Adequate Antenatal Care Visits Research Articles

Compliance towards WHO recommendations on antenatal care for a positive pregnancy experience: Timeliness and adequacy of antenatal care visit in Sub-Saharan African countries: Evidence from the most recent standard Demographic Health Survey data.

Timely and adequate antenatal care (ANC) visits are known to reduce maternal mortality by 20%. Despite the World Health Organization updating its recommendations from four to eight antenatal care contacts, data reporting in the SSA region focused primarily on four visits, and evidence on the timing and adequacy of ANC based on the current recommendation was limited. Hence, this study aimed at assessing the level of timely and adequate ANC visits and their determinants in the 18 Sub-Saharan African countries with the most recent DHS report (2016-2021). The data for this study were pooled from the most recent standardized Demographic and Health Survey data of sub-Saharan African countries from 2016-2021. A total of 171,183 (with a weighted frequency of 171,488) women were included and analyzed by using STATA version 16. To account for data clustering, a multivariable multilevel mixed-effect logistic regression analysis was run to determine the effects of each predictor on the receipt of timely and adequate ANC. Adjusted odds ratio with its corresponding 95% confidence interval was used to declare the statistical significance of the independent variables. The receipt of timely and adequate antenatal care visits was 41.2% (95% CI: 40.9, 41.4) and 10.4% (95% CI: 9.9, 10.2), respectively. Wontedness of pregnancy [AOR = 1.18; 95% CI: 1.13, 1.24], being 1st birth order [AOR = 1.48; 95% CI: 1.41, 2.54], having a mobile phone [AOR = 1.49; 95% CI: 1.26, 2.32], and enrolled in Health insurance schemes [AOR = 2.03; 95% CI: 1.95, 2.42] were significantly associated with early initiation of ANC. Living in a lower community poverty level[AOR = 2.23; 95% CI: 1.90,2.66], being in the richest wealth quintile [AOR = 1.49; 95% CI: 1.36, 1.62], higher educational level [AOR = 3.63; 95% CI: 3.33, 3.96], the timing of ANC visit [AOR = 4.26; 95% CI: 4.08, 4.44], being autonomous in decision making [AOR = 2.29; 95% CI: 1.83, 2.54] and having a mobile phone [AOR = 1.89; 95% CI: 1.76, 2.52] were identified as significant predictors of adequate ANC uptake. The findings revealed a low coverage of timely and adequate ANC visits in SSA countries. Governments and healthcare managers in sub-Saharan African countries should leverage their efforts to prioritize and implement activities and interventions that increase women's autonomy, and economic capability, to improve their health-seeking behavior during pregnancy. More commitment is needed from governments to increase mobile phone distribution across countries, and then work on integrating mHealth into their health system. Finally, efforts should be made to increase the coverage of health insurance schemes enrolment for the citizens.

Antenatal care utilization on low birth weight children among women with high-risk births.

Low birth weight (LBW) is a major public health problem in Indonesia, and is a leading cause of neonatal mortality. Adequate antenatal care (ANC) utilization would help to prevent the incidence of LBW babies. This study aims to examine the association between ANC utilization and LBW children among women with high-risk birth criteria. High-risk birth criteria consisted of 4T which were too young (mother's age <20 years old), too old (mother's age >35 years old), too close (age gap between children <2 years), and too many (number of children >2 children). This study utilized calendar data from the women's module from the 2017 Indonesia Demographic and Health Survey (IDHS), with the unit of analysis only the last birth of women of childbearing age (15-49), which numbered 16,627 women. From this number, analysis was done by separating the criteria for women with high-risk birth. Multivariate logistic regression analyses were employed to assess the impact of ANC and socio-demographic factors on LBW among women with high-risk birth criteria. This study revealed that only among women with too many children criteria (>2 children), adequate ANC utilization was significantly associated with LBW of children, even after controlling for a range of socio-demographic factors (p < 0.05). In all four women criteria, preterm birth was more likely to have LBW than those infants who were born normally (above and equal to 2500 grams) (p < 0.001). According to WHO, qualified ANC standards have not been fully implemented, including in the case of ANC visits of at least eight times, and it is hoped that ANC with health workers at health facilities can be increased. There is also a need for increased monitoring of pregnant women with a high risk of 4T to keep doing ANC visits to reduce LBW births.

Factors determining antenatal care utilization among mothers of deceased perinates in Ethiopia.

Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model. Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR). This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit. The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas.

Association of rural-urban place of residence with adequate antenatal care visit in Bangladesh.

Adequate antenatal care (ANC) is crucial to reduce maternal/neonatal deaths, but the proportion of mothers with appropriate ANC is lower in most low- and middle-income countries (LMICs) than in high-income countries. Furthermore, in many LMICs, including Bangladesh, there are intra-country disparities, and rural regions have substantially lower adequate ANC than urban regions. In this cross-sectional study, we performed secondary analyses on Bangladesh Demographic and Health Survey 2017-18 data to examine the rural-urban differences in adequate initiation, number, and quality of ANC. Women of reproductive age (i.e., 15-49-year-olds) with at least one birth in the three years before the survey were included. After reporting the prevalence of adequate ANC by rural-urban place, simple and multivariable logistic regression analyses were performed to examine the association. Among 4974 women, 1331 and 3643 were from urban rural regions, respectively. The proportions of mothers who initiated the visits in the first trimester, had at least four ANC visits, and had quality ANC were 47.5% (95% confidence interval (CI): 44.6-50.3), 59.0% (95% CI: 56.3-61.8), and 27.1% (95% CI: 24.6-29.6) in urban regions, and 33.4% (95% CI: 31.6-35.1), 42.8% (95% CI: 41.0-44.7), and 14.5% (95% CI: 13.1-15.8) in rural regions, respectively. These differences in ANC utilization were observed regardless of most sociodemographic and socioeconomic characteristics. After adjusting for sociodemographic and socioeconomic characteristics, compared to urban mothers, rural mothers had lower odds of at least four ANC visits (adjusted odds ratio (AOR): 0.77, 95% CI: 0.65-0.91) and quality ANC (AOR: 0.79, 95% CI: 0.65-0.97) but the odds for timely initiation (AOR: 0.85, 95% CI: 0.73-1.01) was not significant. Findings of this study showed significant disparities between rural and urban regions regarding appropriate ANC coverage, and the importance of improving ANC coverage among some sociodemographic groups to reduce these disparities, especially among mothers with low socioeconomic status.

Socio-economic and cultural factors associated with the utilization of maternal healthcare services in Togo: a cross-sectional study

BackgroundProper utilization of maternal healthcare services plays a major role on pregnancy and birth outcomes. In sub-Saharan Africa, maternal and child mortality remains a major public health concern, especially in least developed countries such as Togo. In this study, we aimed to analyze factors associated with use of maternal health services among Togolese women aged 15–49 years.MethodsThis study used data from third round of nationally representative Demographic and Health Survey conducted in Togo in 2013. Analysis included 4,631 women aged 15–49 years. Outcome variables were timely first antenatal care (ANC) visits, adequate ANC4 + visits, and health facility delivery. Data were analyzed using Stata version 16.ResultsOverall, proportion of maternal healthcare utilization was 27.53% for timely first ANC visits, 59.99% for adequate ANC visits, and 75.66% for health facility delivery. Our multivariable analysis showed significant differences among women in highest wealth quintile, especially in rural areas with increasing odds of timely first ANC visits (Odds ratio (OR) = 3.46, 95% CI = 2.32,5.16), attending adequate ANC visits (OR = 2.19, 95% CI = 1.48,3.24), and delivering in health facilities (OR = 8.53, 95% CI = 4.06, 17.92) compared to those in the poorest quintile. Also, women with higher education had increased odds of timely first ANC visits (OR = 1.37, 95% CI = 1.11,1.69), and attending adequate ANC visits (OR = 1.73, 95% CI = 1.42,2.12) compared to those with no formal education. However, having higher parity and indigenous beliefs especially in rural areas decreased odds of using healthcare services.ConclusionsFindings from this study showed that socio-economic inequality and socio-cultural barriers influenced the use of maternal healthcare services in Togo. There is therefore a need to improve accessibility and the utilization of maternal healthcare services through women’s economic empowerment and education to reduce the barriers.

Factors associated with underutilization of antenatal care in India: Results from 2019-2021 National Family Health Survey.

Despite progress in recent years, full antenatal care utilization in India continues to be relatively low and inequitable, particularly between states and districts. In 2015-2016, for example, only 51% of women aged 15-49 in India attended antenatal care at least four times during pregnancy. Using data from the fifth iteration of India's National Family Health Survey, our study aims to explore factors related to the underutilization of antenatal care in India. Data from the most recent live birth in the past five years among women aged 15-49 years were included in our analysis (n = 172,702). Our outcome variable was "adequate antenatal care visits", defined as four or more antenatal visits. Utilizing Andersen's behavioral model, 14 factors were identified as possible explanatory variables. We used univariate and multivariate binary logistic regression models to analyze the association between explanatory variables and adequate visits. Associations were considered statistically significant if p<0.05. Of the 172,702 women in our sample, 40.75% (95% CI: 40.31-41.18%) had an inadequate number of antenatal care visits. In multivariate analysis, women with less formal education, from poorer households and more rural areas had higher odds of inadequate visits. Regionally, women from Northeastern and Central states had higher odds of inadequate antenatal care utilization compared to those from Southern states. Caste, birth order, and pregnancy intention were also among the variables associated with utilization of antenatal care. Despite improvements in antenatal care utilization, there is cause for concern. Notably, the percentage of Indian women receiving adequate antenatal care visits is still below the global average. Our analysis also reveals a continuity in the groups of women at highest risk for inadequate visits, which may be due to structural drivers of inequality in healthcare access. To improve maternal health and access to antenatal care services, interventions aimed at poverty alleviation, infrastructure development, and education should be pursued.

Predictors for achieving adequate antenatal care visits during pregnancy: a cross-sectional study in rural Northwest Rwanda

BackgroundInadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities.MethodsA geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits.ResultsThe majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028).ConclusionsFindings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.

Determinants of Antenatal Care Visits in Bangladesh: A Quantile Regression Analysis.

Maternal and infant mortality is a major problem in a developing country like Bangladesh and these deaths are mostly related to incomplete antenatal care (ANC) visits. Adequate ANC visits for women are crucial in controlling maternal and infant mortality. To investigate factors associated with ANC visits among women of reproductive age (15-49) in Bangladesh using the Bangladesh Demographic Health Survey 2017-2018 (BDHS) data. This study included 5012 respondents, of whom 2414 women (48.2%) were complete ANC visits and 2598 women (51.8%) were incomplete ANC visits. Quantile regression was used for analysis indicating that the effects of different covariates functioned differently across the utilization of antenatal care visits. The results revealed the women's educational level, birth order number, sex of household head, and wealth index were highly significant on the lower, middle, and higher quantiles of the number of incomplete ANC visits. Besides, in the higher quantiles (for example, 75% quantile), the place of residence was highly significant. For division variables, Rajshahi, Rangpur, and Khulna were highly significant in lower and middle quantiles, while Dhaka, Khulna, Mymensingh, and Rajshahi were insignificant in higher quantiles. This study observed that education, wealth index, birth order of children, and place of residence are associated with utilization of ANC visits and significantly influence maternal mortality. These determinations can help healthcare programmers and policymakers to take appropriate policies and programs for complete antennal care visits among pregnant women in Bangladesh. In order to increase the number of ANC visits among women, it is necessary to establish a mutually coordinated and trusting relationship between the government, non-governmental organizations and NGOs.

Association of geographic distribution and birth weight with sociodemographic factors of the maternal and newborn child of hilly and mountain regions of eastern Nepal: a cross-sectional study

ObjectivesTo determine the association of geographic distribution, and birth weight with sociodemographic factors of the maternal and newborn child of hilly region (lower altitude) and mountain region (high altitude) of...

Pengaruh Antenatal Care, Tingkat Kecemasan, Kehamilan Beresiko Dan Jenis Persalinan Terhadap Kesiapan Fisiologis Persalinan

The physiological approach of labor and delivery is preferred for most pregnant women. Most of the research on physiological births has focused on prenatal care. A good prenatal effect on good physiological readiness too. The purpose of this study was to determine the relationship between the frequency and perception of antenatal care services, anxiety levels, pregnancy risks and types of delivery on the physiological readiness of labor. The research method is quantitative descriptive with cross sectional design. The research sample was postpartum mothers after 6 months of delivery in the working area of Puskesmas Pariaman Selatan. Analysis of research data used the chi-square test. The results of the study reported that there is a relationship between the frequency of visits and perceptions of Antenatal care services, anxiety, pregnancy risk and type of delivery with the physiological readiness of maternal delivery. Pregnant women are advised to make adequate antenatal care visits during pregnancy at least four times and encourage mothers to read a lot in order to know the physiological changes during pregnancy. This method is believed to be able to detect early when there are danger signs of pregnancy. Together with midwives and doctors, mothers can plan the process of delivering the fetus well and get positive emotional support to avoid a risky pregnancy

Adequacy and timeliness of antenatal care visits among Ethiopian women: a community-based panel study

ObjectivesThe purposes of the study are; (A) to identify whether Ethiopian women’s antenatal care (ANC) visits are adequate and timely and (B) to explore factors that determine these.DesignPanel study design.SettingEthiopia.ParticipantsA...

Improved Water, Sanitation and Utilization of Maternal and Child Health Services in South Asia-An Analysis of Demographic Health Surveys.

Globally, many millions of people still lack access to safe drinking water and sanitation facilities. Here, we examined associations between household availability of improved drinking water and sanitation, respectively, and use of maternal and child health (MCH) services in South Asian countries. Demographic and Health Survey population-based data from Bangladesh, Nepal, India, and Pakistan were used, restricted to women with a child aged 0–36 months (n = 145,262). Types of households’ water source and sanitation facilities were categorized based on the World Health Organization and UNICEF’s definitions of “improved” and “unimproved”. We applied logistic regressions to estimate odds ratios (OR) and 95% confidence intervals (CI) for improved water and sanitation, respectively, and reported antenatal care visits, having a skilled attendant at birth, and infant vaccination coverage, stratified by maternal education. Among lower educated women, access to improved water source was associated with greater ORs for presence of a skilled attendant at delivery and their children having up-to-date immunizations (OR: 1.29; 95% CI: 1.17, 1.42). Among lower and higher educated women, improved sanitation (vs. unimproved) was associated with greater ORs for having had adequate antenatal care visits (OR: 1.74; 95% CI: 1.62, 1.88; OR: 1.71; 95% CI: 1.62, 1.80), and similarly for having had a skilled attendant at birth, and children with up-to-date immunizations. Approaches addressing water/sanitation and MCH services across sectors could be a suggested public health strategy.

Association between different types of mass media and antenatal care visits in India: a cross-sectional study from the National Family Health Survey (2015–2016)

ObjectiveTo generate evidence for the association between different types of mass media and antenatal care (ANC) visits in India.DesignA cross-sectional study design, analysing data from India’s National Family Health Survey...

Adequate Antenatal Care Visits among Tribal Women in Bangladesh

Adequate Antenatal Care Visits among Tribal Women in Bangladesh

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

BackgroundMaternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda.MethodsThis study is cross-sectional using secondary data from the 2014–15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15–49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.ResultsOf 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results.ConclusionThe study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

Psycho-social factors affecting antenatal care services utilization at the Ministry of Health’s primary health care centers in Jeddah, Kingdom of Saudi Arabia, 2017-2018: an analytical cross-sectional study

Background: This study aimed to explore the psychosocial factors affecting the utilization of antenatal care (ANC) services.Methods: This was an analytical cross-sectional study carried-out in the 4 main MOH maternity hospitals in Jeddah. The study sample included 2 groups: 80 women with inadequate ANC attendance and 159 with adequate ANC attendance. We applied probability proportional to size sampling technique. The outcome of this study was ANC attendance (adequate or inadequate). Independent variables included: age, nationality, educational level, occupation, monthly income, the dependent variables included: the number of ANC visits.Results: The utilization findings of this study revealed that 88 women out of 239 women had not fully used the health services provided to them (underutilization) and the utilization rate was 66.5%. Approximately one-half of the women with inadequate ANC had birth intervals of less than 2 years. Three-quarters of them reported that they did not plan their current pregnancies, and nearly two-thirds of them had high levels of stress. Logistic regression analysis indicated that inadequate ANC attendance was predicted by past negative experiences related to ANC attendance (p=0.001) (OR=0.183 CI=0.065-0.513).Conclusions: The most significant identified barriers to utilization of ANC services were high stress, previous negative ANC experience, unplanned pregnancy, and short birth intervals. Furthermore, women who had adequate ANC visits were more likely to have planned pregnancies and be aware of available ANC services.

Utilization of antenatal care services in Syrian refugee camps in Erbil, Iraq

Background and Objective: Antenatal care can help in preparing women for delivery in addition to raising awareness about the warning signs during pregnancy. This study aimed to assess the pattern of utilization of antenatal care services by the pregnant women in Syrian refugee camps in Erbil. Methods: A cross-sectional study was conducted at the four Syrian refugee camps in Erbil between 1st June 2015 and 1st March 2016. A sample of 470 newly delivered women was included in the study. Data was collected through a specially designed questionnaire. Results: The majority of the women (99.6%) had at least one antenatal care visit during pregnancy with 73.6% having adequate antenatal care visits. About 64% of the women visited both the public and private health sectors. A statistically significant higher proportion of employed women utilized adequate antenatal care services than the non-employed women (84% vs. 63.4%, P = 0.036). There was no statistically significant association between the mothers' age and education with the utilization of adequate antenatal care. Conclusion: A high proportion of women in the Syrian refugee camps in Erbil received antenatal care services during the last pregnancy with a relatively important proportion of them receiving adequate care and having early initiation of antenatal care visits. Further studies are needed to examine the quality of the antenatal care services in the refugee camps and women’s satisfaction with these services.

Prevalence and Associated Factors of Taking Intermittent Preventive Treatment in Pregnancy in Sierra Leone.

Malaria infection during pregnancy is a major public health problem in sub-Saharan Africa. The World Health Organization (WHO) recommends that gestational and congenital malaria can be prevented by using intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). IPTp-SP is a full therapeutic course of antimalarial medicine administered during pregnancy as a component of antenatal care. This study’s objective was to assess the prevalence and predictors of IPTp-SP uptake in pregnancy in Sierra Leone. This study was based on the fifth round of the Multiple Indicator Cluster Survey (MICS 5) conducted in Sierra Leone in 2016. Participants were 8526 women aged between 15–49 years. Outcome variables were uptake of IPTp-SP during the last pregnancy. Data were analysed using cross-tabulation and logistic regression methods. Results showed that the prevalence of taking IPTp-SP was 94.81% (92.40, 96.14), and that the prevalence of taking at least three doses was 93.24% (92.50, 94.81). In the multivariate logistic regression, education, parity, and antenatal care (ANC) use were significant predictors of IPTp-SP uptake. Women with higher education had lower odds of taking IPTp-SP (Odds Ratio = 0.647, 95%CI = 0.444, 0.943); having higher parity (>4) was associated with lower odds of taking IPTp-SP (OR = 0.663; 95%CI = 0.442, 0.994) and adequate ANC use increased the odds of taking IPTp-SP in both urban (OR = 1.450, 95%CI = 1.158, 3.128) and rural areas (OR = 1.903, 95%CI = 1.069, 1.966). In contrast, the positive association between ANC visits and adequate doses of taking IPTp-SP was true for rural women only (OR = 1.408, 95%CI = 1.174, 1.689). In conclusion, the use of IPTp-SP is close to being universal, with the prevalence being relatively higher in the rural areas. Based on our findings, promoting adequate antenatal care visits should be regarded as a key strategy to improve the use of IPTp-SP in Sierra Leone. Further studies could focus on exploring other predictors of IPTp-SP uptake that are not captured by MICS in Sierra Leone.

Antenatal care among Palestine refugees in Jordan: factors associated with UNRWA attendance.

Maternal and neonatal mortality is a global issue acknowledged by the Sustainable Development Goals (SDGs). Adequate ante-natal care (ANC) is pivotal to reducing these mortality rates, while understanding why women don't attend ANC is crucial to addressing the SDGs. Using routine primary health care data to determine the factors associated with inadequate attendance by Palestine refugees (PR) to ANC seeking facilities provided by the United Nations Relief and Works agency for Palestine Refugees in the Near East (UNRWA), Jordan. A backwards logistic regression model incorporating non-health system factors and health system factors, was performed using UNRWA data. A younger age of women was associated with inadequate ANC visits (P = 0.0009) in the non-health systems model. For health system factors, pregnancy risk status, having a gynaecologist review and the health centre attended were factors found to be significantly associated with ANC attendance (P < 0.0001). Understanding the health system factors associated with ANC attendance can lead to changes and improvements in UNRWA's operational policies.

Impact of Community Education on Antenatal Care Visits in Bangladesh: A Multilevel Analysis

Antenatal care (ANC) utilization has a great role in reducing pregnancy-related complications and maternal mortality. Besides individual demographic and socio-economic factors, community characteristics can influence a mother‟s decision to seek antenatal care visits. This study makes an attempt to determine the influence of community education on adequate ANC visits in Bangladesh by using Bangladesh Demographic and Health Survey (BDHS) 2014 data. Multilevel logistic regression model has been employed for the purpose of the analysis. Study findings showed a significant positive association of community education on adequate ANC visits. Other community and individual level covariates such as place of residence, region of residence, birth order, mother‟s age at birth, household wealth, media access, husband‟s education, decision making on health care also showed significant association with adequate ANC visits.&#x0D; Dhaka Univ. J. Sci. 67(1): 41-46, 2019 (January)