Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

Assessment of antenatal care quality in Ethiopia: Facility-based study using service provision assessment data

BACKGROUND

Antenatal care (ANC) coverage in low- and middle-income countries has increased in the past few decades. However, merely increasing care coverage may not enhance maternal and newborn health unless the recommended service components are also provided. Our aim was to assess the quality of ANC and its associated factors in Ethiopia.

METHODS

We used data from 2,042 pregnant women whose first ANC consultation was observed. Data were obtained from the 2021-2022 Ethiopian Service Provision Assessment survey conducted among a nationally representative sample of 1,158 healthcare facilities. Twenty-four components of ANC were assessed, and their values were summed to generate a total ANC quality score (range: 0-24). A higher score indicated a superior ANC quality. A multiple generalized Poisson regression model was fitted to identify factors influencing the quality of ANC. All statistical analyses were performed using STATA version 16.

RESULTS

The mean ANC quality score was 11 (standard deviation [SD]: 3.8). Blood pressure measurement was the most commonly performed ANC component, at 79.5%, and breast examination for cancer screening was the most neglected component of ANC, at 3.3%. ANC quality was higher in the Amhara region (incidence rate ratio [IRR]: 1.088; 95% confidence interval [CI]: 1.0-1.171) and Southern Nations, Nationalities, and Peoples' Region (IRR: 1.081; 95% CI: 1.002-1.166), and when the care was provided by a female healthcare worker (IRR: 1.054; 95% CI: 1.021-1.088). On the other hand, ANC quality decreased in rural healthcare facilities (IRR: 0.964; 95% CI: 0.932-0.998), clinics (IRR: 0.666; 95% CI: 0.581-0.764), and health posts (IRR: 0.817; 95% CI: 0.732-0.91). Similarly, ANC quality decreased when gestational age at the first antenatal visit increased (IRR: 0.994; 95% CI: 0.992-0.996) and when care was received from a non-nearby healthcare facility (IRR: 0.956; 95% CI: 0.923-0.990).

CONCLUSION

Overall, the quality of ANC in Ethiopia is suboptimal. Encouraging women to initiate ANC early and utilize nearby facilities, assisting providers in delivering standardized services through preservice training, supervision, and continuous education, and ensuring the availability and proper use of necessary resources at all facilities are important to improve ANC quality.

Factors Affecting Nonadherence to WHO’s Recommended Antenatal Care Visits among Women in Pastoral Community, Northeastern Ethiopia: A Community-Based Cross-Sectional Study

Introduction. More than half of the pregnant women in Ethiopia do not receive the recommended number of antenatal care visits. In the Afar region, where women have limited access to healthcare services due to pastoral livelihood, evidence on noncompliance to the adequate number of antenatal care visits is scarce. Therefore, this study was intended to examine the level of nonadherence to the recommended antenatal care visits and its associated factors in the pastoral community of Northeast Ethiopia. Methods. A community-based cross-sectional study was conducted from 04 February to 22 March 2020 among randomly selected 703 women who gave birth within 24 months preceding the survey in the Transform HDR districts of the Afar region. Data were collected using a pretested structured interviewer-administered questionnaire. Data were entered into Epi-data version 4.2 and finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the nonadherence to the recommended antenatal care visits. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at a $p$ -value <0.05. Results. Nonadherence to the recommended antenatal care visits was 57.0% (95% CI: 53.3%–60.7%). Attending primary (AOR (95% CI): 0.39 (0.22–0.72)) and secondary education and above (AOR (95% CI): 0.25 (0.08–0.77)), being married at the age of 18 years or older (AOR (95% CI): 0.48 (0.36–0.71)), and attending antenatal care at a health center (AOR (95% CI): 0.46 (0.26–0.81)) were associated decreased odds of nonadherence to the recommend visits. Moreover, a higher likelihood of nonadherence was found among women from households not possessing communication media (AOR (95% CI): 1.85 (1.18–2.88)) and those who initiated antenatal care attendance during the second (AOR (95% CI): 5.23 (3.54–7.72)) and third trimesters (AOR (95% CI): 8.81 (1.88–41.20)). Conclusions. Nearly six in ten women do not receive the recommended antenatal care visits, consistent with the national prevalence. Women’s education, age at marriage, type of health facility, possession of mass media, and timing of antenatal care attendance were associated with nonadherence to the recommended antenatal care visits. Thus, improving women’s literacy, dissemination of information regarding antenatal care through mass media, and strengthening interventions targeted to end child marriage are important in scaling up the level of adherence. Moreover, supporting community-based health education through health extension programs is crucial in reaching women with limited access to mass media.