Factors associated with the timing of antenatal clinic attendance among first-time mothers in rural southern Ghana

Factors associated with timely initiation of antenatal care among reproductive age women in The Gambia: a multilevel fixed effects analysis

BACKGROUND

A significant factor impacting the incidence of maternal and neonatal fatalities is the timely initiation of antenatal care (ANC) services in healthcare facilities. Despite the recommendations by the World Health Organization and the numerous benefits of timely initiation of ANC, studies have revealed that the overall prevalence of timely ANC initiation in 36 sub-Saharan African countries remains low and women in The Gambia also initiate ANC late. However, no known study in The Gambia has focused on assessing the factors associated with timely initiation of ANC at the time of writing this paper. Thus, this study aimed to assess the prevalence and factors associated with the timely initiation of ANC among reproductive-age women in The Gambia.

METHODS

A cross-sectional survey design was used in this study and conducted among 5,734 reproductive-age women using data from the 2019-2020 Gambia Demographic and Health Survey (GDHS). Using STATA version 14.0, we conducted the analysis using descriptive and inferential statistics. Multilevel logistic regression models were fitted to determine the factors associated with timely ANC utilization and adjusted odds ratios were used to present the results with statistical significance set at p < 0.05.

RESULTS

The overall prevalence of timely initiation of ANC services among reproductive-age women in The Gambia was 43.0%. We found that women aged 30-34 [aOR = 1.79, 95% CI = 1.30-2.47], those who were married [aOR = 2.69, 95% CI = 1.85-3.90] as well as women from the richest households [aOR = 1.63, 95% CI = 1.20, 2.20] had higher odds of seeking timely ANC services as compared to their counterparts. Also, those who had given birth to two children [aOR = 0.74, 95% CI = 0.6 -0.91] had lower odds of initiating timely ANC as compared to those who had given birth only once. Women who reside in rural areas [aOR = 1.72, 95%CI = 1.34, 2.20] also had higher odds of seeking timely ANC services than those residing in urban areas.

CONCLUSION

Individual-level factors such as maternal age, marital status, parity, wealth status, place of residence, and religion were associated with the timely initiation of ANC services among reproductive-age women. These factors ought to be considered in efforts to increase the timely initiation of ANC among reproductive-age women in The Gambia.

Individual and community level determinants of delayed antenatal care initiation in Ethiopia: A multilevel analysis of the 2019 Ethiopian Mini Demographic Health Survey

BACKGROUND

Antenatal care (ANC) is essential health care and medical support provided to pregnant women, with the aim of promoting optimal health for both the mother and the developing baby. Pregnant women should initiate ANC within the first trimester of pregnancy to access a wide range of crucial services. Early initiation of ANC significantly reduces adverse pregnancy outcomes, yet many women in Sub-Saharan Africa delay its initiation. The aim of this study was to assess prevalence and determinants of delayed ANC initiation in Ethiopia.

METHODS

We conducted a secondary data analysis of the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). The study involved women of reproductive age who had given birth within the five years prior to the survey and had attended ANC for their most recent child. A total weighted sample of 2,895 pregnant women were included in the analysis. Due to the hierarchical nature of the data, we employed a multi-level logistic regression model to examine both individual and community level factors associated with delayed ANC initiation. The findings of the regressions were presented with odds ratios (OR), 95% confidence intervals (CI), and p-values. All the statistical analysis were performed using STATA-14 software.

RESULTS

This study showed that 62.3% (95% CI: 60.5, 64.1) of pregnant women in Ethiopia delayed ANC initiation. Participants, on average, began their ANC at 4 months gestational age. Women with no education (AOR = 2.1; 95% CI: 1.4, 3.0), poorest wealth status (AOR = 1.9; 95% CI: 1.3, 2.8), from the Southern Nations, Nationalities, and Peoples (SNNP) region (AOR = 2.1; 95% CI: 1.3, 3.3), and those who gave birth at home (AOR = 1.4; 95% CI: 1.1, 1.7) were more likely to delay ANC initiation.

CONCLUSIONS

The prevalence of delayed ANC initiation in Ethiopia was high. Enhancing mothers' education, empowering them through economic initiatives, improving their health-seeking behavior towards facility delivery, and universally reinforcing standardized ANC, along with collaborating with the existing local community structure to disseminate health information, are recommended measures to reduce delayed ANC initiation.

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

OBJECTIVE

To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia.

DESIGN

Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey.

SETTING AND PARTICIPANTS

2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study.

OUTCOME MEASURES

Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC.

RESULTS

In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation.

CONCLUSION

Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.

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

Background

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.

Objective

This study aimed to assess the socioeconomic inequality in the timing of antenatal care visit.

Method

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.

Result

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.

Conclusion

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.

Survival analysis of early intention of antenatal care among women in Bangladesh

This study focuses on the importance of early and regular Antenatal Care (ANC) visits in reducing maternal and child mortality rates in Bangladesh, a country where such health indicators are a concern. The research utilized data from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2017-18 and employed the Cox proportional hazard model to identify factors influencing women's intention of ANC services. The results revealed that 40.4% of women engaged in at least one ANC activity during the first trimester, which, although higher than in other countries, falls below the global average. Notably, women between the aged of 25 and 29 years took 15% less time for their first ANC visit compared to their younger counterparts, suggesting higher awareness and preparedness in this age group. Education, both for women and their partners, had a significant influence on the intention to visit ANC early. Women in the poor wealth quantile exhibited lower odds of seeking timely ANC, whereas those with a planned pregnancy were more likely to do so. Moreover, access to mass media decreased the timing of ANC visits by 26% compared to women who were not exposed. Moreover, living in rural areas was linked to a 17% delay in the timing of the first ANC visit compared to urban areas. These findings underscore the importance of addressing these determinants to improve the timeliness and accessibility of ANC services, thereby enhancing maternal and child health outcomes in Bangladesh.

Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey

BACKGROUND

Timely and adequate Antenatal Care (ANC) effectively prevents adverse pregnancy outcomes and is crucial for decreasing maternal and neonatal mortality. High-parity women (5 + children) are at higher risk of maternal mortality. Limited information on the late timing of ANC among this risky group continues to hamper Uganda's efforts to reduce maternal mortality ratios and improve infant and child survival. This study aimed to determine factors associated with attendance of the first ANC after 12 weeks of gestation among high-parity women in Uganda.

METHODS

This study was based on nationally representative data from the 2016 Uganda Demographic and Health Survey. The study sample comprised 5,266 women (aged 15-49) with five or more children. A complementary log-log regression model was used to identify factors associated with late ANC attendance among high-parity women in Uganda.

RESULTS

Our findings showed that 73% of high parity women delayed seeking their first ANC visit. Late ANC attendance among high-parity women was associated with distance to the health facility, living with a partner, partner's education, delivery in a health facility, and Desire for more children. Women who did not find the distance to the health facility when going for medical help to be a big problem had increased odds of attending ANC late compared to women who found distance a big problem (AOR = 1.113, CI: 1.004-1.234), women not living with partners (AOR = 1.196, 95% CI = 1.045-1.370) having had last delivery in a health facility (AOR = 0.812, 95% CI = 0.709-0.931), and women who desired to have another child (AOR = 0.887, 95% CI = 0.793-0.993) had increased odds compared to their counterparts.

CONCLUSIONS

To increase mothers' timely attendance and improve maternal survival among high-parity women in Uganda, programs could promote and strengthen health facility delivery and integrate family planning with other services such as ANC and postnatal care education to enable women to seek antenatal care within the recommended first trimester. This study calls for increased support for programs for education, sensitization, and advocacy for health facility-based deliveries. This could be done through strengthened support for VHT and community engagement activities.

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

BACKGROUND

Initiation 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.

AIM

To explore perceptions of pregnant women and how they influence antenatal care visits during the first trimester at Area 25 Health Centre in Lilongwe, Malawi.

METHODS

We 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).

RESULTS

Pregnant 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.

CONCLUSION

The 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.

First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors

BACKGROUND

Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa.

METHODS

Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger's test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis.

RESULTS

A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3-41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5-3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2-1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4-2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2-2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5-2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7-2.1; I2 = 94.4%).

CONCLUSION

Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).

Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis

BACKGROUND

Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately.

OBJECTIVE

To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia.

METHOD

The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05.

RESULTS

The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits.

CONCLUSION

A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

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

BACKGROUND

Proper 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.

METHODS

This 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.

RESULTS

Overall, 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.

CONCLUSIONS

Findings 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.

Timely Initiation of Antenatal Care and Associated Factors among Pregnant Women Attending at Wachemo University Nigist Eleni Mohammed Memorial Comprehensive Specialized Hospital, Hossana, Ethiopia: A Cross-Sectional Study

Background. Timely detection and treatment of pregnancy-related or preexisting diseases, health education, and the promotion of adequate care provision improve the health of mothers and unborn children. As such, these factors are crucial within the first pregnancy trimester. However, very few women in low and middle-income countries initiate their first ANC in the recommended trimester of pregnancy. This study is aimed at assessing the prevalence of timely initiation of ANC and its associated factors among pregnant women attending antenatal clinics in Wachemo University Nigist Eleni Mohammed Memorial comprehensive specialized hospital, Hossana, Ethiopia. Methods. A hospital-based cross-sectional study was conducted from April 4, 2022 to May 19, 2022. A systematic sampling technique was used to select study participants. Data were collected from pregnant women using a pretested structured interview questionnaire. EpiData version 3.1 was used to enter the data, and SPSS version 24 was used to analyze it. Bivariate and multivariable logistic regression were used to identify the associated factors at a 95% confidence interval with a $p$ value < 0.05. Results. This study indicated that 118 (34.3%) of the women initiated ANC timely. The factors associated with timely initiation of ANC included women aged 25–34 years ( $\text{AOR}=0.3$ ; 95% CI: (0.1, 0.7)), tertiary maternal education ( $\text{AOR}=3.2$ , 95% CI: (1.0, 9.9)), zero parity ( $\text{AOR}=7.7$ ; 95% CI: (3.6, 15.3)), planned pregnancy ( $\text{AOR}=13.7$ ; 95% CI: (5.5, 34.3)), good knowledge about ANC services ( $\text{AOR}=3.1$ ; 95% (CI: (2.3, 11.3)), and good knowledge about danger signs in pregnancy ( $\text{AOR}=4.8$ ; 95% CI: (2.2, 8.1)). Conclusion. This study demonstrates the importance of making a significant effort to increase the coverage of timely ANC initiation in the study area. Therefore, increasing the awareness level of mothers regarding ANC services given during pregnancy and danger signs in pregnancy and advancing the academic level of mothers are essential to increase the coverage of timely initiation of ANC.

Pooled prevalence and determinants of antenatal care visits in countries with high maternal mortality: A multi-country analysis

Background

Complications during pregnancy and childbirth are the leading causes of maternal and child deaths and disabilities, particularly in low- and middle-income countries. Timely and frequent antenatal care prevents these burdens by promoting existing disease treatments, vaccination, iron supplementation, and HIV counseling and testing during pregnancy. Many factors could contribute to optimal ANC utilization remaining below targets in countries with high maternal mortality. This study aimed to assess the prevalence and determinants of optimal ANC utilization by using nationally representative surveys of countries with high maternal mortality.

Methods

Secondary data analysis was done using recent Demographic and Health Surveys (DHS) data of 27 countries with high maternal mortality. The multilevel binary logistic regression model was fitted to identify significantly associated factors. Variables were extracted from the individual record (IR) files of from each of the 27 countries. Adjusted odds ratios (AOR) with a 95% confidence interval (CI) and p-value of ≤0.05 in the multivariable model were used to declare significant factors associated with optimal ANC utilization.

Result

The pooled prevalence of optimal ANC utilization in countries with high maternal mortality was 55.66% (95% CI: 47.48-63.85). Several determinants at the individual and community level were significantly associated with optimal ANC utilization. Mothers aged 25-34 years, mothers aged 35-49 years, mothers who had formal education, working mothers, women who are married, had media access, households of middle-wealth quintile, richest household, history of pregnancy termination, female household head, and high community education were positively associated with optimal ANC visits in countries with high maternal mortality, whereas being rural residents, unwanted pregnancy, having birth order 2-5, and birth order >5 were negatively associated.

Conclusion and recommendations

Optimal ANC utilization in countries with high maternal mortality was relatively low. Both individual-level factors and community-level factors were significantly associated with ANC utilization. Policymakers, stakeholders, and health professionals should give special attention and intervene by targeting rural residents, uneducated mothers, economically poor women, and other significant factors this study revealed.

Late initiation of antenatal care among pregnant women in Addis Ababa city, Ethiopia: a facility based cross-sectional study

BACKGROUND

Antenatal care (ANC) is the care given to pregnant women to prevent poor feto-maternal outcomes during pregnancy. The World Health Organization recommends first ANC visit be started as early as possible within in 12 weeks of gestation. Although there is improvement in overall ANC coverage, a sizable proportion of pregnant women in Ethiopia delay the time to initiate their first ANC visit. Therefore, this study aimed to investigate factors associated with late ANC initiation among pregnant women attending public health centers in Addis Ababa, Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among 407 randomly selected pregnant women who attended ANC at selected public health centers in Addis Ababa from December 2020 to January 2021. Data were collected using pretested and structured questionnaires through a face-to-face interview and reviewing medical records. Binary and multivariable logistic regressions were fitted sequentially to identify predictors for late ANC initiation. Adjusted odds ratios with 95% CI were computed to measure the strength of associations and statistical significance was declared at a p-value < 0.05.

RESULT

This study showed that 47% of pregnant women started their first ANC visit late.The age of 30 years and above, being married, unplanned pregnancy, having a wrong perception about the timing of the first ANC visit, and not having ANC for previous pregnancy was significantly associated with late ANC initiation.

CONCLUSION

Nearly half of the women initiated their first ANC visit late. Tailored interventions aimed at promoting early ANC initiation should target married women, women with an unplanned pregnancy, women who perceived the wrong timing of their first ANC, and those who have no ANC for their previous pregnancy.

Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis

BACKGROUND

Early initiation of the first antenatal care visit provides a critical opportunity for health promotion, disease prevention, and curative care for women and their unborn fetuses. However, in developing countries, including Ethiopia, it is underutilized and most of the pregnant women didn't attend antenatal care visits during the first trimester (early). Therefore, the objective of this study was to estimate the prevalence of early initiation of antenatal care visits and its determinants among reproductive-age women in Ethiopia.

METHODS

A secondary data analysis was done based on the 2019 intermediate Ethiopian demographic health survey. The data were weighted by sampling weight for probability sampling and non-response to restore the representativeness of the data and have valid statistical estimates. Then, a total weighted sample of 2,935 women aged 15-49 years who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. A multilevel mixed-effects logistic regression model was fitted to examine the determinants of early initiation of first antenatal care visits. Finally, statistical significance was declared at a p-value < 0.05.

RESULTS

In this study, the overall magnitude of early initiation of the first antenatal care visit was 37.4% (95%CI: 34.6-40.2%). Women who attend higher education (AOR = 2.26: 95%CI; 1.36-3.77), medium wealth status (AOR = 1.80: 95%CI; 1.17-2.76), richer wealth status (AOR = 1.86: 95%CI; 1.21, 2.85), richest wealth status (AOR = 2.34: 95%CI; 1.43-3.83), living in Harari region (AOR = 2.24: 95%CI; 1.16-4.30), and living at Dire-Dawa city (AOR = 2.24: 95%CI; 1.16-4.30) were higher odds of early initiation of first ANC visits. However, women who were rural resident (AOR = 0.70: 95%CI; 0.59-0.93), household headed by male (AOR = 0.87: 95%CI; 0.72, 0.97), having ≥ 5 family size (AOR = 0.71: 95%CI; 0.55-0.93), and living in SNNPRs (AOR = 0.44: 95%CI; 0.23-0.84) were lower odds of early initiation of first ANC visits.

CONCLUSION

The prevalence of early initiation of first antenatal care remains low in Ethiopia. Women's education, residence, wealth status, household head, having ≥ 5 family sizes, and region were determinants of early initiation of first antenatal care visits. Improving female education and women's empowerment through economic transitions with special attention given to rural and SNNPR regional state residents could maximize the early initiation of first antenatal care visits. Furthermore, to increase early antenatal care uptake, these determinants should be considered when designing new policies or updating policies and strategies on antenatal care uptake to help increase early attendance, which can help in the reduction of maternal and neonatal mortality and to achieve sustainable development goals 3 by 2030.

Time to first antenatal care booking and its determinants among pregnant women in Ethiopia: survival analysis of recent evidence from EDHS 2019

BACKGROUND

Antenatal care is one of the components of the maternal and child continuum of care. Timely booking ANC during pregnancy is of utmost importance to guarantee the best possible health outcomes for women and children. Inappropriate timing of the first ANC booking is associated with poor pregnancy outcomes, including perinatal death, stillbirth, and early neonatal death. According to WHO focused ANC recommendation, every mother should start booking ANC within the first 12 weeks of gestational age. However, in developing countries, including Ethiopia, many pregnant mothers were not booking ANC at the recommended time. Thus, this study aims to assess the time to first ANC booking and its determinants in Ethiopia.

METHODS

A survival analysis was conducted to determine time to first ANC booking among 3917 weighted study subjects. The data were extracted from EDHS 2019 using STATA version 17 software. A Kaplan Meier survivor curve was computed to estimate the time of first ANC booking. A Long-rank test was used to compare the difference in survival curves. Weibull Inverse Gaussian shared frailty model was used to identify significant predictors. On multivariable analysis, variables having a p-value of ≤ 0.05 are considered statistically significant.

RESULTS

The overall median survival time was four months. The significant determinant of time to first ANC booking are residence (rural [ϕ = 1.111, 95CI: 1.060, 1.164), mother educational level (primary education [ϕ = 0.945, 95CI: 0.915, 0.977], secondary and above educational [ϕ = 0.857, 95CI: 0.819, 0.896]) and wealth index (middle [0.948 (ϕ = 0.948, 95CI: 0.911, 0.986) and rich [ϕ = 0.904, 95CI: 0.865, 0.945]) CONCLUSION: The median time for first ANC booking is 4 month, which is higher than the WHO recommended time. The timing of the first ANC booking in Ethiopia was mainly influenced by the residence of women, mother educational level, and wealth index. It is strongly recommended to expose mothers to educational materials and other awareness-creation campaigns, as well as to support disadvantaged women, such as the uneducated, poor, and those living in rural or remote areas.

Geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia, 2016

Background

Delayed antenatal care is when the first visit is carried out after 12 gestational weeks. Despite the fact that many studies have been conducted on antenatal care initiation, little attention has been paid to its spatial pattern. Therefore, this study examine geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia.

Objective

To assess geographical weighted regression analysis of delayed antenatal care initiation and its factors among all reproductive-aged women in Ethiopia, 2016.

Methods

This study was grounded on the 2016 Ethiopian Demographic Health Survey. It incorporated extracted sample size of 4740 (weighted) reproductive-aged women. ArcGIS version 10.8 and SaTScan™ version 9.7 software were employed to investigate geographic information. To distinguish factors associated with hotspot areas, local and global models were fitted.

Result

the geographic pattern of Delayed antenatal care initiation was clustered (Moran’s I = 0.38, p < 0.001). Kuldorff’s spatial scan statistics discovered three significant clusters. The most likely cluster (LLR = 66.13, p < 0.001) was situated at the zones of SNNP and Oromia regions. In the local model, being uneducated, being poor wealth, having an unwanted pregnancy, and having higher birth order were factors associated with spatial variation of delayed antenatal care.

Conclusion

The spatial pattern of delayed antenatal care in Ethiopia is clustered. Maternal education, wealth status, pregnancy desirability, and birth order were predictor variables of spatial variation of delayed antenatal care. Therefore, designing a hotspot area-based interventional plan could help to improve early ANC initiation.

What predicts delayed first antenatal care contact among primiparous women? Findings from a cross-sectional study in Nigeria

BACKGROUND

Delayed first antenatal care contact refers to first antenatal care contact occurring above twelfth weeks of gestation. Studies in Nigeria and in other countries have examined the prevalence and predictors of delayed first antenatal care contact. Nevertheless, existing studies have rarely examined the predictors among primiparous women. In addition, the evidence of higher health risks associated with primigravida emphasizes the need to focus on primiparous women. This study, therefore, examined the predictors of delayed first antenatal care contact among primiparous women in Nigeria.

METHODS

The study was a descriptive cross-sectional design that analyzed data extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a weighted sample of 3,523 primiparous women. The outcome variable was delayed first antenatal care contact. explanatory variables were grouped into predisposing, enabling, and need factors. The predisposing factors were maternal age, education, media exposure, religion, household size, The knowledge of the fertile period, and women's autonomy. The enabling factors were household wealth, employment status, health insurance, partner's education, financial inclusion, and barriers to accessing healthcare. The need factors were pregnancy wantedness and spousal violence during pregnancy. Data were analyzed using Stata 14. Two multivariable logistic regression models were fitted. Statistical significance was set at p < 0.05.

RESULTS

Nearly two-thirds (65.0%) of primiparous women delayed first antenatal care contact. Maternal age, maternal education, media exposure, religion, household membership, and knowledge of the fertile period were predisposing factors that significantly influenced the likelihood of delayed first antenatal care contact. Also, household wealth, employment status, health insurance, partner's education, perception of distance to the health facility, and financial inclusion were enabling factors that had significant effects on delayed first antenatal care contact. Pregnancy wantedness was the only need factor that significantly influenced the likelihood of delayed first antenatal care contact.

CONCLUSION

The majority of primiparous women in Nigeria delayed first antenatal care contact and the delay was predicted by varied predisposing, enabling, and need factors. Therefore, a public health education program that targets women of reproductive age especially primiparous women is needed to enhance early antenatal care contact in the country.

Correlates of late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age: insights from the 2019 Ghana Malaria Indicator Survey

OBJECTIVE

This study assessed the correlates of late initiation and underutilisation of the WHO's recommended eight or more antenatal care visits among women in Ghana.

DESIGN

We analysed secondary data from 2163 women in the 2019 Ghana Malaria Indicator Survey, which collected data on malaria and antenatal care indicators among women of reproductive age across the previous 10 regions of Ghana.

SETTING AND PARTICIPANTS

Women of reproductive age across the 10 regions of Ghana.

MAIN OUTCOME MEASURES

Late initiation and underutilisation of the recommended eight or more antenatal care visits among women of reproductive age.

RESULTS

About half (49%) of the participants were between the ages of 25 and 34 years; mean (±SD)=30 (±7.10). The majority (57%) of the participants obtained less than eight antenatal care visits, while 32% initiated antenatal care visits after the first trimester. The significant factors associated with the late initiation of antenatal care visits were age, region and parity (p<0.05). Factors associated with underutilisation of the recommended eight or more antenatal care visits were marital status, wealth index, parity, region and place of residence (p<0.05).

CONCLUSION

A majority of the women underused antenatal care services. A significant minority of the women started antenatal care visits late. Socio-demographic factors, parity and socioeconomic factors were identified as the significant factors associated with the late initiation and underutilisation of antenatal care services. Maternal health interventions should prioritise young, multiparous and poor women.

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

Background

Type 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.

Methods

This 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.

Results

The 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.

Conclusion

The 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.

Multilevel Modelling of the Individual and Regional Level Variability in Predictors of Incomplete Antenatal Care Visit among Women of Reproductive Age in Ethiopia: Classical and Bayesian Approaches

Background: Antenatal care is an operational public health intervention to minimize maternal and child morbidity and mortality. However, for varied reasons, many women fail to complete the recommended number of visits. The objective of this study was to assess antenatal care utilization and identify the factors associated with the incomplete antenatal care visit among reproductive age women in Ethiopia. Methods: The 2019 Ethiopian Mini Demographic and Health Survey data were used for this study. Multilevel logistic regression analysis and two level binary logistic regression models were utilized. Results: Around 56.8% of women in Ethiopia did not complete the recommended number of antenatal care visits. Women from rural areas were about 1.622 times more likely to have incomplete antenatal care compared to women from urban areas. Women who had no pregnancy complication signs were about 2.967 times more likely to have incomplete antenatal care compared to women who had pregnancy complication signs. Women who had a slight problem and a big problem with the distance from a health center were about 1.776 and 2.973 times more likely, respectively, to have incomplete antenatal care compared to women whose distance from a health center was not a problem. Furthermore, women who had ever terminated pregnancy were about 10.6% less likely to have incomplete antenatal care compared to women who had never terminated pregnancy. Conclusions: The design and strengthening of existing interventions (e.g., small clinics) should consider identified factors aimed at facilitating antenatal care visits to promote maternal and child health related outcomes. Issues related to urban–rural disparities and noted hotspot areas for incomplete antenatal care visits should be given special attention.

The moderating role of partners' education on early antenatal care in northern Ghana

BACKGROUND

Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners' education attainment and early ANC, and 2) determine whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC.

METHODS

Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals.

RESULTS

Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners' education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18-19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57).

CONCLUSIONS

Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC.

Timely Attendance of the First Antenatal Care among Pregnant Women Aged 15–49 Living with HIV in Juba, South Sudan

Timely attendance of the first antenatal care (ANC) is the period in which pregnant women visit ANC less than four months of pregnancy. There is a paucity of data on timely first ANC attendance and its associated factors among pregnant women living with human immunodeficiency virus (HIV) in Juba. The aim of this study was to investigate timely attendance of the first ANC visit among pregnant women living with HIV. Institutional cross-sectional study was conducted in three public health facilities in Juba by convenience sampling from January 2019 to December 2019. Pearson’s chi-squared test was conducted for bivariate analysis and variables with probability values ( $p$ values) less than 5% were considered as statistically significant for multivariable analyses using Fisher’s exact test. At the multivariate level, binary logistic regression analysis was conducted. Out of the 192 participants studied, 27 (14.1%) had timely first ANC attendance as recommended and 165 (85.9%) attended first ANC at four months and above. Distances (adjusted risk ratio [aOR], 7.14; 95% confidence interval [CI], 1.40–36.68), ANC card (aOR, 3.48; 95% CI, 1.17–10.40), waiting time ([aOR], 0.04; 95% CI, 0.01–0.75), and prevention of mother-to-child transmission (PMTCT) services (aOR, 0.12; 95% CI, 0.03–0.56) were the factors associated with timely first ANC attendance. Health education interventions targeting pregnant women attending ANC at health facilities should focus on increasing knowledge and awareness of the importance of timely first ANC attendance.

Intimate partner violence and timely antenatal care visits in sub-Saharan Africa

BACKGROUND

Intimate partner violence (IPV) during pregnancy has negative physical and psychological health consequences on the pregnant women. As such, women who experience IPV during pregnancy are likely to have challenges accessing maternal healthcare services. In this study, we examined the influence of exposure to IPV on timely antenatal care (ANC) visits in sub-Saharan Africa.

METHODS

Cross-sectional data from the most recent Demographic and Health Survey of twenty-two countries in sub-Saharan Africa between 2012 and 2020 were analysed. Data were obtained from 61,282 women with birth history in the five years prior to the survey. A multilevel logistic regression was used to determine the association between IPV and timely ANC visits while controlling for significant covariates. Adjusted odds ratios (aOR) with 95% Confidence Intervals (CI) were used to present results from the multilevel logistic regression analysis.

RESULTS

The prevalence of timely ANC visit and IPV were 38.1% and 34.9% respectively. The highest and lowest prevalence of IPV were found in Sierra Leone (52.9%) and Comoros (8.1%), respectively. Timely ANC attendance among pregnant women was more prevalent in Liberia (74.9%) and lowest in DR Congo (19.0%). Women who experienced IPV during pregnancy were less likely to utilize timely ANC (aOR = 0.89, 95% CI = 0.86-0.92) compared to those who did not experience IPV. In terms of the covariates, the odds of timely ANC were higher among women aged 40-44 compared to those aged 15-19 (aOR = 1.35, 95% CI = 1.21-1.51). Higher odds of timely ANC was found among women who were cohabiting (aOR = 1.15, 95% CI = 1.10-1.20), those from the richest wealth quintile (aOR = 1.38, 95% CI = 1.28-1.48), those exposed to watching television (aOR = 1.24, 95% CI = 1.18-1.30), and those with health insurance (aOR = 1.46, 95% CI = 1.37-1.56).

CONCLUSION

Findings from the study indicate the role of IPV in timely ANC visit in sub-Saharan Africa. To enhance timely ANC visits, there is the need for policy makers to strengthen and enforce the implementation of policies that alleviate IPV during pregnancy. Education and sensitization of married and cohabiting women and men on the negative effects of IPV on timely ANC should be done using media sources such as television. Inequalities in timely ANC can be eliminated through the provision and strengthening of existing maternal health policies such as health insurance.

Health insurance coverage and timely antenatal care attendance in sub-Saharan Africa

Introduction

Out-of-pocket payments for healthcare remain a significant health financing challenge in sub-Saharan Africa (SSA), preventing women from using maternal health services. There is a paucity of empirical literature on the influence of health insurance coverage on the timeliness of antenatal care (ANC) attendance in low- and middle-income countries. In this study, we examined the association between health insurance coverage and timely ANC attendance among pregnant women in SSA.

Methods

Secondary data from Demographic and Health Surveys conducted between 2015 and 2020 in sixteen (16) sub-Saharan African countries with 113,918 women aged 15-49 years were included in the analysis. The outcome variable was the timing of antenatal care (ANC). A multilevel binary logistic regression analysis was carried out to determine the association between health insurance coverage and timely ANC.

Results

The overall coverage of health insurance and timely antenatal attendance among pregnant women in SSA were 4.4% and 39.0% respectively. At the country level, the highest coverage of health insurance was found in Burundi (24.3%) and the lowest was in Benin (0.9%). For timely ANC attendance, the highest prevalence was in Liberia (72.4%) and the lowest was in Nigeria (24.2%). The results in the model showed that women who were covered by health insurance were more likely to have timely ANC attendance compared to those who were not covered by health insurance (aOR = 1.21, 95% CI = 1.11-1.31).

Conclusion

Our findings show that that being covered under health insurance is associated with higher likelihood of seeking timely ANC attendance. To accelerate progress towards achievement of the Sustainable Development Goal targets by the year 2030, we recommend that governments and health insurance authorities across the sub-Saharan African countries actively implement health insurance policies as well as roll out health educational programmes that facilitate and ensure increased coverage of health insurance.

What prevents pregnant women from adhering to the continuum of maternal care? Evidence on interrelated mechanisms from a cohort study in Kenya

OBJECTIVES

To examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated.

DESIGN

A facility-based prospective cohort study.

SETTING

25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega.

PARTICIPANTS

A total of 5 879 low-income pregnant women aged 13-49 years.

OUTCOME MEASURES

Ordinary least squares, Poisson and logistic regression models were employed, to predict three key determinants of the continuum of maternal care: (i) the week of enrolment at the clinic for antenatal care (ANC), (ii) the total number of ANC visits and (iii) utilisation of skilled birth attendance (SBA). The interrelationship between the three outcome variables was assessed with structural equation modeling.

RESULTS

Each week of delayed enrolment in ANC reduced the number of ANC visits by 3% (incidence rate ratio=0.967, 95% CI 0.965 to 0.969). A higher number of ANC visits increased the relative probability of using SBA (odds ratio=1.28, 95% CI 1.22 to 1.34). The direct association between late enrolment and SBA was positive (odds ratio=1.033, 95% CI 1.02 to 1.04). Predisposing factors (age, household head's education), enabling factors (wealth, shorter distance, rural area) and need factors (risk level of pregnancy, multigravida) were positively associated with adherence to ANC.

CONCLUSION

The results point towards a domino-effect and underscore the importance of enhancing the full continuum of maternal care. A larger number of ANC visits increases SBA, while early initiation of the care journey increases the number of ANC visits, thereby indirectly supporting SBA as well. These beneficial pathways counteract the direct link between enrolment and SBA, which is partly driven by pregnant teenagers who both enrol late and are at heightened risk of complications, stressing the need for specific attention to this vulnerable population.

Timely initiation of antenatal care and its associated factors among pregnant women in sub-Saharan Africa: A multicountry analysis of Demographic and Health Surveys

BACKGROUND

Timely initiation of antenatal care (ANC) is an important component of ANC services that improve the health of the mother and the newborn. Mothers who begin attending ANC in a timely manner, can fully benefit from preventive and curative services. However, evidence in sub-Saharan Africa (sSA) indicated that the majority of pregnant mothers did not start their first visit timely. As our search concerned, there is no study that incorporates a large number of sub-Saharan Africa countries. Thus, the objective of this study was to assess the prevalence of timely initiation of ANC and its associated factors in 36 sSA countries.

METHODS

The Demographic and Health Survey (DHS) of 36 sSA countries were used for the analysis. The total weighted sample of 233,349 women aged 15-49 years who gave birth in the five years preceding the survey and who had ANC visit for their last child were included. A multi-level logistic regression model was used to examine the individual and community-level factors that influence the timely initiation of ANC. Results were presented using adjusted odds ratio (AOR) with 95% confidence interval (CI).

RESULTS

In this study, overall timely initiation of ANC visit was 38.0% (95% CI: 37.8-38.2), ranging from 14.5% in Mozambique to 68.6% in Liberia. In the final multilevel logistic regression model:- women with secondary education (AOR = 1.08; 95% CI: 1.06, 1.11), higher education (AOR = 1.43; 95% CI: 1.36, 1.51), women aged 25-34 years (AOR = 1.20; 95% CI: 1.17, 1.23), ≥35 years (AOR = 1.30; 95% CI: 1.26, 1.35), women from richest household (AOR = 1.19; 95% CI: 1.14, 1.22), women perceiving distance from the health facility as not a big problem (AOR = 1.05; 95%CI: 1.03, 1.07), women exposed to media (AOR = 1.29; 95%CI: 1.26, 1.32), women living in communities with medium percentage of literacy (AOR = 1.51; 95%CI: 1.40, 1.63), and women living in communities with high percentage of literacy (AOR = 1.56; 95%CI: 1.38, 1.76) were more likely to initiate ANC timely. However, women who wanted their pregnancy later (AOR = 0.84; 95%CI: 0.82, 0.86), wanted no more pregnancy (AOR = 0.80; 95%CI: 0.77, 0.83), and women residing in the rural area (AOR = 0.90; 95%CI: 0.87, 0.92) were less likely to initiate ANC timely.

CONCLUSION

Even though the WHO recommends all women initiate ANC within 12 weeks of gestation, sSA recorded a low overall prevalence of timely initiation of ANC. Maternal education, pregnancy intention, residence, age, wealth status, media exposure, distance from health facility, and community-level literacy were significantly associated with timely initiation of ANC. Therefore, intervention efforts should focus on the identified factors in order to improve timely initiation of ANC in sSA. This can be done through the providing information and education to the community on the timing and importance of attending antenatal care and family planning to prevent unwanted pregnancy, especially in rural settings.

Antenatal care services utilization during COVID-19 second wave attack in Pasuruan, Indonesia

Indonesia is currently experiencing the second wave of the COVID-19 pandemic, impacting maternal health services and maternal mortality. This research aims to investigate the use of antenatal care (ANC) during the COVID-19 second wave and the factors that play a role in this situation. A cross-sectional study was conducted during July 2021 on 344 pregnant women in primary, secondary, and tertiary maternal health care facilities in Pasuruan Regency, Indonesia. The data collection technique was simple random sampling, with face-to-face interviews assisted by questionnaires. Logistic regression and adjusted odds ratio with 95% CI and p<0.05 were performed to identify a significant relationship. 136 (39.5%) pregnant women did not use ANC services during the second wave of the COVID-19 outbreak. Husband’s support (AOR=13.814, 95% CI: 8.090–23.588), believing that pregnant women are not afraid of contracting COVID-19 (AOR=6.501, 95% CI: 3.904–10.825), easy access to transportation (AOR=12.145, 95% CI: 6.186–23.846), ease of ANC fees (AOR=4.105, 95% CI: 2.424–6.950), no lockdown policy (AOR=3.130, 95% CI: 1.983–4.940), knowledge regarding COVID-19 (AOR=2.975, 95% CI: 1.793–4.938), COVID-19 information on social media (AOR=3.035, 95% CI: 1.179–7.815), COVID-19 prevention protocols in health facilities (AOR=8.478, 95% CI: 3.611–19.903) were predictors of ANC utilization. This encourages the importance of prioritizing health services for pregnant women during the pandemic, overcoming the fear of contracting COVID-19 through maternal education, husband support, easy access to ANC, and improving the quality of ANC service facilities.

Antenatal screenings and maternal diagnosis among pregnant women in Sao Tome & Principe-Missed opportunities to improve neonatal health: A hospital-based study

Newborn mortality and adverse birth outcomes (ABOs) in Sao Tome & Príncipe (STP) are overwhelmingly high, and access to quality-antenatal care (ANC) is one of the strategies to tackle it. This study aimed to fill the gaps in ANC screenings with a focus on how to improve neonatal outcomes. We conducted a retrospective hospital-based study in which ANC pregnancy cards were reviewed. Screenings were described and compared according to the total number of ANC contacts: 1-3 (inadequate), 4-7 (adequate), and ≥8 (complete). The collected data were entered into QuickTapSurvey and exported to SPSS version 25 for analysis. Statistical significance was considered at a p-value ≤0.05. A total of 511 ANC pregnancy cards were reviewed. Mothers' mean age was 26.6 (SD = 7.1), 51.7% had a first trimester early booking, 14.9% (76) had 1-3 ANC contacts, 46.4% (237) had 4-7 and 38.7% (198) ≥8. Screening absence was found in 24%-41%, lack of money was registered in 36%. Pregnant women had no screening performed for HIV in 4.5%, syphilis in 8.8%, HBV 39.3%, malaria 25.8%, hemoglobin 24.5%, blood glucose 45.4%, urine 29.7%, stool exams 27.8% and 41.1% had no ultrasound. Screening completion for blood group, HIV, malaria, urine, hemoglobin, and coproparasitological exam were found to have a statistically significant difference (p<0.001) for the complete ANC group when compared to other groups. Antenatal problems identified were: 1) bacteriuria (43.2%); 2) maternal anemia (37%); 3) intestinal parasitic infections (59.2%); 4) sickle cell solubility test positive (13%); and 5) a RhD-negative phenotype (5.8%). Missed-ANC treatments were up to 50%. This study reveals a coverage-quality gap in STP since no pregnant woman is left without ANC contact, although most still miss evidence-based screenings with an impact on neonatal outcomes. Strategies such as implementing a total free ANC screening package in STP would enhance maternal diagnosis and prompt treatments.

Impact of COVID-19 on maternal healthcare in Africa and the way forward

Background

The impact of COVID-19 is weighing heavily on many African countries. As of November 14th 2021, 6,109,722 cases had been recorded with 151,173 deaths and 2.5% case fatality rate. Studies reveal substantial morbidity and socioeconomic impacts when accessing quality maternal healthcare including fear of infection and the containment measures in place, including social distancing and community containment. The pandemic has put additional strain on healthcare systems that are overburdened and under-resourced even in normal times and has exposed the vulnerabilities of high-risk population groups in addressing critical healthcare concerns. This study presents a mini review of how COVID-19 has disrupted maternal healthcare in Africa, and it further proposes ways to improve the situation.

Main body

COVID-19 has disrupted antenatal, skilled birth, and postnatal family planning services. Women and girls are vulnerable to the impact of COVID-19 on several fronts and represent a group whose needs including antenatal, skilled birth, and postnatal family planning services have been disrupted, leading to unmet needs for contraception and an increase in unintended pregnancies. Restricted travel due to the fear and anxiety associated with contracting COVID-19 has resulted in delays in accessing prompt skilled care and essential healthcare services such as pregnancy care, immunisation, and nutritional supplementation. Misconceptions relating to COVID-19 have prompted concerns and created distrust in the safety of the healthcare system. Innovative measures are required to address these obstacles and ensure women are not denied access to available, accessible, acceptable, and quality maternal healthcare services in spite of COVID-19.

Conclusions

In the immediate term while physical distancing measures remain in force, deliberate effort must be made to provide evidence-based guidelines, good practice and expert advice that addresses the unique sexual and reproductive health context of African countries. Efforts to train and motivate healthcare providers to adopt online, remote approaches such as use of telemedicine, and expand the involvement of frontline maternal healthcare providers to deliver information on the availability of services through phone-based referral networks, culturally appropriate social media, community radio and folklore messaging strategies are critical to mobilise and secure community confidence in the safety of sexual and reproductive health and maternal care services.

Timing of first antenatal care visits and number of items of antenatal care contents received and associated factors in Ethiopia: multilevel mixed effects analysis

Background

Receiving quality antenatal care (ANC) from skilled providers is essential to ensure the critical health circumstances of a pregnant woman and her child. Thus, this study attempted to assess which risk factors are significantly associated with the timing of antenatal care and the number of items of antenatal care content received from skilled providers in recent pregnancies among mothers in Ethiopia.

Methods

The data was extracted from the Ethiopian Demographic and Health Survey 2016. A total of 6645 mothers were included in the analysis. Multilevel mixed-effects logistic regression analysis and multilevel mixed Negative binomial models were fitted to find the factors associated with the timing and items of the content of ANC services. The 95% Confidence Interval of Odds Ratio/Incidence Rate Ratio, excluding one, was reported as significant.

Results

About 20% of the mothers initiated ANC within the first trimester, and only 53% received at least four items of antenatal care content. Being rural residents (IRR = 0.82; 95%CI: 0.75–0.90), wanting no more children (IRR = 0.87; 95%CI: 0.79–0.96), and the husband being the sole decision maker of health care (IRR = 0.88; 95%CI: 0.81–0.96), were associated with reduced items of ANC content received. Further, birth order of six or more (IRR = 0.74; 95%CI: 0.56–0.96), rural residence (IRR = 0.0.41; 95%CI: 0.34–0.51), and wanting no more children (IRR = 0.61; 95%CI: 0.48–0.77) were associated with delayed antenatal care utilization.

Conclusions

Rural residences, the poorest household wealth status, no education level of mothers or partners, unexposed to mass media, unwanted pregnancy, mothers without decision-making power, and considerable distance to the nearest health facility have a significant impact on delaying the timing of ANC visits and reducing the number of items of ANC received in Ethiopia. Mothers should start an antenatal care visit early to ensure that a mother receives all of the necessary components of ANC treatment during her pregnancy.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-021-01275-9.

The third Sustainable Development Goals prioritizes maternal mortality reduction, intending to lower the worldwide maternal mortality rate to 70 per 100,000 live births by 2030. Regular antenatal care from a skilled provider reduces maternal mortality by 20%. The overall quality of ANC service is determined collectively by the timing of ANC, and the contents of ANC received. Though there is an increase in ANC visits and the quality of services received, only 74% of women who gave birth in 2019 received antenatal care from a skilled provider, ranging from 85% in the urban to 70% in the rural. Thus, the quality and content of care might remain poor while the coverage of ANC visits is high. Therefore, it is necessary to analyze the levels and risk factors that affect the timing of ANC visits and contents to assess the quality of ANC services. This is the focus of the current study's research. In this study, nationally representative data from the 2016 Ethiopian Demographic and Health Survey was employed. Our study shows that rural residences, the poorest wealth quintile, no education level, unexposed to mass media, unwanted pregnancy, without decision-making power, and being far from the nearest health facility were found to be factors that hinder early initiation of ANC visits and reduce the number of items of ANC received. In conclusion, we ought to initiate an ANC visit early for a frequent antenatal care visit so that a mother will receive the necessary ANC components.

A multinomial regression analysis of factors associated with antenatal care attendance among women in Papua New Guinea

Objectives

This study sought to assess the prevalence and factors associated with antenatal care (ANC) uptake among women in Papua New Guinea.

Study design

This is a secondary data analysis of a nationally representative population based cross-sectional survey of households in Papua New Guinea conducted from 2016 to 2018.

Methods

Descriptive statistics in the form of frequencies and percentages and multinomial logistic regression analysis were done to assess the factors associated with ANC uptake and statistical significance was set at p<0.05.

Results

The prevalence of 4 or more ANC visits was 51.4%. The multinomial logistic regression analysis showed that women aged 35–39 [ARRR = 1.630, 95% CI = 1.016,2.615], those in the richest wealth quintile [2.361, 95% CI = 1.595,3.496], women who had secondary/higher level of education [ARRR = 3.644, 95% CI = 2.614,5.079], and those whose partners had secondary/higher education [ARRR = 1.706, 95% CI = 1.310,2.223] were more likely to attain 4 or more ANC visits. The likelihood of 4 or more ANC visits increased among women in Momase region [ARRR = 3.574, 95% CI = 2.683,4.762], those with parity 1 [ARRR = 2.065, 95% CI = 1.513,2.816], women who did not have a big problem with permission to go to the hospital for care [ARRR = 1.331, 95% CI = 1.110,1.597] and distance to health facility [ARRR = 1.970, 95% CI = 1.578,2.458]. However, women who were not working [ARRR = 0.756, 95% CI = 0.630,0.906], those in rural areas [ARRR = 0.712, 95% CI = 0.517,0.980] and those who do not take healthcare decisions alone [ARRR = 0.824, 95% CI = 0.683,0.994] were less likely to attain 4 or more ANC visits.

Conclusion

It was found that 51.4% of women have attained 4 or more ANC visits. Age, wealth status, employment, maternal and partner’s education, region and place of residence, parity, exposure to mass media, problem with distance and getting money needed for treatment and decision making on healthcare are associated with 4 or more ANC uptake among women in Papua New Guinea. To promote optimal number of ANC visits, there is the need for a multi-sectorial collaboration. For example, the various ministries such as the Ministry of Labour/Employment, Education, Development, Women affairs and Finance could collaborate with the Ministry of Health to achieve universal ANC coverage.

The Determinants of Four or More Antenatal Care Visits Among Working Women in Indonesia

This study aimed to analyze the determinants of four or more antenatal care (ANC) visits among working women in Indonesia. The researchers extracted data from the Indonesian Demographic and Health Survey 2017 and obtained a sample size of 8239 working women aged between 15 and 49 years. Women’s residence, age, marital status, education level, parity, economic status, and health insurance were selected as the independent variables. Binary logistic regression was used for the analysis. Older working women, married working women, educated working women, those in higher economic status, and those with health insurance were more likely to complete four or more of their ANC visits. The more children the working women had, the less likely they would complete their ANC visits. In conclusion, age, marital status, education, parity, economic status, and health insurance are the determinants for completing ANC visits among working women in Indonesia. At the same time, place of residence does not affect the frequency of ANC visits.

Access barriers to maternal healthcare services in selected hard-to-reach areas of Zambia: a mixed methods design

Introduction

poor access to maternal health services is a one of the major contributing factors to maternal deaths in low-resource settings, and understanding access barriers to maternal services is an important step for targeting interventions aimed at promoting institutional delivery and improving maternal health. This study explored access barriers to maternal and antenatal services in Kaputa and Ngabwe; two of Zambia´s rural and hard-to-reach districts.

Methods

a concurrent mixed methods approach was therefore, undertaken to exploring three access dimensions, namely availability, affordability and acceptability, in the two districts. Structured interviews were conducted among 190 eligible women in both districts, while key informant interviews, in-depth interviews and focus group discussions were conducted for the qualitative component.

Results

the study found that respondents were happy with facilities´ opening and closing times in both districts. By comparison, however, women in Ngabwe spent significantly more time traveling to facilities than those in Kaputa, with bad roads and transport challenges cited as factors affecting service use. The requirement to have a traditional birth attendant (TBA) accompany a woman when going to deliver from the facility, and paying these TBAs, was a notable access barrier. Generally, services seemed to be more acceptable in Kaputa than in Ngabwe, though both districts complained about long queues, being delivered by male health workers and having delivery rooms next to male wards.

Conclusion

based on the indicators of access used in this study, maternal health services seemed to be more accessible in Kaputa compared to Ngabwe.

Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis

BACKGROUND

In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA).

METHODS

We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI).

RESULTS

The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women's age (44-49 years-aOR = 0.33, 9% CI: 0.14-0.78), health insurance registration, (yes-aOR = 0.53, 95% CI: 0.29-0.98), and economic status (richest-aOR = 0.16, 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children-aOR = 1.68, 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high-aOR = 0.56, 95% CI: 0.32-0.99).

CONCLUSION

About eight out of ten pregnant women did not comply with the WHO's recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.

Does Timing of Antenatal Care Initiation and the Contents of Care Have Effect on Caesarean Delivery in Ethiopia? Findings from Demographic and Health Survey

Background

Antenatal care (ANC) is an important preventive set of core healthcare services through pregnancy. Caesarean deliveries are significantly increasing in many low-, middle-, and high-income countries. However, overuse of the caesarean section service interferes with the quality and cost of the procedure. Hence, this study aimed to assess the effect of timing of first antenatal care initiation and the contents of care on caesarean delivery.

Methods

A population level cross-sectional study was conducted with a total of 4757 study participants. The multivariable analysis was computed using the setup of 3 models.

Results

The rate of caesarean section among women who initiated antenatal care in the first trimester was 1.32% (95% CI = 0.91–4.21). Women initiated antenatal care in the first trimester (AOR = 2.74; 95% CI = 1.49–6.2) and received contents of care (AOR = 1.98; 95% CI = 1.24–3.78])were more likely to have caesarean section delivery as compared to their counterparts.

Conclusion

Caesarean section among women who initiated ANC in the first trimester is low. The finding suggests ANC initiated early (within 16 weeks) can have a positive impact on caesarean section delivery. In addition, being urban residents, primipara women, initiating antenatal care before 16 weeks, received contents of care, and having antenatal care visits three and more increase the odds of having caesarean section. As a result, different obstetric, medical, and surgical complications are detected and managed as early as possible.

Perception of Person-Centred Maternity Care and Its Associated Factors Among Post-Partum Women: Evidence From a Cross-Sectional Study in Enugu State, Nigeria

Objectives: This study validated a person-centred maternity care (PCMC) scale and assessed perception of PCMC and its associated factors among post-partum women.

Methods: A cross-sectional study was conducted among 450 post-partum women in two districts in Enugu State, Nigeria, using a 30-item PCMC scale. Exploratory and confirmatory factor analyses, descriptive, bivariate and Generalized Linear Models analyses were conducted.

Results: Twenty-two items were retained in the PCMC scale with high internal reliability and goodness-of-fit indices. About 25% of women received high PCMC. Marrying at 20–29 years (β = 3.46, ρ = 0.017) and 30–49 years (β = −5.56, ρ = 0.020); self-employment (β = −7.50, ρ = 0.005); marrying government worker (β = 7.12, ρ = 0.020); starting antenatal care in the third trimester (β = −6.78, ρ = 0.003); high participation in decision-making (β = −10.41, ρ < 0.001); domestic violence experience (β = 3.60, ρ = 0.007); delivery at health centre (β = 18.10, ρ < 0.001), private/mission hospital (β = 4.01, ρ = 0.003), by non-skilled attendant (β = −16.55, ρ < 0.001) and community health worker (β = −10.30, ρ < 0.001); and pregnancy complication (β = 4.37, ρ = 0.043) influenced PCMC.

Conclusion: The PCMC scale is valid and reliable in Nigeria. PCMC requires improvement in Enugu State. This study identified factors that may be considered for inclusion in intervention strategies.

Factors Associated with Numbers of Antenatal Care Visits in Rural Ethiopia

INTRODUCTION

Antenatal care (ANC) is a medical care and procedure carried out for pregnant women. Data on ANC visits can help policymakers show gaps in service provision. Therefore, this study assessed the factors associated with the number of ANC visits among women in rural Ethiopia.

METHODS

We included a total of 6611 women who gave birth within 5 years preceding the survey from the 2016 Ethiopian Demographic and Health Survey. A multi-level negative binomial regression analysis was employed to consider the hierarchical nature of the data. In the multivariable analysis, variables with a p-value <0.05 were considered to be significantly associated with the number of ANC visits.

RESULTS

Overall, 27.3% (95% CI: 14.63, 15.76) of women had at least four ANC visits during pregnancy in rural Ethiopia. Among individual level factors, age group 25-29 years (adjusted incidence rate ratio (AIRR)=1.13,95% CI:1.02,1.26), household rich wealth status (AIRR=1.17, 95% CI:1.04,1.31), women's educational status (primary, AIRR=1.19,95% CI:1.08,1.32; secondary, AIRR= 1.30,95% CI:1.08,1.55; above secondary, AIRR=1.35, 95% CI:1.07,1.71), partner educational status (primary, AIRR=1.16, 95% CI:1.05,1.28; secondary, AIRR=1.22,95% CI:1.08,1.38), and autonomy to decision to their care (AIRR=1.25,95% CI:1.10,1.42) were positively associated factors whereas having a birth order of five or more (AIRR=0.80,95% CI: 0.69,0.94) was a negative associated with number of ANC visits. Among community-level variables, being in higher community level literacy (AIRR=1.35, 95% CI: 1.14, 1.59) and higher poverty level (AIRR=0.77, 95% CI: 0.64, 0.92) were significant factors with the number of ANC visits.

CONCLUSIONS AND RECOMMENDATIONS

Women's age, wealth status, women's educational status, partner educational status, autonomy to decision making in health care, and birth order were determinants of the number of ANC visits. Furthermore, poverty and literacy are also important factors at the community level. Addressing economic and educational interventions for rural women should be prioritized.

Influence of information, education and communication on prenatal and skilled delivery in the Tano North District, Ghana: A cross-sectional study

Skilled birth attendance is considered an effective intervention to reduce maternal and early neonatal morbidity and mortality. Yet in Ghana, skilled birth attendance is said to be relatively low despite high antenatal attendance. In this study, we specifically assessed the influence of information, education and communication on prenatal and skilled delivery in the Tano North District of Ghana. A descriptive cross-sectional quantitative survey involving both closed and open-ended questionnaires were conducted among 393 women at three health facilities. The results showed skilled health personnel attended 94.1% of deliveries, which is higher than what has been reported in previous studies. Mothers with Senior High School Education were found to be 11.46 times more likely to be delivered by skilled birth attendant than those without formal education COR = 11.46, 95% (2.01–65.19) and this was statistically significant p = 0.006. There was also a significant association between information received by pregnant women and place of delivery (X² = 20.85, P = 0.000 α = 0.05) in that the usefulness of information to mothers influenced their choice of health facility delivery. Marital status was also strongly correlated to being attended by skilled birth attendant (χ2 = 14.73, p = 0.005) as 0.4 times of mothers who were married were more likely to be attended by skilled birth attendants as compared to those that are single. COR = 0.005, 95% CI (0.00–0.36) and this was statistically significant p = 0.002. This study suggests the incorporation of IE&C into nursing training curriculum to orient students on the importance of IE&C so as to improve ANCs and skilled birth attendance further.

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

BACKGROUND

First-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.

METHODS

A 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.

RESULTS

Data 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.

CONCLUSION

The 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.

Factors associated with early antenatal care attendance among women in Papua New Guinea: a population-based cross-sectional study

BACKGROUND

Early initiation of antenatal care (ANC) is a key component of antenatal care, as suggested by the World Health Organisation (WHO). It helps in early identification and mitigation of adverse pregnancy-related complications. Despite this, a greater proportion of women worldwide still do not adhere to this recommendation. This study, therefore, sought to assess the prevalence and factors associated with early initiation of ANC among women in Papua New Guinea (PNG).

METHODS

A population-based cross-sectional study was conducted among 4,274 women using data from the 2016-2018 PNG Demographic and Health Survey (PDHS). The outcome variable was early initiation of ANC. Bivariate (chi-square) and multivariable logistic regression analyses were done and statistical significance was set at p < 0.05.

RESULTS

The prevalence of early ANC initiation was 23.0 % (CI = 20.8-24.6). The binary logistic regression analysis showed that working women had higher odds of early ANC attendance compared with those who were not working [AOR = 1.37, 95 %CI = 1.17 = 1.60]. The results also showed that women from Islands region had lower odds [AOR = 0.50, 95 %CI = 0.40-0.62] of early ANC attendance compared with those from Southern region. Finally, women with parity 3 had lower odds of early ANC attendance compared to those with parity 1[AOR = 0.64,95 % CI = 0.49-0.84].

CONCLUSIONS

This study found a relatively low prevalence of early ANC uptake among women in PNG. The factors associated with early ANC attendance were region of residence, parity, and working status of mothers. To increase early ANC uptake, these factors should be considered when designing new policies or reviewing policies and strategies on ANC uptake to help increase ANC attendance, which can help in the reduction of maternal mortality.

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.

Patterns and Predictors of Insufficient Antenatal Care Utilization in Nigeria over a Decade: A Pooled Data Analysis Using Demographic and Health Surveys

This study investigated the patterns of antenatal care (ANC) utilization and insufficient use of ANC as well as its association with some proximate socio-demographic factors. This was a cross-sectional study using pooled data Nigeria Demographic and Health Surveys from years 2008, 2013 and 2018. Participants were 52,654 women of reproductive age who reported at least one birth in the five years preceding the surveys. The outcome variables were late attendance, first contact after first trimester and less than four antenatal visits using multivariable logistic regression analysis. The overall prevalence of late timing was 74.8% and that of insufficient ANC visits was 46.7%. In the multivariable regression analysis; type of residency, geo-political region, educational level, household size, use of contraceptives, distance to health service, exposure to the media and total number of children were found to be significantly associated with both late and insufficient ANC attendance. About half of the pregnant women failed to meet the recommendation of four ANC visits. Investing on programs to improve women's socio-economic status, addressing the inequities between urban and rural areas of Nigeria in regard to service utilization, and controlling higher fertility rates may facilitate the promotion of ANC service utilization in Nigeria.

Women's knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana: A cross-sectional study

INTRODUCTION

Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana.

METHODS

A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0.

RESULTS

Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16-8.80), p<0.001], educational level [OR = 10.18 (95%CI: 3.86-26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72-6.82), p<0.001]. Not married [OR = 0.65 (0.39-1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13-0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care.

CONCLUSION

Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductive-age women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana.