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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.
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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
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Nyumwa P, Bula AK, Nyondo-Mipando AL. Perceptions on acceptability of the 2016 WHO ANC model among the pregnant women in Phalombe District, Malawi - a qualitative study using Theoretical Framework of Acceptability. BMC Pregnancy Childbirth 2023; 23:166. [PMID: 36906538 PMCID: PMC10007797 DOI: 10.1186/s12884-023-05497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 03/06/2023] [Indexed: 03/13/2023] Open
Abstract
BACKGROUND The World Health Organization introduced a new model of care, 'The 2016 WHO ANC Model' to overcome challenges encountered during the implementation of the Focused Antenatal Care Approach. For any new intervention to achieve its objective, it must be widely accepted by both the deliverers and recipients. Malawi rolled out the model in 2019 without carrying out acceptability studies. The objective of this study was to explore the perceptions of pregnant women and health care workers on the acceptability of 2016 WHO's ANC model in Phalombe District, Malawi using the Theoretical Framework of Acceptability. METHODOLOGY We conducted a descriptive qualitative study between May and August 2021. The Theoretical Framework of Acceptability was used to guide the development of study objectives, data collection tools, and data analysis. We purposely conducted 21 in-depth interviews (IDIs) among pregnant women, postnatal mothers, a safe motherhood coordinator, and Antenatal care (ANC) clinic midwives, and two focus group discussions (FGDs) among Disease Control and Surveillance Assistants. All IDIs and FGDs were conducted in Chichewa, digitally recorded, and simultaneously transcribed and translated into English. Data was analysed manually using content analysis. RESULTS The model is acceptable among most pregnant women and they reckoned that it would help reduce maternal and neonatal deaths. Support from a husband, peers, and health care workers facilitated acceptability of the model while the increased number of ANC contacts which resulted in fatigue and increased transportation cost incurred by the women was a deterrent. CONCLUSION This study has shown that most pregnant women have accepted the model despite facing numerous challenges. Therefore, there is a need to strengthen the enabling factors and address the bottlenecks in the implementation of the model. Furthermore, the model should be widely publicised so that both intervention deliverers and recipients of care implement the model as intended. This will in turn help to achieve the model's aim of improving maternal and neonatal outcomes and creating a positive experience with health care among pregnant women and adolescent girls.
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Affiliation(s)
- Prince Nyumwa
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, P/Bag 360 Blantyre 3, Blantyre, Malawi. .,Holy Family College of Nursing, P.O. Box 51224, Limbe, Malawi.
| | | | - Alinane Linda Nyondo-Mipando
- Department of Health Systems and Policy, School of Global and Public Health, Kamuzu University of Health Sciences, P/Bag 360 Blantyre 3, Blantyre, Malawi.,Maternal and Fetal Health Group, Malawi Liverpool Wellcome Programme, P.O Box 30096, Blantyre, Malawi
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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.
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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
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Macharia PM, Joseph NK, Nalwadda GK, Mwilike B, Banke-Thomas A, Benova L, Johnson O. Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens. BMC Pregnancy Childbirth 2022; 22:908. [PMID: 36474193 PMCID: PMC9724345 DOI: 10.1186/s12884-022-05238-1] [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: 06/07/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Pregnant women in sub-Saharan Africa (SSA) experience the highest levels of maternal mortality and stillbirths due to predominantly avoidable causes. Antenatal care (ANC) can prevent, detect, alleviate, or manage these causes. While eight ANC contacts are now recommended, coverage of the previous minimum of four visits (ANC4+) remains low and inequitable in SSA. METHODS We modelled ANC4+ coverage and likelihood of attaining district-level target coverage of 70% across three equity stratifiers (household wealth, maternal education, and travel time to the nearest health facility) based on data from malaria indicator surveys in Kenya (2020), Uganda (2018/19) and Tanzania (2017). Geostatistical models were fitted to predict ANC4+ coverage and compute exceedance probability for target coverage. The number of pregnant women without ANC4+ were computed. Prediction was at 3 km spatial resolution and aggregated at national and district -level for sub-national planning. RESULTS About six in ten women reported ANC4+ visits, meaning that approximately 3 million women in the three countries had <ANC4+ visits. The majority of the 366 districts in the three countries had ANC4+ coverage of 50-70%. In Kenya, 13% of districts had < 70% coverage, compared to 10% and 27% of the districts in Uganda and mainland Tanzania, respectively. Only one district in Kenya and ten districts in mainland Tanzania were likely met the target coverage. Six percent, 38%, and 50% of the districts had at most 5000 women with <ANC4+ visits in Kenya, Uganda, and mainland Tanzania, respectively, while districts with > 20,000 women having <ANC4+ visits were 38%, 1% and 1%, respectively. In many districts, ANC4+ coverage and likelihood of attaining the target coverage was lower among the poor, uneducated and those geographically marginalized from healthcare. CONCLUSIONS These findings will be invaluable to policymakers for annual appropriations of resources as part of efforts to reduce maternal deaths and stillbirths.
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Affiliation(s)
- Peter M. Macharia
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Noel K. Joseph
- grid.33058.3d0000 0001 0155 5938Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research Programme, Nairobi, Kenya ,grid.9835.70000 0000 8190 6402Centre for Health Informatics, Computing, and Statistics, Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Beatrice Mwilike
- grid.25867.3e0000 0001 1481 7466Community Health Nursing Department, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Aduragbemi Banke-Thomas
- grid.36316.310000 0001 0806 5472School of Human Sciences, University of Greenwich, London, UK
| | - Lenka Benova
- grid.11505.300000 0001 2153 5088Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Olatunji Johnson
- grid.5379.80000000121662407Department of Mathematics, The University of Manchester, Manchester, UK
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Sserwanja Q, Musaba MW, Kamara K, Mutisya LM, Mukunya D. Status of the latest 2016 World Health Organization recommended frequency of antenatal care contacts in Sierra Leone: a nationally representative survey. BMC Health Serv Res 2022; 22:1208. [PMID: 36171575 PMCID: PMC9520872 DOI: 10.1186/s12913-022-08594-y] [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: 09/19/2021] [Accepted: 09/21/2022] [Indexed: 11/10/2022] Open
Abstract
Background Timely and increased frequency of quality antenatal care (ANC) contacts is one of the key strategies aimed at decreasing maternal and neonatal deaths. In 2016, the World Health Organization (WHO) revised the ANC guidelines to recommend at least eight ANC contacts instead of four. This study aimed to determine the proportion of women who received eight or more ANC contacts and associated factors in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 5,432 women aged 15 to 49 years who had a live birth, within three years preceding the survey. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to identify factors associated with utilisation of eight or more ANC contacts using SPSS version 25 complex samples package. Results Out of 5,432 women, 2,399 (44.8%) (95% CI: 43.1–45.7) had their first ANC contact in the first trimester and 1,197 (22.0%) (95% CI: 21.2–23.4) had eight or more ANC contacts. Women who had their first ANC contact after first trimester (adjusted odds ratio, aOR, 0.58, 95% CI 0.49–0.68) and women aged 15 to 19 years had less odds of having eight or more contacts (aOR 0.64, 95% CI 0.45 to 0.91). Working (aOR 1.33, 95%CI 1.10 to 1.62) and wealthier women had higher odds of having eight or more contacts compared to poorer ones and those not working respectively. Women residing in the southern region, those using internet and less parous (less than five) women were associated with higher odds of having eight or more ANC contacts. Women who had no big problem obtaining permission to go health facilities also had higher odds of having eight or more ANC contacts compared to those who had big problems. Conclusion Sierra Leone’s adoption of eight or more ANC contacts is low and less than half of the women initiate ANC in the first trimester. To ensure increased access to recommended ANC visits, timely ANC should be encouraged. Attributes of women empowerment such as workings status, socio-economic status, and decision-making should also be emphasized. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08594-y.
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Affiliation(s)
| | - Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Kassim Kamara
- National Disease Surveillance Programme, Ministry of Health and Sanitation, Free town, Sierra Leone
| | - Linet M Mutisya
- Maternal and Child Health Project, Swedish Organization for Global Health, Mayuge, Uganda
| | - David Mukunya
- Department of Public Health, Busitema University, Mbale, Uganda.,Department of Research, Nikao Medical Center, Kampala, Uganda
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Incidence of Intrapartum-Related Events at the Largest Obstetric Hospital in Hanoi, Vietnam: A Retrospective Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9030321. [PMID: 35327693 PMCID: PMC8947411 DOI: 10.3390/children9030321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Every year, 2.4 million neonates die during their first month of life and even more suffer permanent injury. The main causes are intrapartum-related events, prematurity, and infection, with sub-Saharan Africa and southern Asia being the worst affected regions. With a focus on intrapartum-related events, we aimed to assess the neonatal demographic characteristics, clinical management, and outcomes among neonates born at the largest obstetric hospital in Hanoi, Vietnam. This was a retrospective cross-sectional study that included all the inborn neonates in November 2019, which was selected as a representative month. A total of 4554 neonates were born during the study period. Of these, 1.0% (n = 44) were stillbirths, 0.15% (n = 7) died in hospital, 0.61% (n = 28) received positive pressure ventilation at birth, and 0.15% (n = 7) were diagnosed with hypoxic ischemic encephalopathy. A total of 581 (13%) neonates were admitted to the neonatal unit, among which the most common diagnoses were prematurity (37%, n = 217) and infection (15%, n = 89). Except for the intrapartum-related events, our findings are consistent with the previously documented data on neonatal morbidity. The intrapartum-related events, however, were surprisingly low in number even in comparison to high-income countries. Research on the current clinical practice at Phu San Hanoi Hospital may bring further clarity to identify the success factors.
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Apanga PA, Kumbeni MT. Association between early antenatal care and antenatal care contacts across low-and middle-income countries: effect modification by place of residence. Epidemiol Health 2021; 43:e2021092. [PMID: 34735758 PMCID: PMC8920740 DOI: 10.4178/epih.e2021092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
Objectives The relationship between early antenatal care (ANC) and having eight or more antenatal contacts (ANC8+) have not been well characterised across low-and middle-income countries (LMICs). It is also unclear whether the association between early ANC and ANC8+ is modified by a woman's place of residence. Our primary aim was to assess the relationship between early ANC and ANC8+ and assessed whether this relationship was modified by place of residence. We also estimated the coverage of ANC8+ across LMICs. Methods We analysed data on 207388 mothers with a live birth using multiple indicator cluster surveys (MICSs) from 30 LMICS conducted between 2017 and 2020. Modified Poisson regression with a robust variance was used to assess the relationship between early ANC and ANC8+, whilst adjusting for country, clustering, stratification and sampling weights. Effect modification by place of residence was assessed on the additive and multiplicative scales. Meta-analysis was used to pool prevalent estimates of ANC8+ across all countries. Results The overall prevalence of ANC8+ was 35.6% and ranged from 1.7% in Madagascar to 99.4% in Belarus. Early ANC was positively associated with ANC8+ [adjusted prevalence ratio (aPR): 2.61, 95% CI: 1.82,3.74]. There was evidence of positive effect modification on the additive [relative excess risk due to interaction (RERI): 0.39, 95% CI: 0.35, 0.44] and multiplicative (aPR: 1.78, 95% CI: 1.08, 2.95) scales. Conclusion Many LMICs may not have adopted the WHO 2016 guidelines on ANC8+. Women who had early ANC were more likely to have ANC8+, particularly those in rural areas.
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