Early Antenatal Care Visit Research Articles

The Effects of Antenatal Care Utilisation on Birthweight: Evidence from Ghana

Abstract In 2015, about 20.5 million babies were born with low birthweight (LBW), with the majority from low- and middle-income countries. The use of antenatal care (ANC) is a recommended health policy measure to reduce the risk of LBW. However, there is limited evidence for its effectiveness in reducing LBW in sub-Saharan Africa, although the region accounts for almost one-quarter of LBW babies, second only to Asia. Moreover, while the number of LBW in other regions is reducing, the number of LBW babies in sub-Saharan Africa is increasing. We therefore use data from Ghana (a sub-Saharan African country with a high incidence rate of LBW) to investigate the effect of using ANC on birthweight. The number of ANC visits and the month of ANC initiation were used as indicators for ANC utilisation. We applied an extended linear regression technique to deal with the potential sample selection bias and endogeneity associated with the use of ANC. The results from the study indicate that early ANC initiation and having more ANC visits are both associated with an increase in birthweight; however, the estimated effect of an early ANC visit is larger than having an additional visit. Therefore, we recommend that policies aimed at tackling the problem of LBW should mostly be geared towards promoting ANC utilisation, especially early ANC initiation. We also find that estimating the effect of ANC on birthweight without accounting for sample selection bias and endogeneity of ANC underestimates the effect of ANC on birthweight.

Socioeconomic inequality in timing of ANC visit among pregnant women in Ethiopia, 2019.

Antenatal care (ANC) remains an invaluable approach to preventive care for ensuring maternal and infant health outcomes. Women in sub-Saharan Africa tend to delay their first antenatal care visits. In Ethiopia, only 20% of women received their first antenatal care during the first trimester of pregnancy. Timely and appropriate antenatal care practices can potentially save the lives of both mothers and children. Understanding socioeconomic inequality in the timing of antenatal care visits and its determinants may contribute to tackling disparities and achieving the sustainable development goals for maternal health. This study aimed to assess the socioeconomic inequality in the timing of antenatal care visit. Secondary data sourced from the Mini Ethiopian Demographic Health Survey 2019 were used for this study. A total of 2,906 pregnant women were included in the study, and concentration curves were used to show inequality among sociodemographic and economic variables. Decomposition analysis was performed to estimate the contribution of each independent variable to the inequality in the timing of antenatal care visits. The estimate of early initiation of antenatal care was 63%. The concentration index was 0.18 (P < 0.001). The inequality in the timing of antenatal care visit was more concentrated among the wealthiest pregnant women with a concentration index value of 0.18 (P < 0.001). Based on decomposition analysis results, the wealth index (81.9%.), education status (22.29%), and region (0.0642%) were identified as contributing factors to the inequality in the timing of antenatal care visits among women. The wealth index, educational status, and region were significant contributors to inequality in the early initiation of antenatal care visit. Improving women's wealth and education and narrowing the inequality gap are crucial for improving the health status of women and their children. We should focus on interventions targeted at early antenatal care visit to address the determinants of socioeconomic inequities.

Perceptions of pregnant women on antenatal care visit during their first trimester at area 25 health center in Lilongwe, Malawi – a qualitative study

BackgroundInitiation of antenatal care during the first trimester is crucial for reducing maternal and neonatal morbidity and mortality. Unfortunately, only 24% of pregnant women in Malawi initiate antenatal care during this time with even lower rates of 15% at Area 25 Health Centre in Lilongwe. Despite such cases, there is little literature on obstacles that prevent women from accessing first-trimester antenatal care in Malawi.AimTo explore perceptions of pregnant women and how they influence antenatal care visits during the first trimester at Area 25 Health Centre in Lilongwe, Malawi.MethodsWe employed a qualitative exploratory study on 55 purposely identified participants. The participants were aged between 18 and 37 years with a gestational period of 36 weeks and below and attended antenatal care at Area 25 Health Centre in Lilongwe Urban, Malawi. Data were collected by MN and 2 data collectors from 19th March 2021 to 16th April 2021 through a total of 15 In-depth Interviews (IDIs) and four Focus Group Discussions (FGDs). Data were manually analysed using thematic analysis, which included categorization and deductive theme identification with reference to the study objectives and the Health Belief Model (HBM).ResultsPregnant women perceived that the first-trimester antenatal care visits were only for those experiencing ill health conditions like backache, headache, and HIV/AIDS during pregnancy. First-trimester pregnancy was perceived as too small and not worthy of seeking antenatal care; the women placed a low value on it. The majority of those who initiated antenatal care in the first trimester had previously experienced disorders and complications such as previous cesarean sections and abortions. In addition to limited knowledge about the required total number of ANC visits, challenges such as long-distance, preoccupation with business, multiple antenatal visits, scheduling of antenatal care visits, negative attitude of health workers, adherence to COVID-19 containment measures, and inadequate partner support, were identified as barriers to seeking antenatal care during the first trimester.ConclusionThe negative perceptions among pregnant women, coupled with various health systems, socio-economic and individual barriers, contributed to low attendance rates for first trimester antenatal care in Malawi. Addressing knowledge gaps and overcoming barriers related to economic, individual and health care delivery can improve women’s early antenatal care visits. Future research should consider the pregnant women from diverse socioeconomic backgrounds to gain a better understanding of these perceptions and barriers.

Prevalence and risk factors for delayed antenatal care visits in Rwanda: an analysis of secondary data from Rwanda demographic health survey 2019-2020.

antenatal care (ANC) delivers services to prevent pregnancy complications and provides counseling for birth, and emergency preparedness. Having ANC on time has life-saving potential for the child and mother. Despite improvements in health infrastructure, human resources, and health insurance, hindrances to early ANC visits still exist in Rwanda. This study aimed to investigate the burden and factors associated with delayed ANC visits in Rwanda so that policymakers can develop strategies to promote early ANC visits. this is a cross-sectional study using Rwanda demographic health survey (RDHS) 2019-2020 that included 6,039 women that had had a pregnancy in the 5 years preceding the survey. Descriptive analysis was used to determine the prevalence and a multivariable logistic regression model using manual backward stepwise regression was used to identify risk factors for delayed ANC in Rwanda. STATA 16 statistical software was used for all the analyses. the prevalence of delayed ANC in Rwanda was 41% and the risk factors include: the number of children 4-6 (AOR = 1.4, 95% CI: 1.2-1.6) and 7 or more children (AOR = 1.5, 95% CI: 1.5-2.1) versus less than 3 children, unwanted pregnancy (AOR = 1.7, 95% CI: 1.5-2.0), not covered by health insurance (AOR = 14, 95% CI: 1.2-1.6), woman´s education level: no education (AOR 2.6, 95% CI: 1.6-4.1), primary education (AOR 2.5, 95% CI: 1.6-3.7), secondary education (AOR 2.2, 95% CI: 1.5-3.2), woman´s occupation: informal (AOR 2.3 95% CI: 1.5-3.7) and unemployment (AOR 2.3. 95% CI: 1.4-3.7). Conclusion: based on the findings from our study, family planning services should be made available to all women of childbearing age to prevent unwanted pregnancies; female education should be considered a priority, promotion of health insurance coverage and community-based education about reproductive health to encourage the early seeking of care among women of childbearing age.

Coverage of antenatal iron-folic acid and calcium distribution during pregnancy and their contextual determinants in the northeastern region of India.

Iron-folic acid (IFA) and calcium supplementation are nutritional interventions recommended prophylactically (against maternal anemia and preeclampsia, respectively) to all antenatal mothers in India under basic antenatal care (ANC) services. Using Health Management Information System data (reporting period: 2018–19 to 2020–21), we mapped the coverage of antenatal IFA and calcium distribution across the remote northeastern region of India relative to the number of pregnant women (PW) who registered for ANC, disaggregated by states and districts. Variations in coverage were also investigated by subgroups based on contextual attributes, viz., physiography (hilly/ plateau/ plain), socioeconomic development (“aspirational”/ “non-aspirational”) and proportion of early ANC visits (low/ medium/ high). Full course of antenatal IFA and calcium supplements were received by 79.36 (95% CI: 79.31–79.40) and 61.26 (95% CI: 61.21–61.32) PW per 100 ANC registered women, respectively. There was widespread heterogeneity in outreach, with calcium coverage generally trailing behind IFA coverage. Among states, coverage of the two interventions (per 100 ANC registered women) was highest in Assam (97.06 and 78.11 PW, respectively) and lowest in Nagaland (24.87 and 16.77 PW, respectively). At the district-level, the two interventions failed to reach even 50 PW per 100 ANC registered women in 32 (out of 115) districts. The coverage tended to be inferior in districts that were hilly, “non-aspirational” and had low proportion of early ANC visits. The granular information provided by our findings will facilitate monitoring, root cause analyses, microplanning, informed resource allocation and tailoring of locally appropriate solutions to achieve targeted coverage improvements.

Magnitude and Factors Associated with Late Initiation of Antenatal Care Booking on First Visit Among Women in Rural Parts of Ethiopia.

Early antenatal care visits enhance early detection and treatment of pregnancy problems, resulting in optimal delivery management. This study aimed to assess the late initiation of antenatal care visits among pregnant women in rural parts of Ethiopia. A 2016 Ethiopian Demographic and Health Survey provided the data for this study and a population-based cross-sectional study was conducted during data collection. Only 3065 women from rural areas were included in this study due to having complete information from all eligible women aged 15 to 49 who participated in the interview during data collection. SPSS-20 and R-4.1.2 statistical software were used to examine the data. The factors associated with the late initiation of antenatal care visits were identified using descriptive analysis and a binary logistic regression model. This finding revealed that only 31% of women visited their initial antenatal care within the first 3months. The distance between the health facility and the participants was a concern for 87.7% of the participants. Our research found that women's education, maternal age, region, media access, women's occupation, distance from the health facility, wealth index, pregnancy complication, and pregnancy plan all had significant effects on the late initiation of antenatal care visits. When compared to the reference group, women with a secondary and above education (AOR = 1.52, p-value = 0.02), women in age group 30-34 (AOR = 1.57, p-value = 0.02), and women in age group 35-39 (AOR = 1.56, p-value = 0.03), women with media access (AOR = 2.4, p-value = 0.04), richer women's (AOR = 1.29, p-value ≤ 0.001), women with pregnancy previous complication (AOR = 1.58, p-value ≤ 0.001), and women who had plan to the pregnancy (AOR = 1.26, p-value = 0.02) were more likely to start visiting ANC service earlier. In addition, private worker mothers, housewife women, and mothers having distance problems were less likely to visit antenatal care service before or at 12weeks of gestation compared to those mothers in reference categories of each variable. In Ethiopia, particularly in rural areas, early registration to antenatal care visits was extremely low. Community-based services such as media coverage, education, transportation, and raising awareness about the need of receiving antenatal care services early are required to encourage expecting mothers to attend their ANC appointment on time.

Type of occupation and early antenatal care visit among women in sub-Saharan Africa

BackgroundType of occupation has been linked to early antenatal care visits whereby women in different occupation categories tend to have different timing for antenatal care visits. Different occupations require varying levels of commitment, remuneration and energy requirements. This study, therefore, sought to investigate the association between the type of occupation and early antenatal care visits in sub-Saharan Africa.MethodsThis is a secondary analysis of Demographic and Health Survey data from 29 countries in sub-Saharan Africa conducted between 2010 and 2018. The study included 131,912 working women. We employed binary logistic regression models to assess the association between type of occupation and timely initiation of antenatal care visits.ResultsThe overall prevalence of early initiation of antenatal care visits was 39.9%. Early antenatal care visit was high in Liberia (70.1%) but low in DR Congo (18.6%). We noted that compared to managerial workers, women in all other work categories had lower odds of early antenatal care visit and this was prominent among agricultural workers [aOR = 0.74, CI = 0.69, 0.79]. Women from Liberia [aOR = 3.14, CI = 2.84, 3.48] and Senegal [aOR = 2.55, CI = 2.31, 2.81] had higher tendency of early antenatal care visits compared with those from Angola.ConclusionThe findings bring to bear some essential elements worth considering to enhance early antenatal care visits within sub-Saharan Africa irrespective of the type of occupation. Women in the agricultural industry need much attention in order to bridge the early antenatal care visit gap between them and workers of other sectors. A critical review of the maternal health service delivery in DR Congo is needed considering the low rate of early antenatal care visits.

FACTORS INFLUENCING ACCESS TO ANTENATAL CARE BY PREGNANT WOMEN IN DEDZA DISTRICT: LESSONS FROM MAGANGA VILLAGE IN TRADITIONAL AUTHORITY TAMBALA’S AREA, MALAWI

Malawi has registered a big number of maternal deaths and newborn or birth complications over the years. This is prevalent in many rural areas and villages across the country. The reason behind these maternal deaths and newborn complications is delayed access to early Antenatal Care visits (ANC). ANC is distinct and special care given to pregnant women to ensure improved health outcomes i.e., to avoid maternal deaths and newborn complications. Chiphwanya Health Centre which is found in Dedza district, the central region of Malawi, is well vested in this task. This research study was, therefore, conducted to assess factors leading to delayed access to ANC care in Maganga Village which surrounds the aforementioned health centre. The study adopted a mixed-method where both qualitative and quantitative data were collected and analysed. Quantitative data were collected from pregnant women while qualitative data was collected from guardians and health personnel. The results indicate that 43% of women and 50% of stakeholders considered traditional beliefs as the key contributor to delayed access to ANC. Over 20% of pregnant women and 6.7% of key stakeholders attributed distance as a reason for delayed access to ANC services. It can be concluded that delayed access to ANC portrayed in this area is due to traditional beliefs and distance. Hence, the need for awareness campaigns so that the community is well informed of the importance of ANC and the local leaders should have a touch on issues regarding ANC.&#x0D;

Influence of women's decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria: evidence from the Nigeria Demographic and Health Survey 2018

BackgroundIn the context of global health priority, understanding the role of power dynamics among women as an important intervention required towards achieving optimum maternal and child health outcomes is crucial. This study examined the influence of women's decision-making autonomy on antenatal care utilisation and institutional delivery services in Nigeria.MethodsThe data for the study were derived from the 2018 Nigeria Demographic and Health Survey and comprised a weighted sample of 20,100 births in the last five years that preceded the survey among married/cohabiting childbearing women. Descriptive and analytical analyses were carried out, including frequency tables and multivariate using the binary logistic regression model.ResultsThe study revealed that despite a large number of women initiating antenatal care visits before 12 weeks of pregnancy (75.9%), far fewer numbers had at least eight antenatal care visits (24.2%) and delivered in a health facility (58.2%). It was established that the likelihood of having at least eight antenatal care visits was significantly increased among women who enjoyed decision-making autonomy on their healthcare (aOR: 1.24, CI: 1.02–1.51) and how their earnings are spent (aOR: 2.02, CI: 1.64–2.48). Surprisingly, women’s decision-making autonomy on how their earnings are spent significantly reduced the odds of initiating antenatal care visits early (aOR: 0.75, CI: 0.63–0.89). Some socio-economic and demographic factors were observed to have a positive influence on quality antenatal care utilisation and delivery in a health facility.ConclusionIn conclusion, women’s decision-making autonomy on their healthcare and how their earnings are spent was significantly found to be protective factors to having eight antenatal care visits during pregnancy. Conversely, women’s autonomy on how their earnings are spent significantly hindered their initiation of early antenatal care visits. There is a need for more pragmatic efforts through enlightenment and empowerment programmes of women to achieve universal access to quality maternal healthcare services in Nigeria.

Initiation of Antenatal Care, Content of Care Received and Determinants for Early Visit -An Opportunity Still Missed in Pakistan

BACKGROUND: Antenatal care coverage increased tremendously in the last two decades in developing countries, with at least half of women having 4 or more visits to a clinic. But this rise in utilization did not translate into substantially lower maternal and neonatal mortality rates. OBJECTIVE: To determine the time of initiating antenatal care and assess the effect of time of initiation of antenatal care (ANC) on the content of care received and factors associated with the time of initiating care. METHODS: This was a retrospective cross-sectional study conducted from September 2020 to December 2020. The study population included all women who delivered at the hospital. The time of the first antenatal visit and content of care received by the woman was assessed. The primary outcome variable was the time of the first antenatal visit. Secondary measures included the content of care received by women. RESULTS: Of the 1388 women included, only 160 (11.5%) had their first visit before 14 weeks of pregnancy. When stratified according to time of visit, blood pressure measurement (p=0.021), weight measurement (p= 0.011), urine testing (p=0.015) and iron and folic acid supplementation (p=0.013) were significantly greater for women who started care within three months. Women who were older (p˂0.001) and had delivered before (p=0.001) were more likely to access antenatal care earlier. Similarly, women with some education (p ˂0.001) and higher monthly income (p=0.003) started visits sooner than those who were uneducated and had lesser income. On the multivariable model, lower age, being nulliparous, no formal education and lower income were determinants of late booking. CONCLUSION: The prevalence of early initiation of antenatal care was very low. The content of care received by women who presented early was also significantly different from those who presented late. Older age, previous birth; education and monthly income were determinants of early antenatal care visits. Awareness programs for early initiation of antenatal care need to be implemented.

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...

An ethnographic study of how health system, socio-cultural and individual factors influence uptake of intermittent preventive treatment of malaria in pregnancy with sulfadoxine-pyrimethamine in a Ghanaian context.

Intermittent preventive treatment of malaria among pregnant women with sulfadoxine-pyrimethamine (IPTp-SP), is one of the three recommended interventions for the prevention of malaria in pregnancy (MiP) in sub-Sahara Africa. The World Health Organisation recommended in 2012 that SP be given at each scheduled ANC visit except during the first trimester and can be given a dose every month until the time of delivery, to ensure that a high proportion of women receive at least three doses of SP during pregnancy. Despite implementation of this policy, Ghana did not attain the target of 100% access to IPTp-SP by 2015. Additionally, negative outcomes of malaria infection in pregnancy are still recurring. This ethnographic study explored how health system, individual and socio-cultural factors influence IPTp-SP uptake in two Ghanaian regions. The study design was ethnographic, employing non-participant observation, case studies and in depth interviews in 8 health facilities and 8 communities, from April 2018 to March 2019, in two Ghanaian regions. Recommended ethical procedures were observed. Health system factors such as organization of antenatal care (ANC) services and strategies employed by health workers to administer SP contributed to initial uptake. Women's trust in the health care system contributed to continued uptake. Inadequate information provided to women accessing ANC, stock-outs and fees charged for ANC services reduced access to IPTp-SP. Socio-cultural factor such as encouragement from social networks influenced utilization of ANC services and IPTp-SP uptake. Individual factors such as refusing to take SP, skipping ANC appointments and initiating ANC attendance late affected uptake. Health system, socio-cultural and individual factors influence uptake of optimum doses of IPTp-SP. Consequently, interventions that aim at addressing IPTp-SP uptake should focus on regular and sufficient supply of SP to health facilities, effective implementation of free ANC, provision of appropriate and adequate information to women and community outreach programmes to encourage early and regular ANC visits.

Timing of the First Antenatal Care Visit and Associated Risk Factors in Rural Parts of Ethiopia

Early antenatal care visit promotes early detection and treatment of complications during pregnancy. The aim of this study was to assess the timing of the first antenatal care visit and associated factors in rural parts of Ethiopia. Only 3065 women from 2016 Ethiopian Demographic and Health Survey in rural area were included in this study. The descriptive and binary logistic regression analysis used to identify the determinants associated with the timing of the first antenatal care visit. This study revealed that 31% of women visited the first antenatal care within the first three months. Our study revealed that women education, maternal age, region, media access, women occupation, distance from health facility, wealth index, pregnancy complication and plan for pregnancy had significant effects on timing of the first antenatal care visit early. To initiate pregnant mothers to attend the first ANC visit timely, community-based services like media coverage, education, transportation and giving awareness about the necessity of having antenatal care service early is mandatory.

Health insurance ownership and maternal health service uptake among Nigerian women

Studies conducted in Nigeria have shown that health insurance coverage for maternal care improves maternal care utilization. However, no previous Nigerian study has explored the effects which the various maternal healthcare services, covered by health insurance policy, have on the particular maternal healthcare and others. This study utilized secondary data from the most recent National Demographic and Health Survey for Nigeria to examine the effects of health insurance enrolment on broad range of maternal healthcare services. The outcome variables were early antenatal care visits, a minimum of four antenatal care contacts, place of delivery and postnatal care for a child within two months of delivery. The key explanatory variables were the various maternal healthcare services covered by health insurance. Binary logistic regression was used to measure the determinants of the various maternal health outcomes while controlling for potentially confounding variables. Health insurance coverage rate among Nigerian women was 2.1% with significant social disparity. The findings from the multivariate logistic regression showed that health insurance for antenatal care significantly increases the chances to make early antenatal care contacts; a minimum of four antenatal care contacts and postnatal care for a child. Having health insurance coverage for delivery care is associated with higher odds for delivery in health facilities. Health insurance policy with cash benefits is associated with increased odds for the various maternal healthcare services. We suggest that more studies be conducted to assess the progress in maternal care utilization, facilitated through health insurance programme

Survival time to first antenatal care visit and its predictors among women in Ethiopia.

BackgroundFirst-trimester pregnancy stage is the fastest developmental period of the fetus, in which all organs become well developed and need special care. Yet, many women make their first antenatal visit with the pregnancy already compromised due to fetomaternal complications. This study aimed to fill this dearth using the 2016 national representative data set to augment early antenatal care visits in Ethiopia.MethodsA cross-sectional study design using the 2016 Ethiopia Demographic and Health Survey (EDHS) data set. Kaplan-Meir estimate was used to explain the median survival time of the timing of the first ANC visit. Multivariate Cox-proportional hazard regression analysis was performed to identify the factors related to the timing of the first ANC visit. Adjusted hazard ratios (AHR) with a 95% Confidence interval (CI) plus a p-value of < 0.05 were considered to declare a statistically significant association.ResultsData for 4666 study participants who had ANC follow-up history during pregnancy were included in the study and analyzed. The overall median survival time in this study was seven months. The timing of the first ANC visit was shorter by 2.5 times (AHR: 2.5; 95% CI: 2.34–3.68), 4.3 times (AHR: 4.3; 95% CI: 2.2–7.66), 4.8 times (AHR: 4.8, 95% CI: 4.56–10.8) among women who attended primary, secondary, and higher education as compared with non-educated one. Similarly, women who were residing in urban areas had 3.6 times (AHR: 3.6; 95% CI: 2.7–4.32) shorter timing of first ANC visit than rural residents. Furthermore, the timing of the first visit among the richest women was 3.2 times (AHR: 3.2; 95% CI: 2.5–9.65) shorter than the poorest women.ConclusionThe median survival time of the first ANC visit was seven months. The timing of the first ANC was longer among younger, poorer women, those who had no access to media, who considered distances as a big challenge to reach a health facility and, those with no education. Therefore, health care providers and community health workers should provide health education to create community awareness regarding the timing of the first ANC visit.

Timing and factors associated with early antenatal visits among pregnant women in west Gojjam, northwest Ethiopia

Background Early and appropriate antenatal care practices have the potential to save the lives of mothers and their children, and enable mothers to receive the full range of antenatal care services. However, in developing countries, including Ethiopia, a number of pregnant women do not attend antenatal care in the recommended time period. Therefore, this article assessed the timing and factors associated with early antenatal care visits in west Gojjam, northwest Ethiopia. Methods An institution-based cross-sectional study was conducted among pregnant women attending antenatal care services in west Gojjam. Data on participants' sociodemographic, obostetric and reproductive health information were collected from 820 participants using a structured interviewer-administered pretested questionnaire. Bivariate and multivariate logistic regression analyses were used to identify variables associated with early antenatal care visits. Variables with P&lt;0.05 were considered significant. A visit was considered ‘early’ if a pregnant woman attended their first antenatal care session within the first 12 weeks of gestation. Results Almost a third (31.5%) of mothers started antenatal care early. The mean gestational age at the first visit was 17 weeks (standard deviation±7.7), with a range of 3–36 weeks. In multivariate analysis, it was found that being nulliparous (adjusted odds ratio: 2.3; P=0.013), travel time to the health facility being less than 30 minutes (adjusted odds ratio: 6.1; P&lt;0.001) and living in an urban area (adjusted odds ratio: 2.4; P=0.001) were significantly associated with attending antenatal care early. Conclusions Early first antenatal care attendance was low in the study area. It is important to decentralise the provision of antenatal care services at health posts through an outreach service, by strengthening the mobilisation, screening and early referral system through health extension workers and the women development army. This will allow more women to receive antenatal care from skilled providers.

Factors associated with the number and timing of antenatal care visits among married women in Cameroon: evidence from the 2018 Cameroon Demographic and Health Survey.

Utilization of antenatal care (ANC) services, as part of reproductive health care, presents a lifesaving chance for health promotion and the early diagnosis and treatment of illnesses throughout pregnancy. This study examines the factors associated with the number and timing of ANC visits among married women in Cameroon using data from the 2018 Cameroon Demographic and Health Survey. The outcome variables were number of ANC visits, categorized as <8 visits or ≥8 visits, and the timing of first ANC visit, categorized as ≤3 months (early) or >3 months (late) (as per the new 2016 WHO recommendations). Descriptive statistics and binary logistic regression were used to analyse the data. Crude odds ratios (cOR) and adjusted odds ratios (aOR) and p-values with significance at <0.05 were used to interpret the results. The proportions of women who had ≥8 ANC visits and first ANC visit at ≤3 months gestation were 6.3% and 35.6% respectively. Women aged 35-39 at childbirth (aOR=3.99, 95% CI=1.30-12.23), middle wealth quintile women (aOR=3.22, 95% CI=1.01-10.27), women whose husbands had secondary (aOR=7.00, 95% CI=2.26-21.71) or higher (aOR=16.93, 95% CI=4.91-58.34) education were more likely to have ≥8 ANC visits. Early timing of first ANC visit was low among women with birth order 3-4 (aOR=0.63, 95% CI=0.46-0.85). Conversely, the likelihood of having early ANC visits was high among women whose pregnancies were intended (aOR=1.32, 95% CI=1.01-1.74), the richest women (aOR=3.89, 95% CI=2.30-6.57) and women whose husbands had secondary (aOR=2.41, 95% CI=1.70-3.64) or higher (aOR=3.12, 95% CI=2.40-7.46) education. The study highlights that age at childbirth, wealth, husband's educational attainment, birth order and pregnancy intention could influence the utilization of ANC services among married women in Cameroon. Hence, to improve attendance and early initiation of ANC, interventions should be targeted at empowering women financially and removing all financial barriers associated with accessing ANC, improving ANC education among women and encouraging male involvement in ANC education.

First trimester antenatal care visit reduces the risk of miscarriage among women of reproductive age in Ghana.

Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first- trimester miscarriage (p <0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages.

Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China.

Background: Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. Methods: A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. Results: Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13–3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16–3.40). Conclusions: Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.

Maternal health services utilisation among primigravidas in Uganda: what did the MDGs deliver?

BackgroundAchieving maternal health outcomes in the SDGs requires the implementation of more targeted policies and strategies. While the MDGs may have deepened our understanding in this regard, we know little about the trends in maternal health services utilisation among primigravidas, and how age and geographical regions could have influenced these trends. In this study, we examined utilisation of antenatal and skilled delivery services among primigravidas in Uganda, a country with one of the highest maternal mortality ratios, and where early childbearing and its attendant challenges are common.MethodsGuided by Andersen’s Behavioural Model, we fitted multivariate regression models to a pooled dataset of the 2006, 2011 and 2016 Ugandan Demographic and Health Survey (n = 3477) to understand the dynamics in Antenatal Care (ANC) and Skilled Birth Attendance (SBAs) utilisation among primigravidas. Post-estimation margins were employed to further highlight the effect of age and geographical regions.ResultsThe analyses show an improvement in access to maternal health services among primigravidas from 2006 to 2016. Compared to 2006, primigravidas in 2016 were 48%, 24% and 2.98 times more likely to have early ANC, four or more ANC visits, and SBAs, respectively. Altogether, a primigravida in 2016 relative to 2006 was 42% more likely to meet all three maternal health service indicators. Post-estimation margins analyses on age and geographical disparities revealed that younger primigravidas have lower probability, while primigravidas in Eastern Region, one of the most deprived in the country, have the lowest probability of accessing maternal health services. Also, the study found education, wealth, women’s household decision-making power, place of residence as important determinants of ANC visits and SBAs.ConclusionsBased on our findings, it is important to address the vulnerabilities of primigravidas, particularly younger individuals, in accessing early ANC. Uganda should scale-up decentralisation and integration of maternal health delivery in local communities as a strategy of addressing lingering geographical disparities, and ultimately improve maternal health outcomes in the SDGs period.