"No visible signs of pregnancy, no sickness, no antenatal care": Initiation of antenatal care in a rural district in Northern Ghana

Has the Gratuité policy reduced inequities in geographic access to antenatal care in Burkina Faso? Evidence from facility-based data from 2014 to 2022

Background

Evidence shows that user fee exemption policies improve the use of maternal, newborn, and child health (MNCH) services. However, addressing the cost of care is only one barrier to accessing MNCH services. Poor geographic accessibility relating to distance is another. Our objective in this study was to assess the effect of a user fee exemption policy in Burkina Faso (Gratuité) on antenatal care (ANC) use, considering distance to health facilities.

Methods

We conducted a cross-sectional study with sub-analysis by intervention period to compare utilization of ANC services (outcome of interest) in pregnant women who used the service in the context of the Gratuité user fee exemption policy and those who did not, in Manga district, Burkina Faso. Dependent variables included were socio-demographic characteristics, obstetric history, and distance to the lower-level health facility (known as Centre de Santé et Promotion Sociale) in which care was sort. Univariate, bivariate, and multivariate analyses were performed across the entire population, within those who used ANC before the policy and after its inception.

Results

For women who used services before the Gratuité policy was introduced, those living 5-9 km were almost twice (OR = 1.94; 95% CI: 1.17-3.21) more likely to have their first ANC visit (ANC1) in the first trimester compared to those living <5 km of the nearest health facility. After the policy was introduced, women living 5-9 km and >10 km from the nearest facility were almost twice (OR = 1.86; 95% CI: 1.14-3.05) and over twice (OR = 2.04; 95% CI: 1.20-3.48) more likely respectively to use ANC1 in the first trimester compared to those living within 5 km of the nearest health facility. Also, women living over 10 km from the nearest facility were 1.29 times (OR = 1.29; 95% CI: 1.00-1.66) more likely to have 4+ ANC than those living less than 5 km from the nearest health facility.

Conclusions

Insofar as the financial barrier to ANC has been lifted and the geographical barrier reduced for the populations that live farther away from services through the Gratuité policy, then the Burkinabé government must make efforts to sustain the policy and ensure that benefits of the policy reach the targeted and its gains maximized.

Factors Associated with Late Antenatal Initiation among Women in Malawi

Background Early initiation of antenatal care (ANC) is critical in identifying and mitigating adverse pregnancy-related complications. However, globally, a high percentage of women initiate ANC only at a late stage of their pregnancy. In view of this, the main objective of the study is to establish the prevalence and factors associated with late ANC initiation among women in Malawi. Methods The study was based on the 2015-16 Malawi Demographic and Health Survey (MDHS). The study population consisted of 13,251 women of reproductive age who had given birth during the five years preceding the survey. The data was analyzed using the chi-square test and multivariate logistic regression. Results The prevalence of late ANC initiation in Malawi was 75.6%. The logistic regression modelling revealed increased odds of late ANC initiation attendance among women residing in the Northern Region (AOR: 1.172; 95% CI: 1.021-1.345) and the Central Region (AOR: 1.178; 95% CI: 1.074-1.291), women residing in urban areas (AOR: 1.273; 95% CI: 1.108-1.463), women with no education (AOR: 1.814; 95% CI: 1.13-1.47) or with primary education (AOR: 1.697; 95% CI: 1.13-1.47), women with less than four ANC visits (AOR: 4.155; 95% CI: 4.002-4.814), unmarried women (AOR: 1.478; 95% CI: 1.111-1.985) and those whose last birth was not by caesarean section (AOR: 1.377; 95% CI: 1.179-1.607). Reduced odds of late ANC initiation among women were observed among women in the 20-24 age group (AOR: 0.634; 95% CI: 0.456-0.881), those in the 25-29 age group (AOR: 0.645; 95% CI: 0.476-0.874) and those aged 30-34 years (AOR: 0.634; 95% CI: 0.456-0.881). Conclusions The study found that ANC initiation in Malawi is often delayed, with most first visits occurring after the first trimester. Late ANC initiation is associated with region, place of residence, marital status, and the women's age. These are significant factors to be considered when designing new or reviewing ANC policies and strategies aimed at increasing ANC utilization and encouraging early initiation of ANC. Earlier ANC initiation among Malawian women can contribute positively towards improving maternal and child health in Malawi. Therefore, government policies and interventions should target women with no or little education, those living in poor families and other modifiable risk factors, such as young unmarried women.

Navigating antenatal care: The lived experiences of adolescent girls and young women and caregiver perspectives in Zambia

INTRODUCTION

Adolescent pregnancy remains a global concern, especially in low- and middle-income countries. Sub-Saharan African nations, including Zambia, bear a disproportionate burden of adolescent pregnancies, contributing to high rates of maternal and child mortality. Despite efforts to improve antenatal care (ANC) services, utilization rates remain suboptimal, especially among adolescent girls and young women (AGYW).

OBJECTIVE

To explore the barriers and facilitators to ANC services among AGYW and how these factors might differ by age and HIV status.

DESIGN

This qualitative study employs a combination of in-depth interviews (IDIs) and focus group discussions (FGDs) to gather comprehensive insights into the experiences of AGYW regarding ANC services. The study design follows a socio-ecological framework (SEF) to identify multiple levels of influence on ANC utilization.

METHODS

We conducted 40 IDIs with AGYW aged 15-24; and 2 FGDs with caregivers of AGYW (n = 16). IDIs explored AGYWs barriers and facilitators to accessing and utilizing healthcare services during pregnancy, as well as social support and HIV treatment and prevention. FGD topics included social support, barriers and facilitators to ANC, and HIV services. We developed a codebook based on the SEF and coded transcripts using Dedoose software.

RESULTS

Results showed that early pregnancy knowledge did not always translate to AGYW seeking ANC services right away or within the first trimester. More than half of the AGYW did not initiate ANC until well into the second trimester. Factors including lack of motivation, denial of pregnancy, desires to terminate pregnancies, social norms, policies, clinic environment, and financial constraints contributed to delays in ANC initiation. Social support from family, partners, peers, and the community were crucial motivators for early ANC. Lastly, challenges to ANC continuation included lack of transportation, long clinic waiting times, perceived provider indifference, and stigma at both community and clinic levels.

CONCLUSION

In conclusion, gaining insights from qualitative data is essential for comprehensively understanding the barriers and challenges to accessing ANC among this specific age group. By identifying and addressing these barriers while enhancing facilitators, effective programs can be developed and implemented to improve the health and well-being of young mothers and their children.

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).

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.

Understanding Healthcare Professionals' Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study

Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.

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.

Malaria surveillance amongst pregnant women attending antenatal care in private hospitals in Onitsha metropolis, South Eastern Nigeria

Background

Recent reports suggest that pregnant women living in holoendemic regions of sub-Sahara Africa die in great numbers annually due to malaria disease resulting from their higher susceptibility, reduced immunity and demographic associated factors. This work investigated the prevalence of Plasmodium falciparum in pregnant women attending antenatal care (ANC) in selected private hospitals in Onitsha metropolis South East Nigeria.

Methods

Venous blood samples were collected from 270 pregnant women during ANC visits between October 2016 and December 2017. A questionnaire was used to collect demographic data, gestational age, knowledge of malaria and preventive measures while clinical presentations and symptoms were extracted from the physician's clerking form. Laboratory diagnosis was done using microscopy. The effect of the demographic variables and other associated factors on prevalence and parasite densities was studied using Chi-square and ANOVA tests.

Results

The overall P. falciparum prevalence was 42.6%. Prevalence varied with the maternal age, gestational age, preventive measures adopted by the pregnant women and clinical presentations. 27.8 % of the infected women were highly parasitized (>5000 parasites/μl); 67% had a moderate parasite density (1,000-4,999 parasites/μl) and 5.2% showed a low parasite density (1-999 parasites/μl). We observed that 35.2%, 30%, 18.9% and 5.2% of the study cohorts preferred and used treated bed nets, insecticides, windows and door screening and non-treated bed nets respectively as malaria preventive measures. 5.9% did not use any protection.

Conclusions

The findings of this study revealed high prevalence of malaria among pregnant women living in Onitsha metropolis with high mean parasite densities despite strong adherence to use of sulphadoxine-pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) and other malaria preventive measures.

Maternal social support and health facility delivery in Southwest Ethiopia

BACKGROUND

Maternal mortality continues to decrease in the world but remain the most important health problems in low-income countries. Although evidence indicates that social support is an important factor influencing health facility delivery, it has not been extensively studied in Ethiopia. Therefore, this study aimed to assess the effect of maternal social support and related factors on health facility delivery in southwest Ethiopia.

METHODS

A cross-sectional survey data on 3304 women aged 15-47 years in three districts of Ethiopia, were analyzed. Using multivariable logistic regression, we assessed the association between health facility birth, social support, and socio-demography variables. Adjusted odds ratios with 95% confidence intervals were used to identify statistically significant associations at 5% alpha level.

RESULT

Overall, 46.9% of women delivered at health facility in their last pregnancy. Average travel time from closest health facility (AOR: 1.51, 95% CI 1.21 to 2.90), mean perception score of health facility use (AOR: 1.83, 95% CI 1.44 to 2.33), involvement in final decision to identify their place of childbirth (AOR: 2.12, 95% CI 1.73 to 2.58) had significantly higher odds of health facility childbirth. From social support variables, women who perceived there were family members and husband to help them during childbirth (AOR: 3.62, 95% CI 2.74 to 4.79), women who received continuous support (AOR: 1.97, 95% CI 1.20 to 3.23), women with companions for facility visits (AOR: 1.63, 95% CI 1.34 to 2.00) and women who received support from friends (AOR: 1.62, 95% CI 1.16 to 3.23) had significantly higher odds of health facility childbirth.

CONCLUSIONS

Social support was critical to enhance health facility delivery, especially if women's close ties help facility delivery. An intervention to increase facility delivery uptake should target not only the women's general social supports, but also continuous support during childbirth from close ties including family members and close friends as these are influential in place of childbirth. Also actions that increase women's healthcare decision could be effective in improving health facility delivery.

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.

Determinants of Utilization and Quality of Antenatal Care Services in Lubumbashi, in the Democratic Republic of the Congo

Objectives:

Maternal and perinatal mortality is one of the best indicators of a society’s health status and development level. In the Democratic Republic of the Congo, antenatal care (ANC) utilization is generally low, and delayed initiation of care is very common. It is in this context that the present study on the utilization and quality of ANC carried out among women in Lubumbashi city aimed to identify determinants of the utilization and quality of ANC services.

Material and Methods:

This was a cross-sectional study conducted in Lubumbashi, relating to 1472 women who had given birth during the 12 months preceding the survey, selected by cluster sampling. Logistic regression was used to identify the relative effects of socio-demographic risk factors and all statistical tests were declared significant at a P < 0.05.

Results:

One tenth (10.5%) of the women in the sample did not attend ANC during their most recent pregnancy and 89.5% had attended ANC at least once. Of the 1318 women with at least one ANC visit, 55.9% had an early initiation of ANC and 53.2% received high quality ANC. Women aged 20–29 years (adjusted odds ratios [aOR] = 2.8 [1.6–5.1]), 30–39 years (aOR = 4.3 [2.1–8.9]) and ≥40 years (aOR = 6.5 [2.6–16.2]), married women (aOR = 1.9 [1.1–3.2]), women with secondary educational level (aOR = 4.9 [3.4–7.2]), and women with higher educational level (aOR = 15.3 [5.3–43.8]) were more likely to have at least one ANC during their pregnancy. Factors contributing to attend four or more ANC visits were secondary educational level (aOR = 1.4 [1.0–2.0]) and higher educational level (aOR = 1.9 [1.2–2.9]), primiparity (aOR = 1.5 [1.1–2.1]), and doing business activities (aOR = 1.4 [1.0–1.8]). Determinant of early initiation ANC was only the higher educational level (aOR = 2.2 [1.4–3.4]). Factors associated with high quality ANC were secondary educational level (aOR = 3.0 [2.1–4.3]) and higher educational level (aOR = 6.2 [3.8–9.9]), and receiving ANCs in a general referral hospital (aOR = 1.5 [1.2–2.0]).

Conclusion:

The use and quality of ANC services remain a serious problem in Lubumbashi city. This situation hampers the achievement of maternal and child health goals. Health education can help reduce this in our context.

Determinants of uptake of intermittent preventive treatment for malaria with sulfadoxine pyrimethamine in pregnancy: a cross-sectional analytical study in the Sekondi-Takoradi Metropolis of Ghana

BACKGROUND

Ghana malaria control programme recommends the uptake of five doses of sulfadoxine pyrimethamine (SP) during pregnancy following the review of the World Health Organization recommendations in 2012. The uptake of higher doses of SP since the implementation of the new policy in 2016, has been low across the country. The current study determined factors that can be improved to increase uptake of SP for intermittent preventive treatment of malaria in pregnancy (IPTp-SP).

METHODS

A cross-sectional analytical study was carried out among women who had just delivered in selected health facilities in the Sekondi-Takoradi Metropolis of Ghana. Participants were enrolled from the lying-in wards of the study facilities after delivery. Data including time of initiating antenatal care (ANC), number of visits, time of first dose of SP and number of doses were collected. ANC books were also reviewed. Logistic and ordered logistic regression analysis were done to determine respondent factors associated with uptake of IPTp-SP using Stata 15.

RESULTS

Out of the 496 mothers who participated in the study, 370 (74.60%) initiated ANC during the first trimester, 123 (24.80%) during the second, with only three (0.60%) starting during the third trimester. Majority (463/496, 93.35%) made > 4 visits. Uptake of at least one dose of SP was 98.79% (490/496), ≥ 2 doses was 92.75 (460/496), ≥ 3 doses was 80.65% (400/496) and ≥ 4 doses was 40.32% (200/496). Uptake of IPTp 5 was very low (6.65%, 33/490). A unit increase of one ANC visit was associated with 20% higher odds of receiving 3-4 doses of SP with respect to receiving 1-2 doses (p <  0.001). The probability of receiving 5 or more doses of SP with respect to 1-2 doses was 26% higher with a unit increase of one ANC visit.

CONCLUSION

Uptake of 3-4 doses and ≥ 5 doses of SP were associated with making more ANC visits. Encouraging and motivating expectant mothers to make more ANC visits can improve uptake of ≥5 doses of SP.

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.

Determinants of change in timely first antenatal booking among pregnant women in Ethiopia: A decomposition analysis

Background

Even though maternal health was highly targeted in different global strategies, maternal mortality could not be decreased as was expected. Besides this, prior decomposition analysis to the possible cause of changes to timely first antenatal booking has not been conducted. Therefore, this study aimed to assess determinants of change in timely first antenatal booking among pregnant women in Ethiopia.

Methods

The study utilized three consecutive Ethiopia Demographic and Health Survey (EDHS) datasets which were collected through cross-sectional study design. The number of pregnant women who gave birth in 2005, 2011 and 2016 survey included in the analysis was 7,307, 7,908 and 7,590 respectively. The data were analyzed by using Stata/SE version 14.0. Logit-based decomposition analysis was done to identify contributing factors for change in timely first antenatal booking and statistical significance was determined by using P-value.

Results

The trend of timely first antenatal booking was increased from 6% to 20% in the last ten years. The analysis revealed that 14% of the overall change was because of the change in women’s composition. Changes in the composition of women according to region, education and occupation status were the major sources of this change. The remaining, 86% of the change was due to differences in the coefficient. Mostly, the change in behaviors of the Oromia population, those who have lived in the rural areas and male household head were some of the contributing factors for the increase in timely first antenatal booking.

Conclusions

There was a significant increase in timely first antenatal booking among pregnant women in Ethiopia from 2005 to 2016 EDHS. The change in the women composition according to residency, education and occupation status of women and the difference in behaviors like: behavior of rural residents and male household head contributed to the majority of the change. Interventions targeting the male household head, rural residents and those women who lived in the Oromia region should be emphasized to increase further timely booking. In addition, promoting women in terms of education and creating job opportunities could be the other recalled intervention areas of the country.

Modifiable socio-cultural beliefs and practices influencing early and adequate utilisation of antenatal care in rural Bangladesh: A qualitative study

OBJECTIVE

Our objective was to explore the socio-cultural factors that influence women's early and adequate utilisation of antenatal care (ANC) in rural Bangladesh.

METHODS

A qualitative study was conducted in two rural settings of Bangladesh, including 32 in-depth interviews with pregnant or recently delivered women, husbands whose wives were pregnant or had a recent birth, mothers-in-law whose daughters-in-law were pregnant or had a recent birth; 2 focus group discussions with husbands; and 4 key-informant interviews with community health workers. We used thematic analysis to analyse the data.

FINDINGS

ANC initiation in the first trimester was not a priority for most women. Women's lack of awareness about the appropriate timing of the first ANC contact, lack of decision-making autonomy and fear of caesarean section were the major barriers to the early and adequate ANC utilisation. There were many superstitions around pregnancy in rural settings which prevented women seeking early and adequate antenatal care and led them to seek care from traditional care providers instead of formal care providers.

CONCLUSION

ANC utilisation in rural Bangladesh was associated with several socio-cultural beliefs which are modifiable with interventions that have been used in similar settings. Targeting these socio-cultural barriers with context- and community-specific interventions is important to improve overall ANC utilisation at the community-level which can lead to significant improvements in perinatal outcomes.

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.