 95%CI 1.1-4.6), monthly household income greater than 20,000 Bangladeshi Taka (OR 3.4, 95%CI 1.4-8.6); knowledge of pregnancy-related complications (OR 3.6, 95%CI 1.6-8.1), knowledge about nearest health facilities (OR 4.3, 95%CI 2.1-8.8); and attending secondary school or above (OR 4.8, 95%CI 2.1-11). Independent factors associated with attending ANC services were having prior knowledge of ANC benefits (OR 7.7, 95%CI 3.6-16), Indigenous women residing in Khagrachhari Sadar subdistrict (OR 6.5, 95%CI 1.7-25); and monthly household income of 20,000 Bangladeshi Taka or above (OR 2.8, 95%CI 1.1-7.4). Approximately half of Indigenous women from Chittagong Hill Tracts Bangladesh attended ANC services at least once. Better awareness and education may improve ANC attendance for Indigenous women. Cultural factors influencing attendance need to be explored.

Highlights

Maternal health outcomes have been the center of public health-related international manifestos since the Millennium Development Goals were signed by 189 world leaders in 2000 [1]
Socio-demographic and obstetric characteristics were used to determine factors associated with knowledge and attendance using multivariable logistic regression techniques adjusted for clustering by village; results are presented as odds ratios (OR), adjusted OR, and 95% confidence intervals (CI)
Sixty-nine percent were aware of antenatal care (ANC) services and the prevalence of attending ANC services was 53% (n = 232, 95%CI 0.48–0.58)

Summary

Introduction

Maternal health outcomes have been the center of public health-related international manifestos since the Millennium Development Goals were signed by 189 world leaders in 2000 [1]. The proportion of women in Bangladesh receiving at least one ANC visit from a medically trained health care provider increased from 28% in the early 1990s to 64% in 2014 [4, 6]. This has not meant that the reduction has been inclusive and equitable for women from different socio-cultural backgrounds [5]; rather there is a lack of information regarding MHC accessibility and utilization including ANC visits for cultural minority groups including Indigenous women in the Chittagong Hill Tracts (CHT) [7, 8]. This study aims to estimate the prevalence of accessing ANC services by Indigenous women in the CHT and identify factors associated with knowledge of, and attendance at, ANC services

Objectives

Methods

Results

Conclusion