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Towongo MF, Ngome E, Navaneetham K, Letamo G. Factors associated with Women’s timing of first antenatal care visit during their last pregnancy: evidence from 2016 Uganda demographic health survey. BMC Pregnancy Childbirth 2022; 22:829. [DOI: 10.1186/s12884-022-05167-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/30/2022] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Utilization of antenatal care services (ANC) during pregnancy has been recognized as a major public health intervention to abate maternal morbidity and mortality. Uganda has experienced high levels of maternal morbidity and mortality over the past two decades. This could be partly attributed to the lower proportion of women who initiated their first antenatal care visit during the first trimester of their gestation period. This study aimed at investigating the factors associated with timing of first ANC visit by women in Uganda.
Method
This study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study population comprises of women aged 15–49 who reported to have given their last birth during the five years preceding the 2016 UDHS survey. The outcome variable for this study was the timing of first ANC visit. Univariate, bivariate, and multilevel binary logistic regression analysis was used to determine the factors associated with the utilization of timing of first ANC visit.
Results
Findings show that only 30% [95%CI; 0.28–0.31] of women utilized ANC during the first trimester. Women of higher parity (4+) were less likely to utilize ANC in the first trimester compared to the lower parity (1) (AOR, 0.74, CI; 0.60–0.92). Women who reside in communities with good access to health facility were more likely to utilize ANC during the first trimester as compared to women residing in communities inaccessible to health facility (AOR, 1.36, CI; 1.04–1.77). Women who reside in less diverse ethnic communities were less likely to utilize ANC in the first trimester compared to their counterparts (AOR, 0.15, CI; 0.11–0.22).
Conclusion
This study demonstrated that contextual factors are important predictors of utilization of ANC during the first trimester apart from individual, factors. It is thus important for maternal health programme interventions to consider both individual and contextual factors when encouraging women to utilize ANC services during the first trimester.
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da Silva PHA, Aiquoc KM, da Silva Nunes AD, Medeiros WR, de Souza TA, Jerez-Roig J, Barbosa IR. Prevalence of Access to Prenatal Care in the First Trimester of Pregnancy Among Black Women Compared to Other Races/Ethnicities: A Systematic Review and Meta-Analysis. Public Health Rev 2022; 43:1604400. [PMID: 35860809 PMCID: PMC9289875 DOI: 10.3389/phrs.2022.1604400] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: To analyze the prevalence of access to prenatal care in the first trimester of pregnancy among black women compared to other races/ethnicities through a systematic review and meta-analysis.Methods: Searches were carried out at PUBMED, LILACS, Web of Science, Scopus, CINAHL, and in the grey literature. The quality of the studies and the risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulatesd and analyzed qualitatively and quantitatively through meta-analysis.Results: Black women had the lowest prevalence of access to prenatal services in the first trimester, with prevalence ranging from 8.1% to 74.81%, while among white women it varied from 44.9 to 94.0%; 60.7% of black women started prenatal care in the first trimester, while 72.9% of white women did so.Conclusion: Black women compared to other racial groups had lower prevalence of access to prenatal care, with less chance of access in the first trimester, and it can be inferred that the issue of race/skin color is an important determinant in obtaining obstetric care.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020159968_, PROSPERO CRD42020159968.
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Affiliation(s)
| | - Kezauyn Miranda Aiquoc
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
| | | | | | - Talita Araujo de Souza
- Postgraduate Program in Public Health, Federal University of Rio Grande do Norte, Natal, Brazil
- *Correspondence: Talita Araujo de Souza,
| | - Javier Jerez-Roig
- Faculty of Health Sciences and Welfare, University of Vic–Central University of Catalonia, Barcelona, Spain
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Sserwanja Q, Nabbuye R, Kawuki J. Dimensions of women empowerment on access to antenatal care in Uganda: A further analysis of the Uganda demographic health survey 2016. Int J Health Plann Manage 2022; 37:1736-1753. [PMID: 35178763 DOI: 10.1002/hpm.3439] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Women empowerment has been viewed as a good strategy in the reduction of global maternal morbidity and mortality. Most of the recent studies in Uganda have focussed on antenatal care (ANC) frequency and the associated factors with no focus on the effect of women empowerment. Our study aims at examining the prevalence of optimal access to ANC by considering the timing of initiation, type of ANC provider and ANC frequency and their association with women empowerment. METHODS We used Uganda Demographic and Health Survey 2016 data of 9957 women aged 15-49 years. Multistage stratified sampling was used to select study participants and we conducted multivariable logistic regression to establish the association between women empowerment and access to ANC using Statistical package for the social sciences version 25. RESULTS Out of 9957 women, 2953 (29.7%: 95% CI: 28.5.0-30.2) had initiated ANC in first trimester, 6080 (61.1%: 95% CI: 60.4-62.3) had 4 or more ANC contacts, and 9880 (99.2%: 95% CI: 99.0-99.3) had received ANC from a skilled provider. Overall, 2399 (24.1%: 95% CI: 23.0-24.6) had optimal access to ANC. Economic empowerment and exposure to media were the only women empowerment indices that were positively associated with optimal access to ANC. Other factors that were significant include; region, wealth index, age, level of education and working status. CONCLUSION To ensure increased access to ANC, policy-makers and other stakeholders should prioritise the use of mass media in maternal health programs, equitable allocation of the limited financial resources with a focus on older, poor and uneducated women.
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Affiliation(s)
| | | | - Joseph Kawuki
- Jockey Club School of Public Health and Primary Care, Centre for Health Behaviours Research, the Chinese University of Hong Kong, Hong Kong, China
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Rahman A, Nisha MK, Begum T, Ahmed S, Alam N, Anwar I. Trends, determinants and inequities of 4 + ANC utilisation in Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2017; 36:2. [PMID: 28086970 PMCID: PMC5237328 DOI: 10.1186/s41043-016-0078-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 12/23/2016] [Indexed: 05/20/2023]
Abstract
BACKGROUND The objectives of this study are to document the trend on utilisation of four or more (4+) antenatal care (ANC) over the last 22 years period and to explore the determinants and inequity of 4+ ANC utilisation as reported by the last two Bangladesh Demographic and Health surveys (BDHS) (2011 and 2014). METHODS The data related to ANC have been extracted from the BDHS data set which is available online as an open source. STATA 13 software was used for organising and analysing the data. The outcome variable considered for this study was utilisation of 4+ ANC. Trends of 4+ ANC were measured in percentage and predictors for 4+ ANC were measured through bivariate and multivariable analysis. The concentration index was estimated for assessing inequity in 4+ ANC utilisation. RESULTS Utilisation of 4+ ANC has increased by about 26% between the year 1994 and 2014. Higher level of education, residing in urban region and richest wealth quintile were found to be significant predictors. The utilisation of 4+ ANC has decreased with increasing parity and maternal age. The inequity indices showed consistent inequities in 4+ ANC utilisation, and such inequities were increased between 2011 and 2014. CONCLUSIONS In Bangladesh, the utilisation of any ANC rose steadily between 1994 and 2014, but progress in terms of 4+ ANC utilisation was much slower as the expectation was to achieve the national set target (50%: 4+ ANC utilisation) by 2016. Socio-economic inequities were observed in groups that failed to attend a 4+ ANC visit. Policymakers should pay special attention to increase the 4+ ANC coverage where this study can facilitate to identify the target groups whom need to be intervened on priority basis.
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Affiliation(s)
- Aminur Rahman
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | | | - Tahmina Begum
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Sayem Ahmed
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Nurul Alam
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Iqbal Anwar
- International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
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Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care. J Racial Ethn Health Disparities 2016; 4:79-86. [PMID: 26823064 DOI: 10.1007/s40615-015-0204-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/27/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although early, consistent prenatal care (PNC) can be helpful in improving poor birth outcomes, rates of PNC use tend to be lower among African-American women compared to Whites. This study examines low-income African-American women's perspectives on barriers and facilitators to receiving PNC in an urban setting. METHODS We conducted six focus groups with 29 women and individual structured interviews with two women. Transcripts were coded to identify barriers and facilitators to obtaining PNC; codes were reviewed to identify emergent themes. RESULTS Barriers to obtaining PNC included structural barriers such as transportation and insurance, negative attitudes towards PNC, perceived poor quality of care, unintended pregnancy, and psychosocial stressors such as overall life stress and chaos. Facilitators of PNC included positive experiences such as trusting relationships with providers, respectful staff and providers, and social support. CONCLUSIONS Findings suggest important components in an ideal PNC model to engage low-income African-American women.
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Abrokwah SO, Moser CM, Norton EC. The effect of social health insurance on prenatal care: the case of Ghana. ACTA ACUST UNITED AC 2014; 14:385-406. [PMID: 25143181 DOI: 10.1007/s10754-014-9155-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 08/01/2014] [Indexed: 11/28/2022]
Abstract
Many developing countries have introduced social health insurance programs to help address two of the United Nations' millennium development goals-reducing infant mortality and improving maternal health outcomes. By making modern health care more accessible and affordable, policymakers hope that more women will seek prenatal care and thereby improve health outcomes. This paper studies how Ghana's social health insurance program affects prenatal care use and out-of-pocket expenditures, using the two-part model to model prenatal care expenditures. We test whether Ghana's social health insurance improved prenatal care use, reduced out-of-pocket expenditures, and increased the number of prenatal care visits. District-level differences in the timing of implementation provide exogenous variation in access to health insurance, and therefore strong identification. Those with access to social health insurance have a higher probability of receiving care, a higher number of prenatal care visits, and lower out-of-pocket expenditures conditional on spending on care.
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Joshi C, Torvaldsen S, Hodgson R, Hayen A. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth 2014; 14:94. [PMID: 24589139 PMCID: PMC3943993 DOI: 10.1186/1471-2393-14-94] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Good quality antenatal care (ANC) reduces maternal and neonatal mortality and improves health outcomes, particularly in low-income countries. Quality of ANC is measured by three dimensions: number of visits, timing of initiation of care and inclusion of all recommended components of care. Although some studies report on predictors of the first two indicators, no studies on the third indicator, which measures quality of ANC received, have been conducted in Nepal. Nepal follows the World Health Organization's recommendations of initiation of ANC within the first four months of pregnancy and at least four ANC visits during the course of an uncomplicated pregnancy. This study aimed to identify factors associated with 1) attendance at four or more ANC visits and 2) receipt of good quality ANC. METHODS Data from Nepal Demographic and Health Survey 2011 were analysed for 4,079 mothers. Good quality ANC was defined as that which included all seven recommended components: blood pressure measurement; urine tests for detecting bacteriuria and proteinuria; blood tests for syphilis and anaemia; and provision of iron supplementation, intestinal parasite drugs, tetanus toxoid injections and health education. RESULTS Half the women had four or more ANC visits and 85% had at least one visit. Health education, iron supplementation, blood pressure measurement and tetanus toxoid were the more commonly received components of ANC. Older age, higher parity, and higher levels of education and household economic status of the women were predictors of both attendance at four or more visits and receipt of good quality ANC. Women who did not smoke, had a say in decision-making, whose husbands had higher levels of education and were involved in occupations other than agriculture were more likely to attend four or more visits. Other predictors of women's receipt of good quality ANC were receiving their ANC from a skilled provider, in a hospital, living in an urban area and being exposed to general media. CONCLUSIONS Continued efforts at improving access to quality ANC in Nepal are required. In the short term, less educated women from socioeconomically disadvantaged households require targeting. Long-term improvements require a focus on improving female education.
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Affiliation(s)
- Chandni Joshi
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Siranda Torvaldsen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Ray Hodgson
- Australians for Women’s Health, Port Macquarie, NSW, Australia
| | - Andrew Hayen
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Determinants of time of start of prenatal care and number of prenatal care visits during pregnancy among Nepalese women. J Community Health 2012; 37:865-73. [PMID: 22134620 DOI: 10.1007/s10900-011-9521-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This study is aimed at investigating the factors determining the timing of first prenatal care (PNC) visit and the number of PNC visits among a national representative sample of Nepali women. Data was drawn from the 2006 Nepal Demographic and Health Survey on women age 15-49 years old who had delivery within three years prior to the survey (N = 4,136). Multinomial logistic regression was used to study the association between socio-demographic variables and two outcome variables--the timing of first PNC and number of PNC visits. Most of the women (45%) started prenatal care after 3 months of pregnancy while 28% had no care. About 43% of women had 1-3 PNC visits, 29% had more than 3 visits. Age, education, parity and wealth were associated with both the timing of PNC and the number of PNC visits such that older women and those socioeconomically disadvantaged had late and fewer PNC visits compared to the younger ones and those with socioeconomic advantage, respectively. Women with higher parity and those in rural residencies were more likely to delay PNC, have fewer PNC or have no care at all. Majority of Nepali women do not attend prenatal care during the first trimester of pregnancy contrary to the WHO recommendation for women in developing countries. Programmes aimed at improving maternal health in general and participation in PNC in particular should target all Nepali women, especially those: in rural residencies, with no education, with high parity; older women and those from poor households.
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Ruwe M, Capitman J, Bengiamin M, Soto T. A systematic review and meta-analysis of racial disparities in prenatal care in California: How much? Does insurance matter? SOCIAL WORK IN PUBLIC HEALTH 2010; 25:550-571. [PMID: 21058214 DOI: 10.1080/19371910903344217] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This meta-analysis compares California to 13 states with regard to adequacy of prenatal care in the context of the major Medicaid expansion. It shows a reduction in prenatal care inadequacy after 1992, especially in California. It also shows persistent racial ethnic disparities. By examining how California differed from other states, this study provides not only benchmarks for attaining the Healthy People 2010 goal of 90% adequacy but also possible strategies for achieving this goal. Attaining the Healthy People 2010 objective for prenatal care for California as a whole will require further efforts to understand and address racial/ethnic and insurance-related inequalities.
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Affiliation(s)
- Mathilda Ruwe
- Fresno College of Health and Human Services, Central Valley Health Policy Institute, California State University, Fresno, California, USA.
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Bloch JR, Dawley K, Suplee PD. Application of the Kessner and Kotelchuck prenatal care adequacy indices in a preterm birth population. Public Health Nurs 2009; 26:449-59. [PMID: 19706128 DOI: 10.1111/j.1525-1446.2009.00803.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Healthy People 2010 goals to eliminate racial and ethnic health disparities that persist in the utilization of prenatal care (PNC) highlight the importance of measuring PNC as a variable in maternal and infant health outcomes research. These disparities are significantly correlated to adverse infant outcomes in preterm birth (PTB), a leading cause of infant mortality and life-long morbidity. Currently the most extensively used PNC adequacy indices (Kessner and Kotelchuck) were developed to measure outcomes in populations consisting mostly of full-term births. It is unclear whether these PNC adequacy indices are reliable when pregnancy is truncated due to PTB (<37 weeks). This paper compares and demonstrates how they can be applied in a specific PTB cohort. DESIGN AND SAMPLE This secondary analysis of a nested case-control study compares Kessner and Kotelchuck adequacy scores of 367 mothers of PTB infants. RESULTS There were significant differences in the rating of PNC inadequacy ( p<.001) depending on the PNC adequacy index used. CONCLUSION Critical evaluation is warranted before using these PNC adequacy indices in future public health nursing and PTB research.
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Affiliation(s)
- Joan Rosen Bloch
- College of Nursing & Health Professions, Drexel University, 245 N.15th Street, MS 1030, Philadelphia, PA 19102, USA.
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Abstract
OBJECTIVES The impact of a Medicaid-managed care system on access to prenatal care was investigated. STUDY DESIGN Postpartum interviews and medical chart abstractions were conducted among 493 Hispanic women who reside on the El Paso Texas/Juarez Mexico border (the Paso del Norte region). Descriptive analysis identified barriers and facilitators to prenatal care. Logistic regression identified the impact of social and demographic characteristics on selected maternal and infant outcomes. RESULTS The factors reported by these women as barriers to timely entry and sustaining enrollment in prenatal care were related to the availability of social support networks and affiliation with the Mexican/Hispanic culture (acculturation). Having Medicaid-managed care or other insurance was associated with receiving more adequate levels of prenatal care. Women who crossed the border to seek perinatal services were more likely to have infants who received higher levels of neonatal care (odds ratio 0.500; 95% CI [0.264, 0.946]). CONCLUSIONS The promotion of preconceptional, prenatal, and family planning services is strongly recommended as a strategic, regional, public health intervention.
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