Determinants Of Antenatal Care Research Articles

Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen’s behaviour model

BackgroundPapua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG.MethodsThe study was conducted using the 2016–2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05.ResultsThe prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women’s employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors.ConclusionsThis study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women’s education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.

Antenatal Care Dropout and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis.

The prevalence and determinants of antenatal care (ANC) dropout in Ethiopia were studied. However, the results were inconsistent and showed considerable variation. Hence, this meta-analysis aimed at estimating the overall prevalence of ANC dropout and its predictors in Ethiopia. A comprehensive search of published studies was done using different international databases such as such as PubMed, DOJA, Embase, Cochrane Library, Google Scholar, and the institutional repository of Ethiopian universities were used to search for relevant studies. Data were extracted using Microsoft Excel spreadsheet, and exported to STATA v17 for analysis. A random effect model was used to estimate the overall national prevalence of ANC dropout. Fixed effects model were used to compute the pooled adjusted odd ratios (AOR) with the corresponding 95% confidence intervals (CIs). I 2test was used to assess heterogeneity of the included studies. Egger's tests was used to check for the presence of publication bias. A total of 7 studies were included in this systematic review and meta-analysis with 11,839 study participants. The overall pooled prevalence of ANC in Ethiopia was found to be 41.37% (95% CI =35.04, 47.70). Distance from the health care facility (AOR = 2.93, 95% CI = 2.75, 3.11), pregnancy complication signs (AOR = 2.97, 95% CI = 2.77, 3.16), place of residence (AOR = 1.79, 95% CI = 1.31, 2.26), educational level (AOR = 1.79, 95%CI = 1.37, 2.21), and age group (30-49) (AOR = 0.61, 95% CI = 0.45, 0.78) were significantly associated with ANC dropout. Based on this review and meta-analysis, 41% of Ethiopian women dropped out of ANC visits before the minimum recommended visit (4 times). Hence, to reduce the number of ANC dropouts, it is important to counsel and educate women during their first prenatal care. Issues of urban-rural disparities and noted hotspot areas for ANC dropout should be given further attention.

Determinants or barriers associated with specific routine check-up in antenatal care in gestational period: A study from EAG states, India

BackgroundFor a long period of time Empowered Action Group States (EAG) of India are cursed with maternal mortality and morbidity. Most of the pregnant women are not acquiescent to receive the routine check-up during Antenatal Care (ANC) and many of them cautiously skip the same. The study aims to explore the obstacle of ANC in women's perspective and their participation in this. MethodsThe study has incorporated most recent fourth round of National Family Health Survey data conducted in 2015–16. Descriptive statistics along with association test and binary logistic regression model have been applied to understand the differential and determinants of ANC. ResultThe behaviour of not taking ANC check-ups (measuring the weight and BP, tested urine and blood sample, taking iron supplements) during pregnancy was significantly higher among women who married in early age (<18 years), had no formal education, belonged to poor socioeconomic status. ConclusionMost of the maternal health issues during the gestational period are associated with socio-economic and demographic aspects and mostly due to unawareness and ignorance of the people. It would be benevolent in increasing awareness and taking the necessary visit to receive the routine check-up in ANC is for the duo mothers and foetus.

Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data

BackgroundGlobally, maternal health remains a major priority. Most of maternal deaths globally occur in sub-Saharan Africa, with most of these deaths linked to lack of access to antenatal care and skilled assistance during delivery. This study assessed the determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea.MethodsData for this study were obtained from the 2018 Guinea Demographic and Health Survey (GDHS). Data of 4,917 childbearing women were considered as our analytical sample. The outcome variables for the study were utilization of antenatal care and skilled birth attendance. Analysis was carried out using chi-square tests and multivariable logistic regression.ResultsThe results showed that women aged 15-24 (AOR=1.29, CI=1.03-1.62), women who had secondary/higher level of education (AOR=1.70, CI=1.33-2.19), and those whose partners had secondary/higher level of education (AOR=1.46, CI=1.22-1.75), women in the richest wealth quintile (AOR=5.09, CI=3.70-7.00), those with planned pregnancies (AOR=1.50, CI=1.23-1.81), Muslim women (AOR=1.65, CI=1.38-2.12), those who take healthcare decisions alone (AOR=1.53, CI=1.24-1.89), and those who listened to radio less than once a week (AOR= 1.30, CI=1.10-1.53) had higher odds of antenatal care uptake. Also, women with secondary/higher level of education (AOR=1.83, CI=1.25-2.68), those whose partners had secondary/higher level of education (AOR=1.40, CI=1.11-1.76), those in the richest wealth quintile (AOR=10.79, CI=6.64-17.51), those with planned pregnancies (AOR=1.25, CI=1.03-1.52), Christian women (AOR=4.13, CI=3.17-5.39), those living in urban areas (AOR=3.00, CI=2.29-3.94), women with one birth (AOR= 1.58, CI=1.20-2.06), those who take healthcare decisions alone (AOR=1.87, CI=1.46-2.39), those who read newspaper at least once a week (AOR= 1.19, CI=1.01-1.40), those who watched television at least once week (AOR=1.69, CI=1.30-2.19), and those in female-headed households (AOR=1.52, CI=1.20-1.92) were more likely to utilize the services of skilled birth attendants.ConclusionThe study proved that various socio-economic and contextual factors influence antenatal care and skilled birth attendance in Guinea. These findings suggest the need to design community-based interventions (e.g., miniature local ANC clinics, early screening services) that prioritize women’s education and vocational training, media accessibility, especially among the poor, and those residing in rural settings. Such interventions should not ignore the influence of other socio-cultural norms that hinder the utilization of antenatal care and skilled birth attendance services in Guinea.

Factors associated with antenatal and health facility delivery care in selected areas of Subornochor upazila, Noakhali, Bangladesh

Improving maternal health and reducing maternal mortality rate (MMR) are major challenges for Bangladesh. Utilization of antenatal care (ANC) services from skilled professionals and deliveries in health facilities are therefore important to tackle MMR and socioeconomic differences play a major part for these service utilization. The purpose of the current study was to identify the level and determinants of ANC and health facility delivery care utilization in Subornochor upazila (a rural sub-district), Noakhali, Bangladesh. The study was a community based cross sectional study. A total of 360 women (15–49 years) who had a child in the last five years preceding the survey were interviewed and studied. The results of overall analysis showed that only 34.6% women received ANC from health professionals, whereas mere 5.3% deliveries were taken place at health facilities. Mother's education, partner's occupation, family income and area of residence were significant predictors of these services utilization. Place of receiving ANC was an influencing factor of health facility delivery. Women who didn't receive ANC in health facilities were almost three times (OR: 2.95, 95% CI: 1.06–7.9) less likely to deliver in health facilities compared to the women who received ANC. The study underscores the urgent need of addressing socioeconomic differences and targeted interventions might help the women who need to utilize these services more often. The study also pointed out huge differences of these services utilization with national average. Though further investigation is necessary but emphasis should be given more to address the barriers of maternal health service.

Utilization of key preventive measures for pregnancy complications and malaria among women in Jimma Zone, Ethiopia

BackgroundIn Ethiopia, malaria infections and other complications during pregnancy contribute to the high burden of maternal morbidity and mortality. Preventive measures are available, however little is known about the factors influencing the uptake of maternal health services and interventions by pregnant women in Ethiopia.MethodsWe analyzed data from a community-based cross-sectional survey conducted in 2016 in three rural districts of Jimma Zone, Ethiopia, with 3784 women who had a pregnancy outcome in the year preceding the survey. We used multivariable logistic regression models accounting for clustering to identify the determinants of antenatal care (ANC) attendance and insecticide-treated net (ITN) ownership and use, and the prevalence and predictors of malaria infection among pregnant women.ResultsEighty-four percent of interviewed women reported receiving at least one ANC visit during their last pregnancy, while 47% reported attending four or more ANC visits. Common reasons for not attending ANC included women’s lack of awareness of its importance (48%), distance to health facility (23%) and unavailability of transportation (14%). Important determinants of ANC attendance included higher education level and wealth status, woman’s ability to make healthcare decisions, and pregnancy intendedness. An estimated 48% of women reported owning an ITN during their last pregnancy. Of these, 55% reported to have always slept under it during their last pregnancy. Analysis revealed that the odds of owning and using ITNs were respectively 2.07 (95% CI: 1.62–2.63) and 1.73 (95% CI: 1.32–2.27) times higher among women who attended at least one ANC visit. The self-reported prevalence of malaria infection during pregnancy was low (1.4%) across the three districts. We found that young, uneducated, and unemployed women presented higher odds of malaria infection during their last pregnancy.ConclusionANC and ITN uptake during pregnancy in Jimma Zone fall below the respective targets of 95 and 90% set in the Ethiopian Health Sector Transformation Plan for 2020, suggesting that more intensive programmatic efforts still need to be directed towards improving access to these health services. Reaching ANC non-users and ITN ownership and use as part of ANC services could be emphasized to address these gaps.

Determinants of antenatal care and skilled birth attendance in sub-Saharan Africa: A multilevel analysis.

To determine individual- and country-level determinants of utilization of key maternal health services in sub-Saharan Africa (SSA). We used the most recent standard demographic and health survey data from the period of 2005 to 2015 for 34 SSA countries. Predictors of key maternal health service indicators were determined using a sample of 245178 women who had at least one live birth 5years preceding the survey. We used a two-level hierarchical model, considering individual predictors at level one and country factors at level two of the hierarchy. While the skilled birth attendance (SBA) utilization rate reached 53 percent during the study period, the recommended four or more antenatal care (ANC) coverage was commonly low with less significant differences among different groups of women and countries. Being in a middle-income country increased the individual-level association between ANC and SBA (OR=2.34, 95% CI: 1.24, 4.44). Less privileged women with lower education level were less likely to receive maternal health services. This study reveals the existence of wide gaps between ANC and SBA coverage in SSA. Urgent policy attention is required to improve access, utilization, and quality of maternal health services.

Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey

ABSTRACTBackground: Improving maternal health is a global challenge. In Ghana, maternal morbidity and mortality rates remain high, particularly in rural areas. Antenatal care (ANC) attendance is known to improve maternal health. However, few studies have updated current knowledge regarding determinants of ANC attendance.Objective: This study examined factors associated with ANC attendance in predominantly rural Ghana.Methods: We conducted a cross-sectional study at three sites (i.e. Navrongo, Kintampo, and Dodowa) in Ghana between August and September 2013. We selected 1500 women who had delivered within the two years preceding the survey (500 from each site) using two-stage random sampling. Data concerning 1497 women’s sociodemographic characteristics and antenatal care attendance were collected and analyzed, and factors associated with attending ANC at least four times were identified using logistic regression analysis.Results: Of the 1497 participants, 86% reported attending ANC at least four times, which was positively associated with possession of national health insurance (AOR 1.64, 95% CI: 1.14–2.38) and having a partner with a high educational level (AOR 1.64, 95% CI: 1.02–2.64) and negatively associated with being single (AOR 0.39, 95% CI: 0.22–0.69) and cohabiting (AOR 0.57, 95% CI: 0.34–0.97). In site-specific analyses, factors associated with ANC attendance included marital status in Navrongo; marital status, possession of national health insurance, partners’ educational level, and wealth in Kintampo; and preferred pregnancy timing in Dodowa. In the youngest, least educated, and poorest women and women whose partners were uneducated, those with health insurance were more likely to report at least four ANC attendances relative to those who did not have insurance.Conclusions: Ghanaian women with low socioeconomic status were less likely to report at least four ANC attendances during pregnancy if they did not possess health insurance. The national health insurance scheme should include a higher number of deprived women in predominantly rural communities.

Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria.

IntroductionUtilization of antenatal care, institutional delivery and postnatal care services in Nigeria are poor even by african average.MethodsWe analysed the 2013 Nigeria DHS to determine factors associated with utilization of these health MCH indicators by employing both bivariate and multivariate logistic regressions.ResultsOverall, 54% of women had at least four ANC visits, 37% delivered in health facility and 29% of new born had postnatal care within two of births. Factors that consistently predict the utilization of the three MCH services are maternal and husband's level education, place of residence, wealth level and parity. Antenatal care strongly predicts both health facility delivery (OR = 2.16, 95%CI: 1.99-2.34) and postnatal care utilization (OR = 4.67, 95%CI: 3.95-5.54); while health facility delivery equally predicting postnatal care (OR = 2.84, 95%CI: 2.20-2.80).ConclusionImproving utilization of these three MCH indicators will require targeting women in the rural areas and those with low level of education as well as creating demand for health facility delivery. Improving ANC use by making it available and accessible will have a multiplier effect of improving facility delivery which will lead to improved postnatal care utilization.