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Adewuyi EO, Auta A, Adewuyi MI, Philip AA, Olutuase V, Zhao Y, Khanal V. Antenatal care utilisation and receipt of its components in Nigeria: Assessing disparities between rural and urban areas-A nationwide population-based study. PLoS One 2024; 19:e0307316. [PMID: 39008484 PMCID: PMC11249263 DOI: 10.1371/journal.pone.0307316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 06/28/2024] [Indexed: 07/17/2024] Open
Abstract
INTRODUCTION Antenatal care (ANC) is crucial for positive pregnancy outcomes, but it is underutilised in Nigeria, suggesting unmet needs, and potentially contributing to the country's high burden of maternal and neonatal mortalities. This study comprehensively assesses ANC utilisation and receipt of its components in Nigeria, focusing on disparities between rural and urban areas. METHODS We used the data disaggregation approach to analyse the Nigeria Demographic and Health Survey 2018. We estimated ANC utilisation, assessed the receipt of ANC components, and identified factors associated with eight or more (≥ 8) ANC contacts nationally and across rural and urban residences. RESULTS Nationwide, only 20.3% of women had ≥ 8 ANC contacts, with a significant disparity (P < 0.001) between urban (35.5%) and rural (10.4%) areas in Nigeria. The North-East region had the lowest ANC utilisation nationally (3.7%) and in urban areas (3.0%), while the North-West had the lowest in rural areas (2.7%). Nationally, 69% of mothers received iron supplements, 70% had tetanus injections, and 16% received medicines for intestinal parasites, with urban residents having higher proportions across all ANC components. Maternal and husband education, health insurance, and maternal autonomy were associated with increased ANC odds at the national, rural, and urban residences. However, differences exist, with all ethnicities having higher ANC odds than the Hausa/Fulanis in urban areas and the Yorubas demonstrating greater odds than other ethnicities in rural settings. Internet use was significant only in the national context, watching television only in urban settings, while maternal working status, wealth, birth type, religion, and radio listenership were significant in rural areas. CONCLUSION Our study reveals significant disparities in ANC utilisation and components across Nigeria, with rural residents, particularly in northern regions, as well as socioeconomically disadvantaged and teenage mothers facing notable challenges. A multifaceted approach prioritising the interplay of intersectional factors like geography, socioeconomic status, education, religion, ethnicity, and gender dynamics is essential. Key strategies should include targeted interventions to promote educational opportunities, expand health insurance coverage, leverage internet and context-specific media, and foster socioeconomic empowerment, with priority for underserved populations.
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Affiliation(s)
- Emmanuel O Adewuyi
- School of Medical and Health Sciences, Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Asa Auta
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, United Kingdom
| | - Mary I Adewuyi
- Faculty of Health, Department of Social Work, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Aaron Akpu Philip
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Victory Olutuase
- Department of Clinical Pharmacy and Pharmacy Practice, University of Jos, Jos, Nigeria
| | - Yun Zhao
- School of Population Health, Faculty of Health Science, Curtin University, Perth, Western Australia, Australia
| | - Vishnu Khanal
- Menzies School of Health Research, Charles Darwin University, Alice Springs, Northern Territory, Australia
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Ajoseh SM, Sifat RI, Whesu JT. Food-based domestic violence and anemia among women in sexual unions in Nigeria: the effect of urbanization. J Public Health Policy 2024:10.1057/s41271-024-00504-2. [PMID: 38992219 DOI: 10.1057/s41271-024-00504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2024] [Indexed: 07/13/2024]
Abstract
In 2019, 1.74 billion people worldwide had anemia. In Nigeria, women of reproductive age are the most affected. Domestic violence affects the anemia prevalence, but few studies have examined the influence of urbanization on women in heterosexual unions (currently married, and cohabiting between). Using the social determinants of health framework, we argue that food-based violence and anemia vary among women residing in rural and urban areas. We used the Chi-square test and logistic regression to analyze the 2018 Nigeria Demographic and Health Survey records (n = 10,499). The study showed that anemia occurs more among women in rural (66%) than in urban (34%) areas. In rural areas, anemia was 29% higher among women who approved food-based domestic violence (OR: 1.29, CI 1.15-1.57) than those who did not. In urban areas, food-based domestic violence was not significantly associated with anemia. This study emphasizes the urgent need for culturally sensitive maternal health interventions aimed at re-orienting individuals and families on violence in rural areas.
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Affiliation(s)
- Seun Mauton Ajoseh
- Department of Sociology and Criminology & Law, University of Florida, Gainesville, FL, 32603, USA
| | - Ridwan Islam Sifat
- School of Public Policy, University of Maryland, Baltimore County, Baltimore, MD, 21250, USA.
| | - John Tasheyon Whesu
- Department of Sociology, Case Western Reserve University, Cleveland, OH, 44106, USA
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Gube AA, Murányi E, Vitrai J, Lohner S. Inequity in uptake of maternal health care services in developing countries: a systematic review and meta-analysis. Front Public Health 2024; 12:1415092. [PMID: 38989116 PMCID: PMC11233804 DOI: 10.3389/fpubh.2024.1415092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
Background Maternal health service uptake remains an important predictor of maternal outcomes including maternal mortality. This systematic review and meta-analysis aimed to summarize the available evidence on the uptake of maternal health care services in developing countries and to assess the impact of place of residence, education status, and wealth index on the uptake of these services. Methods We examined the databases MEDLINE, Web of Science, Global Index Medicus, and Scopus until June 14, 2022. Cross-sectional studies done between 2015 and 2022 were considered. Mothers of reproductive age and all states of health were included in the study. Independently, two authors determined the eligibility of studies, extracted data, evaluated the risk of bias, and ranked the evidence's degree of certainty. To combine the data, we performed a random-effects meta-analysis. The PROSPERO registration ID is CRD42022304094. Results We included 51 studies. Mothers living in urban areas were three times more likely to receive antenatal care (OR 2.95; 95% CI 2.23 to 3.89; 15 studies; 340,390 participants) than rural mothers. Compared with no education, those with primary education were twice as likely to utilize antenatal care (OR 2.36; 95% CI 1.80 to 3.09; 9 studies; 154,398 participants) and those with secondary and higher education were six and fourteen times more likely to utilize antenatal care, respectively. Mothers in the second wealth index were twice as likely as mothers in the lowest wealth index to utilize antenatal care (OR 1.62; 95% CI 1.36 to 1.91; 10 studies; 224,530 participants) and antenatal care utilization increased further among mothers in the higher wealth index. We observed similar relative inequalities in skilled delivery care and postnatal care utilization based on the pace of residence, education, and wealth index. Conclusion In developing countries, the problem of inequity in utilizing maternal health care services persists and needs considerable attention.
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Affiliation(s)
- Addisu Alemayehu Gube
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Edit Murányi
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Jozsef Vitrai
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Szimonetta Lohner
- Department of Public Health Medicine, Medical School, University of Pécs, Pécs, Hungary
- Cochrane Hungary, Medical School, University of Pécs, Pécs, Hungary
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Demissie KA, Jejaw M, Wondimu BG, Mersha YT, Demsash ES, Dessie SG, Teshome AG, Geberu DM, Tiruneh MG. Only 9% of mothers have eight and more ANC visit in 14 sub-saharan African countries; evidence from the most recent DHS 2018-2023: a multilevel analysis. BMC Public Health 2024; 24:1631. [PMID: 38898450 PMCID: PMC11186201 DOI: 10.1186/s12889-024-19145-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND The world health organization's global health observatory defines maternal mortality as annual number of female deaths, regardless of the period or location of the pregnancy, from any cause related to or caused by pregnancy or its management (aside from accidental or incidental causes) during pregnancy and childbirth or within 42 days of termination of pregnancy and an estimated 287 000 women worldwide passed away from maternal causes between 2016 and 2020, that works out to be about 800 deaths per day or about one every two minutes. METHOD The most recent 2018-2023 DHS data set of 14 SSA countries was used a total of 89,489 weighted mothers who gave at list one live birth 3 years preceding the survey were included, a multilevel analysis was conducted. In the bi-variable analysis variables with p-value ≤ 0.20 were included in the multivariable analysis, and in the multivariable analysis, variables with p-value less than ≤ 0.05 were considered to be significant factors associated with having eight and more ANC visits. RESULT The magnitude of having eight and more ANC visits in 14 sub-Saharan African countries was 8.9% (95% CI: 8.76-9.13) ranging from 3.66% (95% CI: 3.54-3.79) in Gabon to 18.92% (95% CI: 18.67-19.17) in Nigeria. The multilevel analysis shows that maternal age (40-44, AOR;2.09, 95%CI: 1.75-2.53), maternal occupational status (AOR;1.14, 95%CI; 1.07-1.22), maternal educational level (secondary and above, AOR;1.26, 95%CI; 1.16-1.38), wealth status(AOR;1.65, 95%CI; 1.50-1.82), media exposure (AOR;1.20, 95%CI; 1.11-1.31), pregnancy intention (AOR;1.12, 95%CI; 1.05-1.20), ever had terminated pregnancy (AOR;1.16 95%CI; 1.07-1.25), timely initiation of first ANC visit (AOR;4.79, 95%CI; 4.49-5.10), empowerment on respondents health care (AOR;1.43, 95%CI; 1.30-1.56), urban place of residence (AOR;1.33, 95%CI; 1.22-1.44) were factors highly influencing the utilization of AN. On the other hand higher birth order (AOR;0.54, 95%CI; 0.53-0.66), not using contraceptive (AOR;0.80, 95%CI; 0.75-0.86) and survey year (AOR;0.47, 95%CI; 0.34-0.65) were factors negatively associated with having eight and more ANC visits. CONCLUSION In the 14 SSA included in this study, there is low adherence to WHO guidelines of eight and more ANC visits. Being educated, having jobs, getting access to media being from rural residence and rich wealth group contribute to having eight and more ANC visits, so we highly recommend policy implementers to advocate this practices.
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Affiliation(s)
- Kaleb Assegid Demissie
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
| | - Melak Jejaw
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Befikir Gezahegn Wondimu
- Department of Obstetrics and Gynecology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yekunuamlak Teshome Mersha
- Department of Anatomic Pathology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Eyuale Sitotaw Demsash
- Department of Surgery, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Samuel Getachew Dessie
- Department of Internal Medicine, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Asteway Gashaw Teshome
- Department of Anatomic Pathology, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Demiss Mulatu Geberu
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Misganaw Guadie Tiruneh
- Department of Health Systems and Policy, Institute of Public Health, Collage of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Atlaw D, Charkos TG, Kasim J, Chatu VK. Why does the number of antenatal care visits in Ethiopia remain low?: A Bayesian multilevel approach. PLoS One 2024; 19:e0302560. [PMID: 38701069 PMCID: PMC11068190 DOI: 10.1371/journal.pone.0302560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
INTRODUCTION Antenatal care (ANC) visit is a proxy for maternal and neonatal health. The ANC is a key indicator of access and utilization of health care for pregnant women. Recently, eight times ANC visits have been recommended during the pregnancy period. However, nearly 57% of women received less than four ANC visits in Ethiopia. Therefore, the objective of this study is to identify factors associated withthe number of ANC visits in Ethiopia. METHODS A community-based cross-sectional study design was conducted from March 21 to June 28/2019. Data were collected using interviewer-administered questionnaires from reproductive age groups. A stratified cluster sampling was used to select enumeration areas, households, and women from selected households. A Bayesian multilevel negative binomial model was applied for the analysis of this study. There is an intra-class correlation (ICC) = 23.42% and 25.51% for the null and final model, respectively. Data were analyzed using the STATA version 17.0. The adjusted incidence risk ratio (IRR) with 95% credible intervals (CrI) was used to declare the association. RESULT A total of 3915 pregnant women were included in this study. The mean(SD) age of the participants was 28.7 (.11) years. Nearly one-fourth (26.5%) of pregnant women did not have ANC visits, and 3% had eight-time ANC visits in Ethiopia. In the adjusted model, the age of the women 25-28 years (IRR:1.13; 95% CrI: 1.11, 1.16), 29-33 years (IRR: 1.15; 95% CrI: 1.15, 1.16), ≥34 years (IRR:1.14; 95% CrI: 1.12, 1.17), being a primary school (IRR: 1.22, 95% CrI: 1.21, 1.22), secondary school and above (IRR: 1.26, 95% CrI: 1.26, 1.26), delivered in health facility (IRR: 1.93; 95% CrI: 1.92, 1.93), delivered with cesarian section (IRR: 1.18; 95% CrI: 1.18, 1.19), multiple (twin) pregnancy (IRR: 1.11; 95% CrI: 1.10, 1.12), richest (IRR:1.23; 95% CrI: 1.23, 1.24), rich family (IRR: 1.34, 95% CrI: 1.30, 1.37), middle income (IRR: 1.29, 95% CrI: 1.28, 1.31), and poor family (IRR = 1.28, 95% CrI:1.28, 1.29) were shown to have significant association with higher number of ANC vists, while, households with total family size of ≥ 5 (IRR: 0.92; 95% CrI: 0.91, 0.92), and being a rural resident (IRR: 0.92, 95% CrI: 0.92, 0.94) were shown to have a significant association with the lower number of ANC visits. CONCLUSION Overall, 26.5% of pregnant women do not have ANC visits during their pregnancy, and 3% of women have eight-time ANC visits. This result is much lower as compared to WHO's recommendation, which states that all pregnant women should have at least eight ANC visits. In this study, the ages of the women 25-28, 29-33, and ≥34 years, being a primary school, secondary school, and above, delivered in a health facility, delivered with caesarian section, multiple pregnancies, rich, middle and poor wealth index, were significantly associated with the higher number of ANC visits, while households with large family size and rural residence were significantly associated with a lower number of ANC visits in Ethiopia.
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Affiliation(s)
- Daniel Atlaw
- Public Health Department, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | | | - Jeylan Kasim
- Public Health Department, School of Health Science, Madda Walabu University, Bale Goba, Ethiopia
| | - Vijay Kumar Chatu
- Center for Transdisciplinary Research, Saveetha Dental College, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, India
- Center for Evidence-Based Research, Global Health Research and Innovations Canada (GHRIC), Toronto, ON, Canada
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Oyedele OK. Multilevel and subnational analysis of the predictors of maternity continuum of care completion in Nigeria: a cross-sectional survey. Sci Rep 2023; 13:20863. [PMID: 38012380 PMCID: PMC10682393 DOI: 10.1038/s41598-023-48240-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 11/23/2023] [Indexed: 11/29/2023] Open
Abstract
Understanding population discrepancy in maternity continuum of care (CoC) completion, particularly in sub-Saharan Africa is significant for interventional plan to achieve optimal pregnancy outcome and child survival. This study thus investigated the magnitudes, distribution, and drivers of maternity CoC completion in Nigeria. A secondary analysis of 19,474 reproductive age (15-49 years) women with at least a birth (level 1) in 1400 communities (level 2) across 37 states covered in the 2018 cross-sectional survey. Stepwise regression initially identified important variables at 10% cutoff point. Multilevel analysis was performed to determine the likelihood and significance of individual and community factors. Intra-cluster correlation assessed the degree of clustering and deviance statistics identified the optimal model. Only 6.5% of the women completed the CoC. Completion rate is significantly different between communities "4.3% in urban and 2.2% in rural" (χ2 = 392.42, p < 0.001) and was higher in southern subnational than the north. Education (AOR = 1.61, 95% CI 1.20-2.16), wealth (AOR = 1.73, 95% CI 1.35-2.46), media exposure (AOR = 1.22, 95% CI 1.06-1.40), women deciding own health (AOR = 1.37, 95% CI 1.13-1.66), taking iron drug (AOR = 1.84, 95% CI 1.43-2.35) and at least 2 dose of tetanus-toxoid vaccine during pregnancy (AOR = 1.35, 95% CI 1.02-1.78) are associated individual factors. Rural residency (AOR = 1.84, 95% CI = 1.43-2.35), region (AOR = 1.84, 95% CI 1.43-2.35) and rural population proportion (AOR = 1.84, 95% CI 1.43-2.35) are community predictors of the CoC completion. About 63.2% of the total variation in CoC completion was explained by the community predictors. Magnitude of maternity CoC completion is generally low and below the recommended level in Nigeria. Completion rate in urban is twice rural and more likely in the southern than northern subnational. Women residence and region are harmful and beneficial community drivers respectively. Strengthening women health autonomy, sensitization, and education programs particularly in the rural north are essential to curtail the community disparity and optimize maternity CoC practice.
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Affiliation(s)
- Oyewole K Oyedele
- International Research Centre of Excellence, Institute of Human Virology, Nigeria (IHVN), Abuja (FCT), Nigeria.
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
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Tesfay N, Kebede M, Asamene N, Tadesse M, Begna D, Woldeyohannes F. Factors determining antenatal care utilization among mothers of deceased perinates in Ethiopia. Front Med (Lausanne) 2023; 10:1203758. [PMID: 38020089 PMCID: PMC10663362 DOI: 10.3389/fmed.2023.1203758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model. Method Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR). Result This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit. Conclusion The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas.
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Affiliation(s)
- Neamin Tesfay
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Mandefro Kebede
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Negga Asamene
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Muse Tadesse
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Dumesa Begna
- Center of Public Emergency Management, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Fitsum Woldeyohannes
- Health Financing Program, Clinton Health Access Initiative, Addis Ababa, Ethiopia
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Mussa I, Makhubela-Nkondo O, Maruta MB, Debella A. Missed Opportunity of Antenatal Care Services Utilization and Associated Factors among Reproductive Age Women in Eastern Hararghe Zone, Eastern Ethiopia: Mixed Methods Study. J Pregnancy 2023; 2023:8465463. [PMID: 37811139 PMCID: PMC10555490 DOI: 10.1155/2023/8465463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/30/2023] [Accepted: 09/13/2023] [Indexed: 10/10/2023] Open
Abstract
Background Despite the enormous advantages of early pregnancy-related problem diagnosis and therapy during prenatal care visits, not all pregnant women begin antenatal care at the proper time. Thus, this study aims to identify factors associated with missed opportunities for antenatal care service utilization among reproductive-age women in Eastern Ethiopia. Methods A mixed methods study design (quantitative and qualitative) was conducted in Grawa, Meta, and Haramaya woredas from September 5 to December 5, 2019. The quantitative data were analyzed using SPSS version 25. A multivariable logistic regression analysis model was used to identify the predictors. Statistical software programs based on ATLAS.ti version 8.2 was were used to conduct the thematic analysis of the qualitative data. Results Overall, missed opportunities for antenatal care were 15.4% of 95% (12.1, 19.1%). Factors such as maternal age being 15-24 (AOR = 6.9, 95% CI: 2.89-8.81); having a college education (AOR = 0.02, 95% CI: 0.001, 0.42), elementary (AOR = 0.05, 95% CI: 0.002, 0.98), and secondary education (AOR = 0.04, 95% CI: 0.001, 0.88); having five and more parity (AOR = 0.08, 95% CI: 0.01, 0.75); three visits (AOR = 0.10, 95% CI: 0.02, 0.71); those in the first trimester (AOR = 0.02, 95% CI: 0.001, 0.35) and the second trimester (AOR = 0.01, 95% CI: 0.001, 0.26); and get information from a health facility (AOR =0.09, 95% CI: 0.01, 0.67) and traditional birth attendance (AOR = 0.02, 95% CI: 0.001, 0.74) were factors statistically associated with outcome variables. Conclusions According to this report, relatively high proportions of pregnant women experienced missed opportunities in antenatal care follow-up. Factors such as maternal age, education, parity, frequency, timing, and media access were statistically significantly correlated with missed antenatal care follow-up. Therefore, all stakeholders should emphasize advocating for and enhancing the benefits of antenatal care; this in turn plays a crucial role in increasing the follow-up of clients for these crucial services. Moreover, health policy implementers need to coordinate their tracking of pregnant women who missed their antenatal care session.
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Affiliation(s)
- Ibsa Mussa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - On Makhubela-Nkondo
- Department of Health Studies, College of Human Sciences, School of Social Sciences, University of South Africa, South Africa
| | - Melat B. Maruta
- Department of Obstetrics and Gynecology, Menelik Specialized Comprehensive Hospital, Addis Ababa, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Nwabueze CO, Okeke CC, Nwevo CO, Nwodo LA, Nwekpa WC, Nwaiwu PI. Assessing Focused Antenatal Care Awareness and Utilization Among Pregnant Women in Enugu State, Nigeria: A Cross-Sectional Survey. Cureus 2023; 15:e38403. [PMID: 37265919 PMCID: PMC10231945 DOI: 10.7759/cureus.38403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 06/03/2023] Open
Abstract
INTRODUCTION Focused antenatal care (FANC) is a newer and better approach to antenatal care for pregnant women than the traditional model. FANC emphasizes individual assessment and decision-making by both the provider and the pregnant woman, resulting in better health outcomes for both mother and baby. Despite the adoption of FANC care in Nigeria, maternal mortality indices have not significantly decreased. This study aimed to assess the level of awareness and utilization of FANC among pregnant women in Nigeria, as well as the factors that influence its utilization. METHODS This study was conducted in Enugu, Nigeria, using the antenatal clinics of three major tertiary hospitals. A cross-sectional design was used, and a sample size of 300 pregnant women was selected using systematic random sampling. Data were collected using a structured, self-administered questionnaire and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The findings were presented using frequencies, tables, charts, and figures, and Fisher's exact test was used to determine the relationship between respondents' knowledge of focused antenatal care and their demographic factors. RESULTS A study involving 300 pregnant women in Nigeria found that only 15% of them had heard of focused antenatal care (FANC) and just 7.3% had good knowledge of its components, which was attributed to the low level of education among the respondents (X2=16.68, p=0.001). Health talks during antenatal visits were the most common source of information on FANC. The study also revealed that late initiation of antenatal care (n=144, 48%) in current pregnancy and (n=106, 54.6%) among those previously pregnant, as well as insufficient attendance, were identified as risk factors for maternal mortality. Long waiting times (n=196, 65.3%) and overcrowded healthcare facilities (n=110, 36.7%) were the major causes of dissatisfaction with antenatal care services among the respondents. Pregnant women preferred delivering at tertiary hospitals or private hospitals due to the perceived better quality of care and personal preference. These findings could inform targeted interventions to improve knowledge and awareness of FANC among pregnant women, particularly those with lower levels of education. CONCLUSION This study provides important insights into the low awareness and utilization of FANC among pregnant women in Enugu, Nigeria, highlighting the need for targeted interventions to improve knowledge and awareness of FANC. The study's findings have important implications for the development of maternal and child health policies and interventions aimed at improving the utilization of healthcare services during pregnancy and childbirth in Nigeria. Further research that includes qualitative methods could provide more nuanced information on pregnant women's experiences and perspectives on FANC.
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Affiliation(s)
- Cherechi O Nwabueze
- Public Health, George Washington University, Washington, D. C., USA
- Medicine and Surgery, University of Nigeria Teaching Hospital, Enugu, NGA
| | - Chinyere C Okeke
- Community Medicine, University of Nigeria Teaching Hospital, Enugu, NGA
| | - Chimaobi O Nwevo
- Medicine and Surgery, University of Calabar Teaching Hospital, Calabar, NGA
| | - Lynda A Nwodo
- Medicine and Surgery, University of Nigeria Teaching Hospital, Enugu, NGA
| | - Williams C Nwekpa
- Medicine and Surgery, University of Nigeria Teaching Hospital, Enugu, NGA
| | - Peter I Nwaiwu
- Medicine and Surgery, University of Nigeria Teaching Hospital, Enugu, NGA
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Dickson KS, Boateng ENK, Adde KS, Ameyaw EK, Munro-Kramer ML. Non-adherence to WHO's recommended 8-contact model: geospatial analysis of the 2017 Maternal Health Survey. BMC Pregnancy Childbirth 2023; 23:192. [PMID: 36934240 PMCID: PMC10024456 DOI: 10.1186/s12884-023-05504-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 03/07/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Evidence shows that most women in Ghana do not meet the minimum 8-contact model for antenatal care as recommended by WHO with only 31.2%-41.9% of them meeting the recommendation. To the best of our knowledge, no study in Ghana has examined women's noncompliance with the WHO's recommended 8-contact model for antenatal care using geospatial analysis, as this study sets out to do. METHODS We sourced data from the recent version of the Ghana Maternal Health Survey which was executed in 2017. A sample of 10,077 women with complete data participated in this study. The link between the explanatory variables and the outcome variable was investigated using binary and multivariate logistic regression models and Spatial analyses such as spatial autocorrelation (Moran's I), hotspot, cluster and outlier analysis, and geographically weighted regression were conducted using ArcMap version 10.7. RESULTS Districts found in the north-eastern and south-western parts of the country were more likely to experience noncompliance with ANC. Women staying within the middle belt without health insurance were more likely (17-29%) to be noncompliant with ANC. Women with low community socioeconomic status were found to be more likely (17-34%) to be noncompliant with ANC in the eastern parts of Ghana. CONCLUSION The study has shown that in order to achieve targets one and three of Sustainable Development Goal 3, the government of Ghana, the Ministry of Health, together with the Ghana Health Service may have to intensify health education in the identified areas to highlight the importance of adherence to the WHO recommendations on ANC 8-contact model.
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Affiliation(s)
- Kwamena Sekyi Dickson
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer N. K. Boateng
- grid.413081.f0000 0001 2322 8567Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | - Kenneth Setorwu Adde
- grid.413081.f0000 0001 2322 8567Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Edward Kwabena Ameyaw
- grid.411382.d0000 0004 1770 0716Institute of Policy Studies and School of Graduate Studies, Lingnan University, Hong Kong, Hong Kong
- L and E Research Consult Ltd, Upper West Region Wa, Ghana
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Woldeamanuel BT. Factors associated with inadequate prenatal care service utilization in Ethiopia according to the WHO recommended standard guidelines. Front Public Health 2022; 10:998055. [PMID: 36408015 PMCID: PMC9670123 DOI: 10.3389/fpubh.2022.998055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Adequate maternal health care could prevent 54% of maternal deaths in low- and middle-income countries. In Ethiopia, the maternal mortality rate was reduced from 817 to 412 deaths per 100,000 live births between 2000 and 2016. Thus, the current study focuses on the adequacy of prenatal care (PNC) services rather than the mere prenatal contacts available to assess compliance with the WHO recommended standard guidelines. Methods A nationally representative cross-sectional dataset from the Ethiopian Mini Demographic and Health Survey 2019 was analyzed. Risk factors for prenatal care adequacy were assessed using a multilevel ordinal logistic regression model. Results About 43% of women met the old WHO recommendation of at least four prenatal contacts, while only 3.5% of women met the new WHO recommended minimum of eight prenatal contacts. The overall adequacy of prenatal care based on the four prenatal care utilization indicators was 52.1% no PNC, 37.4% received inadequate PNC and 10.5% received adequate PNC. Being a rural resident [AOR = 0.694 (95% CI: 0.557, 0.865)] and wanting no more children [AOR = 0.687 (95% CI: 0.544, 0.868)] are associated with inadequate prenatal care. Higher educational attainment of women and spouses, exposure to the media, upper wealth quintile, and a perceived shorter distance to a health facility were significantly associated with adequate prenatal care. Conclusion The prevalence of adequate prenatal care was lower. Multi-sectoral efforts are needed to improve maternal health targets by reducing maternal mortality through improved health care services.
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Acquah E, Nyarko SH, Boateng ENK, Dickson KS, Addo IY, Adzrago D. Spatial and multilevel analysis of unskilled birth attendance in Chad. BMC Public Health 2022; 22:1561. [PMID: 35974406 PMCID: PMC9382725 DOI: 10.1186/s12889-022-13972-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 08/08/2022] [Indexed: 11/28/2022] Open
Abstract
Background Unskilled birth attendance is a major public health concern in Sub-Saharan Africa (SSA). Existing studies are hardly focused on the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad (a country in SSA), although the country has consistently been identified as having one of the highest prevalence of maternal and neonatal deaths in the world. This study aimed to analyse the socio-demographic correlates and geospatial distribution of unskilled birth attendance in Chad. Methods The study is based on the latest Demographic and Health Survey (DHS) data for Chad. A total of 10,745 women aged between 15 and 49 years were included in this study. A multilevel analysis based on logistic regression was conducted to estimate associations of respondents’ socio-demographic characteristics with unskilled birth attendance. Geographic Information System (GIS) mapping tools, including Getis-Ord Gi hotspot analysis tool and geographically weighted regression (GWR) tool, were used to explore areas in Chad with a high prevalence of unskilled birth attendance. Results The findings show that unskilled birth attendance was spatially clustered in four Chad departments: Mourtcha, Dar-Tama, Assoungha, and Kimiti, with educational level, occupation, birth desire, birth order, antenatal care, and community literacy identified as the spatial predictors of unskilled birth attendance. Higher educational attainment, higher wealth status, cohabitation, lowest birth order, access to media, not desiring more births, and higher antenatal care visits were associated with lower odds of unskilled birth attendance at the individual level. On the other hand, low community literacy level was associated with higher odds of unskilled birth attendance in Chad whereas the opposite was true for urban residency. Conclusions Unskilled birth attendance is spatially clustered in some parts of Chad, and it is associated with various disadvantaged individual and community level factors. When developing interventions for unskilled birth attendance in Chad, concerned international bodies, the Chad government, maternal health advocates, and private stakeholders should consider targeting the high-risk local areas identified in this study. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13972-6.
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Affiliation(s)
- Evelyn Acquah
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Samuel H Nyarko
- Department of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ebenezer N K Boateng
- Department of Geography and Regional Planning, University of Cape Coast, Cape Coast, Ghana
| | | | - Isaac Yeboah Addo
- Centre for Social Research in Health, The University of New South Wales, Sydney, Australia.
| | - David Adzrago
- Center for Health Promotion and Prevention Research, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Andegiorgish AK, Elhoumed M, Qi Q, Zhu Z, Zeng L. Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys. BMJ Open 2022; 12:e051675. [PMID: 35149562 PMCID: PMC8845176 DOI: 10.1136/bmjopen-2021-051675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To explore the factors associated with antenatal care (ANC) visits. DESIGN A secondary data analysis from cross-sectional studies was conducted. SETTING Sub-Saharan Africa. PARTICIPANTS 56 002 women aged 15-49 years in Ghana (3224), Kenya (10 981), Malawi (9541), Namibia (2286), Rwanda (4416), Senegal (6552), Tanzania (5536), Uganda (7979) and Zambia (5487) were analysed. OUTCOMES 4+ANC visits. RESULTS Overall, 55.52% (95% CI: 55.11% to 55.93%) of women made 4+ANC visits. The highest 4+ANC visits were in Ghana (85.6%) and Namibia (78.9%), and the lowest were in Senegal (45.3%) and Rwanda (44.5%). Young women 15-19 years had the lowest uptake of 4+ANC visits. Multivariable analysis indicated that the odds of 4+ANC visits were 14% lower among women from rural areas compared with those living in towns (adjusted OR (AOR) 0.86; 95% CI: 0.81 to 0.91). This difference was significant in Kenya, Malawi, Senegal and Zambia. However, in Zambia, the odds of 4+ANC visits were 48% higher (AOR 1.48; 95% CI: 1.2 to 1.82) among women from rural compared with urban areas. Women with higher educational level had more than twofold higher odds of 4+ANC visits in seven of the nine countries, and was significant in Kenya, Malawi, Rwanda and Zambia. Compared with the poorest household wealth category, odds of 4+ANC visits increased by 12%, 18%, 32% and 41% for every 20% variation on the wealth quantile. Women in their first-time pregnancy had higher odds of 4+ANC visits compared with others across all countries, and women who had access to media at least once a week had a 22% higher probability of 4+ANC visits than women who had no access to media (AOR 1.22, 95% CI: 1.15 to 1.29). CONCLUSION The number of ANC visits was considered to be inadequate with substantial variation among the studied countries. Comprehensive interventions on scaling uptake of ANC are needed among the low-performing countries. Particular attention should be given to women of low economic status and from rural areas.
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Affiliation(s)
- Amanuel Kidane Andegiorgish
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Department of Epidemiology and Biostatistics, Asmara College of Health Sciences, Asmara, Eritrea
| | - Mohamed Elhoumed
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Qi Qi
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Zhonghai Zhu
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lingxia Zeng
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, Shaanxi, China
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Arefaynie M, Kefale B, Yalew M, Adane B, Dewau R, Damtie Y. Number of antenatal care utilization and associated factors among pregnant women in Ethiopia: zero-inflated Poisson regression of 2019 intermediate Ethiopian Demography Health Survey. Reprod Health 2022; 19:36. [PMID: 35123503 PMCID: PMC8817592 DOI: 10.1186/s12978-022-01347-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/19/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The frequency of antenatal care utilization enhances the effectiveness of the maternal health programs to maternal and child health. The aim of the study was to determine the number of antenatal care and associated factors in Ethiopia by using 2019 intermediate EDHS. METHODS Secondary data analysis was done on 2019 intermediate EDHS. A total of 3916.6 weighted pregnant women were included in the analysis. Zero-inflated Poisson regression analysis was done by Stata version 14.0. Incident rate ratio and odds ratio with a 95% confidence interval were used to show the strength and direction of the association. RESULT About one thousand six hundred eighty eight (43.11%) women were attending four and more antenatal care during current pregnancy. Attending primary education (IRR = 1.115, 95% CI: 1.061, 1.172), secondary education (IRR = 1.211, 95% CI: 1.131, 1.297) and higher education (IRR = 1.274, 95% CI: 1.177, 1.378), reside in poorer household wealth index (IRR = 1.074, 95% CI: 1.01, 1.152), middle household wealth index (IRR = 1.095, 95% CI: 1.018, 1.178), rich household wealth index (IRR = 1.129, 95% CI: 1.05, 1.212) and richer household wealth index (IRR = 1.186, 95% CI: 1.089, 1.29) increases the number of antenatal care utilization. The frequency of antenatal care was less likely become zero among women attending primary (AOR = 0.434, 95% CI: 0.346, 0.545), secondary (AOR = 0.113, 95% CI: 0.053, 0.24), higher educational level (AOR = 0.052, 95% CI: 0.007, 0.367) in the inflated part. CONCLUSION The number of antenatal care utilization is low in Ethiopia. Being rural, poorest household index, uneducated and single were factors associated with low number of antenatal care and not attending antenatal care at all. Improving educational coverage and wealth status of women is important to increase the coverage and frequency of antenatal care.
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Affiliation(s)
- Mastewal Arefaynie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Bereket Kefale
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Melaku Yalew
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, PO Box 1145, Dessie, Ethiopia
| | - Bezawit Adane
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Reta Dewau
- Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Yitayish Damtie
- Department of Reproductive and Family Health, School of Public Health, College of Medicine and Health Sciences, Wollo University, PO Box 1145, Dessie, Ethiopia
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Odusina EK, Ahinkorah BO, Ameyaw EK, Seidu AA, Budu E, Zegeye B, Yaya S. Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6696829. [PMID: 34589549 PMCID: PMC8476249 DOI: 10.1155/2021/6696829] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 09/04/2021] [Accepted: 09/06/2021] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Emmanuel Kolawole Odusina
- Department of Demography and Social Statistics, Faculty of Social Sciences, Federal University, Oye Ekiti, Nigeria
| | - Bright Opoku Ahinkorah
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology, Sydney, Australia
| | - Edward Kwabena Ameyaw
- The Australian Centre for Public and Population Health Research (ACPPHR), Faculty of Health, University of Technology, Sydney, Australia
| | - Abdul-Aziz Seidu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Eugene Budu
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | | | - Sanni Yaya
- University of Parakou, Faculty of Medicine, Parakou, Benin
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Wulandari RD, Laksono AD, Rohmah N. Urban-rural disparities of antenatal care in South East Asia: a case study in the Philippines and Indonesia. BMC Public Health 2021; 21:1221. [PMID: 34167514 PMCID: PMC8229737 DOI: 10.1186/s12889-021-11318-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background The government is obliged to guarantee equal access to antenatal care (ANC) between urban and rural areas. This study aimed to analyze urban-rural disparities in ≥4 ANC visits during pregnancy in the Philippines and Indonesia. Methods The study processed data from the 2017 PDHS and the 2017 IDHS. The analysis unit was women aged 15–49 years old who had given birth in the last 5 years. The weighted sample size was 7992 respondents in the Philippines and 14,568 respondents in Indonesia. Apart from ANC as the dependent variable, other variables analyzed were residence, age, husband/partner, education, parity, and wealth. Determination of urban-rural disparities using binary logistic regression. Results The results show that women in the urban Philippines are 0.932 times more likely than women in the rural Philippines to make ≥4 ANC visits. On the other side, women in urban Indonesia are more likely 1.255 times than women in rural Indonesia to make ≥4 ANC visits. Apart from the type of residence place (urban-rural), five other tested multivariate variables also proved significant contributions to ANC’s use in both countries, i.e., age, have a husband/partner, education, parity, and wealth status. Conclusions The study concluded that disparities exist between urban and rural areas utilizing ANC in the Philippines and Indonesia. Pregnant women in the rural Philippines have a better chance of making ≥4 ANC visits. Meanwhile, pregnant women in urban Indonesia have a better chance of making ≥4 ANC visits.
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Affiliation(s)
- Ratna Dwi Wulandari
- Faculty of Public Health, Universitas Airlangga Surabaya, Campus C Mulyorejo, Surabaya, 60115, Indonesia.
| | - Agung Dwi Laksono
- National Institute of Health Research and Development of The Ministry of Health of the Republic of Indonesia, Percetakan Negara 29, Jakarta, 10560, Indonesia
| | - Nikmatur Rohmah
- Faculty of Health Science, Muhammadiyah University of Jember, Gumuk Kerang, Karangrejo, Kec. Sumbersari, Jawa Timur, Kabupaten Jember, East Java, 68124, Indonesia
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