Abstract
BackgroundAn effective continuum of maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care received.MethodsWe pooled nationally representative data from Demographic and Health Surveys conducted in 28 African countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).ResultsAmong ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure checked, received information about pregnancy complications, had blood tests conducted, received at least one tetanus injection, and had urine tests conducted.ConclusionsHigher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received prenatally may increase client retention during delivery, reducing maternal mortality.
Highlights
An effective continuum of skilled maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death [2]
An additional spreadsheet file shows this in more detail (Table 4). In this analysis of 115,374 births in 28 African countries, we found that one-third of antenatal care (ANC) clients dropped out of the maternal continuum of care prior to receiving skilled birth attendance (SBA)
This study demonstrates that these hypotheses bear out in the empirical literature: when skilled providers do more for ANC clients, it increases the odds of their retention in SBA
Summary
An effective continuum of maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. An effective continuum of skilled maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death [2]. Few studies have characterized the determinants of retention along the continuum of care in Africa These include a recent study of 6 countries (Ethiopia, Malawi, Rwanda, Senegal, Tanzania, and Uganda) [4] and another study that focused on Nigeria [5]. These studies focused exclusively on demographic characteristics of antenatal clients, demonstrating that retention in subsequent skilled birth attendance is predicted by factors such as higher wealth and maternal education. There is little evidence on the influence of prior antenatal care experience on subsequent retention in the continuum of maternal care, Chukwuma et al BMC Pregnancy and Childbirth (2017) 17:152 independent of demographic determinants of maternal health care use
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