1
|
Tegegne BA, Alem AZ, Amare T, Aragaw FM, Teklu RE. Multilevel modelling of factors associated with eight or more antenatal care contacts in low and middle-income countries: findings from national representative data. Ann Med Surg (Lond) 2024; 86:3315-3324. [PMID: 38846896 PMCID: PMC11152864 DOI: 10.1097/ms9.0000000000002034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/30/2024] [Indexed: 06/09/2024] Open
Abstract
Background Antenatal care (ANC) is the care provided by skilled healthcare professionals to pregnant women in order to ensure the best health conditions for both mother and baby. Antenatal care provides a platform for important healthcare functions including risk identification, prevention and management of pregnancy-related diseases. Inadequate ANC utilization is a global problem especially for low and middle-income countries. The 2016 WHO ANC model with a minimum of eight ANC visits was aimed to provide pregnant women with person specific care at every contact. However, there are limited studies that investigate the associated factors of inadequate ANC after the endorsement of the WHO 2016 guideline. Therefore, to enrich the evidence in the low and middle-income countries (LMICs), this study aimed to determine the pooled prevalence and associated with eight or more ANC contacts during pregnancy. Methods This study used data from 20 LMICs that have a recent Demographic and Health Survey. About 43 720 women aged 15-49 years who had live births within the year prior to the surveys were included. To identify associated factors of 8 or more ANC contacts, we used multilevel binary logistic regression, and four models were constructed. The results have been presented as odds ratios with 95% CIs, and P values less than 0.05 were considered significant factors for greater than or equal to 8 ANC contacts. Results In LMICs, the pooled utilization of 8 or more ANC contact was 18.11% (95% CI: 12.64, 23.58), and it ranged from 0.27% in Rwanda to 76.62% in Jordan. In the final multilevel logistic regression model, women with higher education [adjusted odds ratio (AOR)=3.83, 95% CI: 3.32, 4.41], husbands with higher education (AOR=1.98, 95% CI: 1.72, 2.28), women who have access to media (AOR=1.32, 95% CI: 1.19, 1.45), women with decision-making autonomy (AOR=1.52, 95% CI: 1.39, 1.66), women aged 35-49 years (AOR=1.70, 95% CI: 1.5, 1.91), women from communities with high media access (AOR=1.38, 95% CI: 1.23, 1.53), and husbands residing in communities with high literacy (AOR=1.76, 95% CI: 1.55, 1.98) were associated with higher odds of greater than or equal to 8 ANC contacts. Conversely, women with a birth order of greater than or equal to 6 (AOR=0.65, 95% CI: 0.56, 0.76), women who perceive the distance to a health facility as a significant problem (AOR=0.90, 95% CI: 0.83, 0.96), those with unwanted pregnancies (AOR=0.85, 95% CI: 0.78, 0.93), delayed initiation of ANC (AOR=0.26, 95% CI: 0.23, 0.3), women from households with the richest wealth index (AOR=0.45, 95% CI: 0.40, 0.52), and rural residents (AOR=0.47, 95% CI: 0.43, 0.51) were associated with lower odds of ≥8 ANC contacts. Conclusion and recommendations In compliance with the WHO guideline, the number of ANC contacts is low in LMICs. Individual-level, household-level, and community-level variables were associated with greater than or equal to 8 ANC contacts. Therefore, implementation strategies should focus on the identified factors in order to achieve the new WHO recommendation of greater than or equal to 8 ANC contacts.
Collapse
Affiliation(s)
- Biresaw Ayen Tegegne
- Department of Anesthesia, School of medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tsegaw Amare
- Department of Health System and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Rediet Eristu Teklu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
2
|
Oyato BT, Abasimel HZ, Tufa DG, Gesisa HI, Tsegaye TG, Awol M. Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model. BMJ Open 2024; 14:e075965. [PMID: 38642996 PMCID: PMC11033649 DOI: 10.1136/bmjopen-2023-075965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 02/06/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia. DESIGN Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey. SETTING AND PARTICIPANTS 2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study. OUTCOME MEASURES Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC. RESULTS In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation. CONCLUSION Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.
Collapse
Affiliation(s)
| | | | | | | | | | - Mukemil Awol
- Midwifery, Salale University, Fitche, Oromia, Ethiopia
| |
Collapse
|
3
|
Kumbeni MT, Alem JN, Ziba FA, Afaya A, Apanga PA. The practice of polygyny on the utilisation of reproductive health services among married women in Ghana. J Biosoc Sci 2024:1-12. [PMID: 38173346 DOI: 10.1017/s0021932023000299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
While the practice of polygyny is common in Ghana, little is known about its impact on the use of reproductive health services. The aim of this study was to assess the relationship between polygynous marriage and the utilisation of skilled antenatal care (ANC), assisted skilled birth, and modern contraceptive services among married women in Ghana. Secondary data from the 2017 Ghana Maternal Health Survey were used for this study. The study included a weighted sample of 9,098 married women aged 15-49 years. We used multivariable logistic regression models to assess the association between polygyny and each outcome variables. Sensitivity analysis was conducted to assess the dose-response relationship between polygyny and each outcome variable. The prevalence of eight or more ANC contacts, assisted skilled births, and use of modern contraception were 47.0%, 81.4%, and 25.4%, respectively. The prevalence of women in polygynous marriages was 15.3%. Compared to monogynous marriage, polygynous marriage was associated with 19% lower odds of having eight plus ANC contacts (adjusted odds ratio [aOR] 0.81, 95% CI: 0.69, 0.96), 25% lower odds of having assisted skilled birth (aOR 0.75, 95% CI: 0.63, 0.89), and 19% lower odds of modern contraceptive utilisation (aOR 0.81, 95% CI: 0.66, 0.99). Interventions on reproductive health may need to prioritise women in polygynous marriages in order to improve the utilisation of skilled ANC, assisted skilled birth, and modern contraceptive services.
Collapse
Affiliation(s)
- Maxwell Tii Kumbeni
- School of Public Health and Nutrition, College of Health, Oregon State University, Corvallis, USA
| | - John Ndebugri Alem
- Department of Peadiatric Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Florence Assibi Ziba
- Department of Peadiatric Nursing, School of Nursing and Midwifery, University for Development Studies, Tamale, Ghana
| | - Agani Afaya
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | | |
Collapse
|
4
|
Stanikzai MH, Tawfiq E, Jafari M, Wasiq AW, Seddiq MK, Currie S, Sayam H, Baray AH, Saeedzai SA. Contents of antenatal care services in Afghanistan: findings from the national health survey 2018. BMC Public Health 2023; 23:2469. [PMID: 38082286 PMCID: PMC10712111 DOI: 10.1186/s12889-023-17411-y] [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: 08/23/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal and newborn mortality is a public health concern in low- and middle-income countries (LMICs), including Afghanistan, where the evolving socio-political circumstances have added new complexities to healthcare service delivery. Birth outcomes for both pregnant women and their newborns are improved if women receive benefits of quality antenatal care (ANC). OBJECTIVES This study aimed to assess the contents of ANC services and identify predictors of utilization of services by pregnant women during ANC visits to health facilities in Afghanistan. METHODS In this cross-sectional study, we used data from the Afghanistan Health Survey 2018 (AHS2018). We included a total of 6,627 ever-married women, aged 14-49 years, who had given birth in the past 2 years or were pregnant at the time of survey and had consulted a health worker for ANC services in a health facility. The outcome was defined as 1-4 services and 5-8 services that a pregnant woman received during an ANC visit. The services were (i) taking a pregnant woman's blood pressure, (ii) weighing her, (iii) testing her blood, (iv) testing her urine, (v) providing advice on nutrition, (vi) advising about complicated pregnancy, (vii) advising about the availability of health services, and (viii) giving her at least one dose of Tetanus Toxoid (TT) vaccine. The binary outcome (1-4 services versus 5-8 services) was used in a multivariable logistic regression model. RESULTS Of all 6,627 women, 31.4% (2,083) received 5-8 services during ANC visits. Only 1.3% (86) received all 8 services, with 98.7% (6,541) receiving between 1 and 7 services, and 71.6% (4,745) women had their blood pressure measured during ANC visits. The likelihood (adOR = Adjusted Odds Ratio) of receiving 5-8 services was higher in women who could read and write (adOR = 1.33: 1.15-1.54), in women whose husbands could read and write (adOR = 1.14: 1.00-1.28), in primipara women (adOR = 1.42: 1.02-1.98), in women who knew one danger sign (adOR = 5.38: 4.50-6.45), those who knew 2 danger signs (adOR = 8.51: 7.12-10.19) and those who knew ≥ 3 danger signs (adOR = 13.19: 10.67-16.29) of complicated pregnancy, and in women who had almost daily access to TV (adOR = 1.16: 1.01-1.33). However, the likelihood of receiving 5-8 services was lower in women who used private clinics (adOR = 0.64: 0.55-0.74) and who received services from nurses (adOR = 0.27 (0.08-0.88). CONCLUSION Our findings have the potential to influence the design and implementation of ANC services of health interventions to improve the delivery of services to pregnant women during ANC visits.
Collapse
Affiliation(s)
- Muhammad Haroon Stanikzai
- Department of Public Health, Faculty of Medicine, Kandahar University, District # 10, Kandahar, 3801, Afghanistan.
| | - Essa Tawfiq
- The Kirby Institute, UNSW Sydney, Sydney, Australia
| | | | - Abdul Wahed Wasiq
- Department of Internal Medicine, Faculty of Medicine, Kandahar University, Kandahar, Afghanistan
| | | | - Sheena Currie
- Jhpiego, 1615 Thames Street, Baltimore, MD, 21231, USA
| | - Hadia Sayam
- Department of Para-clinic, Faculty of Medicine, Malalay Institute of Higher Education, Kandahar, Afghanistan
| | - Ahmad Haroon Baray
- Department of Public Health, Faculty of Medicine, Kandahar University, District # 10, Kandahar, 3801, Afghanistan
| | | |
Collapse
|
5
|
Ngowi AF, Mkuwa S, Shirima L, Ngalesoni F, Frumence G. Determinants of Focused Antenatal Care Utilization Among Women in Simiyu Region Tanzania. SAGE Open Nurs 2023; 9:23779608231170728. [PMID: 37113997 PMCID: PMC10126641 DOI: 10.1177/23779608231170728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/20/2023] [Accepted: 04/02/2023] [Indexed: 04/29/2023] Open
Abstract
Antenatal care (ANC) is a critical period for promoting the health of both mothers and babies. ANC visit is a key entry point for a pregnant woman to the health care system to receive health intervention. The new World Health Organization (WHO) guideline recommends eight ANC contacts. However, the coverage of at least four ANC visits is still low in the Simiyu region. Objective To assess determinants of focused ANC visits utilization among women in the Simiyu Region Tanzania. Methodology The study employed a cross-sectional study among women of reproductive age. Data was collected through an interviewer-administered questionnaire and analyzed using Stata version 15. Data were summarized using mean and standard deviation for continuous variables while frequency and percentage were used for categorical variables. A generalized linear model, Poisson family, with a log link was used to identify determinants of focused ANC utilization. Results All 785 women analyzed reported having at least one ANC visit, with 259 (34%) having four or more visits and only 40 (5.1%) having eight or more visits. Women who made a self-decision were 30% less likely to complete four and more ANC visits than their counterparts (APR = 0.70; 95%CI = 0.501-0.978). Women who visited the dispensary were 27% less likely to complete four ANC visits than those who visited health centers (APR = 0.73; 95%CI = 0.540-0.982). However, education level and planned pregnancy were both marginally significantly associated with focused ANC utilisation. Conclusion Generally, the majority of pregnant women in the Simiyu region do not adequately utilize four and more ANC visits. There is a need to enhance health education to women and their spouses on the importance of attending four or more visits and improving the quality of maternal health services to facilitate the utilization of ANC among women in the study area.
Collapse
Affiliation(s)
- Agatha F. Ngowi
- Department of Public Health, College of
Health Sciences, Dodoma University, Dodoma, Tanzania
- Agatha F. Ngowi, Department of Public
Health, College of Health Sciences, Dodoma University, P.O.Box 395, Dodoma,
Tanzania.
| | | | - Laura Shirima
- Institute of Public Health, Department
of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University
College (KCMUCo), Moshi, Tanzania
| | - Frida Ngalesoni
- Amref Health Africa,
Tanzania, Dar es Salaam, Tanzania
- Department of Development Studies,
School of Public Health and Social Sciences, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
| | - Gasto Frumence
- Department of Development Studies,
School of Public Health and Social Sciences, Muhimbili University of Health and Allied
Sciences, Dar es Salaam, Tanzania
| |
Collapse
|
6
|
Apanga PA, Kumbeni MT, Sakeah JK, Olagoke AA, Ajumobi O. The moderating role of partners' education on early antenatal care in northern Ghana. BMC Pregnancy Childbirth 2022; 22:391. [PMID: 35513775 PMCID: PMC9070613 DOI: 10.1186/s12884-022-04709-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Maxwell Tii Kumbeni
- Oregon State University, College of Public Health and Human Sciences, Corvallis, USA
| | - James Kotuah Sakeah
- University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - Ayokunle A Olagoke
- University of Illinois at Chicago, School of Public Health, Chicago, USA
| | - Olufemi Ajumobi
- University of Nevada, Reno, School of Public Health, Reno, USA
| |
Collapse
|