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

Sociodemographic characteristics of maternal mortality in Japan: An analysis of national data from 2010 to 2022

OBJECTIVE

There is a paucity of studies investigating sociodemographic characteristics of maternal mortality in Japan. In this study, we investigated the sociodemographic factors associated with maternal mortality in Japan using national data.

MATERIALS AND METHODS

The Vital Statistics data in Japan (birth and mortality data) from 2010 to 2022 were used in the analysis. Region, maternal age group, maternal nationality, maternal marital status, and the main type of occupation in the household (household occupation) were used as sociodemographic variables. The maternal mortality ratio per 100,000 live births, maternal age group-specific maternal mortality ratio, and the maternal mortality ratio standardized by maternal age group were calculated by the sociodemographic characteristics.

RESULTS

A total of 12,535,198 live births and 457 maternal deaths were included in the analysis. The age-standardized maternal mortality ratio of metropolitan areas was the lowest among regions. The age-standardized maternal mortality ratio of non-Japanese mothers was approximately twice as high as that of Japanese mothers, and the ratio of unmarried mothers was approximately five times as high as that of married mothers. The age-standardized maternal mortality ratio of households with a full-time worker in a larger company and unemployed households was the lowest and highest, respectively, among household occupations, and that of unemployed households was approximately nine times as high as that of households with a full-time worker in a larger company.

CONCLUSIONS

Some sociodemographic factors, such as maternal marital status and type of household occupation, were associated with maternal mortality in Japan.

Quality of antenatal care services in Afghanistan: findings from the national survey 2022-2023

BACKGROUND

The optimum use of antenatal care (ANC) services can reduce pregnancy-related complications and deaths. However, there is limited information on the quality of ANC services in Afghanistan. This study aimed to assess the quality of ANC services and examine the influence of sociodemographic factors on the quality of ANC services received by pregnant women in Afghanistan.

METHODS

This study analyzed the data from the 2022-23 Afghanistan Multiple Indicators Cluster Survey (MICS), including 9,243 ever-married women aged 15-49 years who had given birth two years prior to the survey. ANC quality was classified as "good" if a woman had at least four ANC visits, initiated ANC during the first trimester, and received all four essential ANC services. Binary logistic regression was employed to examine the likelihood of receiving good-quality ANC across various sociodemographic variables.

RESULTS

Only 6.2% of women received good-quality ANC. Factors significantly associated with receiving good-quality ANC included woman's secondary (AOR:1.87, 95%CI: 1.33-2.63) and higher education levels (AOR: 1.75, 95%CI: 1.01-3.03), household head's higher education level (AOR:1.63, 95%CI: 1.11-2.40), and wealth status (1.71, 2.26, 1.92, and 1.97 higher odds of receiving good-quality ANC for 2nd, 3rd, 4th, and 5th as compared to 1st quintiles of wealth, respectively).

CONCLUSION

The low utilization of good-quality ANC among women in Afghanistan, particularly among those at lower wealth status, with low education levels, underscores the need for targeted interventions to improve access and utilization of antenatal care services.

Individual and community-level factors associated with adequate antenatal care service utilization in sub-Saharan Africa

BACKGROUND

Sub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.

METHOD

We used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.

RESULTS

The pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28-55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07-2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51-1.60), rich women AOR = 1.26, 95% CI 1.24-1.29), women 35-49 years of age (AOR = 1.36, 95% CI 1.32-1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11-1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78-0.82), not having mass media access (AOR = 0.74, 95% CI 0.72-0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68-0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.

CONCLUSION

The sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.

Individual and community-level determinants of quality antenatal care in six South Asian countries

Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality  ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15-49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35-49 years (AOR = 1.16; 95% CI = 1.09-1.24), higher education (AOR = 2.84; 95% CI = 2.69-2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49-1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04-3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89-0.95) and 2-4 birth order (AOR = 0.86; 95% CI = 0.83-0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74-0.8), and big problem - distance to health facility (AOR = 0.63; 95% CI: 0.53-0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32-25.08) and Maldives (AOR: 33.33; 95% CI: 31.06-35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia.

Regional disparities in antenatal care utilization among pregnant women and its determinants in Ethiopia

Background

Antenatal care primarily focuses on health care checkups, the provision of advice on healthy behaviors, and the delivery of psychological, social, and emotional support for women with pregnancy. The national target set by the Ethiopian government is to achieve 95% of at least four ANC visits. Nevertheless, 43.11% of women had four or more checkups, according to the 2019 Ethiopian Demographic and Health Survey. Despite this achievement, antenatal care visits differ significantly between Ethiopian regions. Consequently, the purpose of this study was to assess regional disparities in pregnant women's utilization of antenatal care and its determinants in Ethiopia.

Methods

We have used 2019 intermediate Ethiopian Demographic and Health Survey data for analysis. The analysis comprised a total of 3,917 weighted women age 15-49 who had a live birth in the 5 years preceding the survey. Poisson regression analysis was done using SAS software version 9.4. To show the strength and direction of the association, an incidence rate ratio with a 95% confidence interval was used. Variables with a p-value <0.05 were declared as significant factors associated with the number of ANC visits.

Results

In Ethiopia, the number of ANC visits differs between regions. With a mean of 4.74 (95% CI: 4.49, 4.99), Addis Ababa reported the highest percentage of ANC visits (82.7%), while the Somali Region reported the lowest percentage (11.3%) with a mean of 0.73 (95% CI: 0.57, 0.88). Maternal age, educational level, religion, household wealth index, place of delivery, and household size show significant associations with the number of antenatal care visits.

Conclusions

In Ethiopia, there is the highest regional disparity in the number of ANC visits. The number of ANC visits was influenced by the mother's age, education, religion, household wealth index, place of delivery, and household size. Regarding the ANC visits, there should be initiatives that address the demands of pastoralist and agro-pastoralist communities to increase ANC utilization. As with many other health outcomes, education and low socio-economic status were associated with low ANC visit but these are tied to the overall social development of a country and are not immediately amenable to public health interventions.

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.