The effect of national antenatal care guidelines and provider training on obstetric danger sign counselling: a propensity score matching analysis of the 2014 Ethiopia service provision assessment plus survey

Assessment of healthcare facilities' readiness to provide antenatal care in Ethiopia: facility based study using service provision assessment data

BACKGROUND

Readiness of healthcare facilities is essential for delivering quality healthcare services. There is limited evidence on the antenatal care (ANC) readiness of healthcare facilities in Ethiopia. This study aimed to assess the readiness of ANC services and its influencing factors in Ethiopian healthcare facilities.

METHODS

A secondary data analysis was performed using data from the Ethiopian Service Provision Assessment conducted from 11th August 2021 to 4th February 2022. A total of 905 healthcare facilities from nine regions and two city administrations in Ethiopia that provided ANC were included. Healthcare facilities' ANC readiness was evaluated using 22 indicators across five domains: trained staff and ANC guidelines (3), basic medical equipment (4), medicines and commodities (4), infection prevention tools (6), and diagnostic tests (5). A higher score in each domain indicated greater readiness to deliver recommended ANC. A Generalized Poisson regression model identified factors influencing each domain of ANC readiness indicators. Data analysis was conducted using Stata software version 16.

RESULTS

The total number of ANC readiness indicators in healthcare facilities ranged from two to seventeen. The mean score for each indicator of ANC readiness in healthcare facilities was as follows: trained staff and guidelines (1.36/3, SD = 0.96), basic medical equipment (3.20/4, SD = 0.99), medicines and commodities (1.95/4, SD = 1.36), infection prevention tools (4.33/6, SD = 1.51), and diagnostic tests (2.22/5, SD = 1.80), based on the included indicators in each domain. Regression results showed lower availability of medicines and commodities, infection prevention tools, and diagnostic tests in clinics and rural facilities. Trained staff and ANC guidelines were less available in private healthcare institutions, health posts, and clinics. Conversely, medicines and commodities were more available in healthcare facilities in the Afar, Amhara, and Somali regions.

CONCLUSION

Most healthcare facilities in Ethiopia lacked key ANC readiness indicators, which are crucial for comprehensive ANC and achieving maternal and child health Sustainable Development Goals. Strategic interventions are needed to ensure ANC readiness indicators are available in healthcare facilities and to address disparities by facility type, managing authority, location and region.

Disparities in Antenatal Care Visits between Urban and Rural Ethiopian Women

Background

Utilizing antenatal care is one of the best ways to identify issues that are already present or could arise throughout pregnancy. Despite increased efforts to expand health services and antenatal care utilization, less is known regarding antenatal care disparities across different population segments. Therefore, the purpose of this study was to assess the degree of discrepancies between urban and rural Ethiopian pregnant women's use of antenatal care.

Methods

A total sample of 3927 women who gave birth to living children between 2014 and 2019 was included in the study from the 2019 Ethiopia Mini Demographic and Health Survey. Negative binomial Poisson's regression was adopted to analyze the data.

Results

The majority of pregnant women (73.8%) attend at least one antenatal care. Pregnant women in rural areas visited fewer number of antenatal care (68.36%) than those in urban areas (90.1%). Women with age range of 30-40 (IRR: 4.56, 95% CI: 1.07-19.34), women with attending incomplete primary education (IRR: 0.05, 95% CI: 0.02-0.12), women with attending complete primary education (IRR: 0.17, 95% CI: 0.07-0.42), women from middle-income households (IRR: 0.12, 95% CI: 0.06-0.24), women from richer household (IRR: 0.26, 95% CI: 0.14,0.5), women from the richest household (IRR: 0.45, 95% CI: 0.24-0.86), and pregnant women from rural areas (IRR: 0.615, 95%: 0.56-0.67) were observed to be linked with the frequency of antenatal care visits.

Conclusion

In Ethiopia, three-fourths of pregnant women attend at least one antenatal care. Place of residence, educational attainment, age in five years' group, and wealth index for urban/rural were related to the frequency of antenatal care visits.