Determinants of prenatal care use and HIV testing during pregnancy: a population-based, cross-sectional study of 7080 women of reproductive age in Mozambique

Abstract Background In low-income countries with poor coverage of healthcare services such as Mozambique, antenatal care serves as a vital tool for providing life-saving and cost-effective services for pregnant mothers. Nonetheless, many countries in Africa, including Mozambique, are struggling to attain an optimum level of antenatal care (at least 4 visits) utilisation among pregnant women. In the present study, we aimed to assess the sociodemographic and economic factors associated with antenatal care use in Mozambique. Methods Cross-sectional data from the latest round of Mozambique Demographic and Health Survey (2011) on women aged 15–49 years (n = 7080) were analysed. The outcome measures were early and adequate antenatal visit and HIV tests during the last pregnancy. Data were analysed using descriptive and multivariate regression methods. The predictor variables included various demographic (e.g. age, parity), empowerment (e.g. type of employment, household wealth status) and sociocultural factors (e.g. ethnicity, religion). Results Of the 7080 women whose data was analyzed, 15.3 and 60.1% had early and adequate ANC visits respectively while 75.4% received HIV test during ANC visits. The odds of early ANC visits were higher [OR = 1.300, 95%CI = 1.062,1.592] among women in the rural areas compared with those in the urban areas. However, participants in rural areas had lower odds [OR = 0.788, 0.687,0.902] of receiving HIV tests during ANC visits. Women in the urban areas with secondary [OR = 1.296, 95%CI = 1.007,1.666] and higher [OR = 1.663, 95%CI = 1.052,2.628] education had higher odds of having early ANC visit. Those in the higher wealth quintiles also had significantly increased odds of using all three types of ANC indicators, particularly for rural women in the highest wealth quintile [OR = 4.776, 95%CI = 1.250,18.24]. Being within the higher wealth quintiles was found to significantly increase the odds of using all three types of ANC indicators, particularly women from rural areas with highest wealth quintile [OR = 4.776, 95%CI = 1.250,18.24]. Conclusion About two-fifth of the women in Mozambique are not using adequate antenatal care and about and a quarter do not take HIV tests during pregnancy. The sources of low and unequal use of these vital health services might be rooted in women’s socioeconomic status and cultural issues that require special policy and research attention.

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Knowledge and intake of folic acid to prevent neural tube defects among pregnant women in urban China: a cross-sectional study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-03893-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mingming Cui ◽

Xiao-Lin Lu ◽

Yan-Yu Lyu ◽

Fang Wang ◽

Xiao-Lu Xie ◽

...

Keyword(s):

Folic Acid ◽

Pregnant Women ◽

Neural Tube ◽

Neural Tube Defects ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Unplanned Pregnancy ◽

Urban China ◽

Cross Sectional

Abstract Background The prevalence of neural tube defects (NTDs) in China declined during 2000–2017 with periconceptional folic acid (FA) supplementation, which is effective in reducing the risk of birth defects. We aimed to assess the knowledge and actual use of FA among Chinese pregnant women and to explore factors associated with FA use before pregnancy. Methods All data were collected in face-to-face interviews during health visits among pregnant women. We collected information about knowledge and use of FA supplements and demographic, socioeconomic, and health status. One maternity and childcare hospital was chosen in each of four cities: Beijing, Huaibei, Kunming, and Haikou. In total, 435 pregnant women were randomly recruited for interviews conducted from June to December 2016. Results A total of 428 pregnant women were included in this survey. Of these, 82.0% (351/428) knew that FA can prevent NTDs, and 75.9% (325/428) knew the correct time to take FA. Overall, 65.9% (282/428) of women knew both that FA can prevent NTDs and the recommended time to take FA before pregnancy. Approximately 95.1% (407/428) of women reported having ever taken FA, only 46.3% (198/428) had begun to take FA supplementation before conception, and 64.5% (109/169) of women from rural areas failed to take FA before pregnancy. Women living in northern China (odds ratio [OR] = 1.81, 95% confidence interval [CI], 1.18–2.77), those with unplanned pregnancy (OR = 1.99, 95% CI 1.30–3.04), and highly educated women (OR = 2.37, 95% CI 1.45–3.88) were more likely to know about FA. Women who were homemakers (OR = 1.94, 95% CI 1.21–3.11) and had unplanned pregnancy (OR = 6.18, 95% CI 4.01–9.53) were less likely to begin taking FA before pregnancy. Conclusions Our survey showed that most pregnant women knew about FA. Although preconception intake of FA can help to reduce NTDs, improving the rate of FA intake before pregnancy is needed in urban areas of China, especially among homemakers and women from rural areas or with unplanned pregnancy. Campaigns are needed to increase awareness about FA and FA use before pregnancy among rural women, homemakers, and those with unplanned pregnancy and lower education levels.

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Country compliance with WHO-recommended antenatal care guidelines: equity analysis of the 2015–2016 Demography and Health Survey in Myanmar

BMJ Global Health ◽

10.1136/bmjgh-2019-002169 ◽

2020 ◽

Vol 5 (12) ◽

pp. e002169

Author(s):

Ngatho Samuel Mugo ◽

Kyaw Swa Mya ◽

Camille Raynes-Greenow

Keyword(s):

Antenatal Care ◽

Pregnant Women ◽

Adolescent Mothers ◽

Health Survey ◽

Rural Areas ◽

Urban Areas ◽

Multinomial Logistic Regression ◽

Wealth Quintile ◽

Adjusted Risk ◽

Factors Associated

IntroductionEarly access to adequate antenatal care (ANC) from skilled providers is crucial for detecting and preventing obstetric complications of pregnancy. We aimed to assess factors associated with the utilisation of the new WHO ANC guidelines including the recommended number, on time initiation and adequate components of ANC contacts in Myanmar.MethodsWe examined data from 2943 mothers aged 15–49 years whose most recent birth occurred in the last 5 years prior to the 2015–2016 Myanmar Demographic and Health Survey. Factors associated with utilisation of the new WHO recommended ANC were explored using multinomial logistic regression and multivariate models. We used marginal standardisation methods to estimate the predicted probabilities of the factors significantly associated with the three measures of ANC.ResultsApproximately 18% of mothers met the new WHO recommended number of eight ANC contacts. About 58% of the mothers received adequate ANC components, and 47% initiated ANC within the first trimester of pregnancy. The predicted model shows that Myanmar could achieve 70% coverage of adequate components of ANC if all women were living in urban areas. Similarly, if ANC was through private health facilities, 63% would achieve adequate components of ANC. Pregnant women from urban areas (adjusted risk ratio (aRR): 4.86, 95% CI 2.44 to 9.68) were more than four times more likely to have adequate ANC components compared with women from rural areas. Pregnant women in the highest wealth quintile were three times more likely to receive eight or more ANC contacts (aRR: 3.20, 95% CI 1.61 to 6.36) relative to mothers from the lowest wealth quintile. On time initiation of the first ANC contact was fourfold for mothers aged 30–39 years relative to adolescent mothers (aRR: 4.07, 95% CI 1.53 to 10.84).ConclusionThe 2016 WHO ANC target is not yet being met by the majority of women in Myanmar. Our results highlight the need to address health access inequity for women who are from lower socioeconomic groups, or are younger, and those living in rural areas.

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Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980014000275 ◽

2014 ◽

Vol 17 (11) ◽

pp. 2407-2418 ◽

Cited By ~ 16

Author(s):

Helga Bjørnøy Urke ◽

Maurice B Mittelmark ◽

Martín Valdivia

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Cross Sectional ◽

Growth Standards ◽

Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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The nutrition transition in Mexico 1988–2016: the role of wealth in the social patterning of obesity by education

Public Health Nutrition ◽

10.1017/s1368980018001167 ◽

2018 ◽

Vol 21 (13) ◽

pp. 2394-2401 ◽

Cited By ~ 8

Author(s):

Carolina Pérez-Ferrer ◽

Anne McMunn ◽

Paola Zaninotto ◽

Eric J Brunner

Keyword(s):

Rural Areas ◽

Urban Areas ◽

Prevalence Ratio ◽

Household Wealth ◽

Education Level ◽

Obesity Prevalence ◽

Cross Sectional ◽

The Social ◽

Lower Education ◽

Urban And Rural Areas

AbstractObjectiveThe present study investigates whether the reversal of the social gradient in obesity, defined as a cross-over to higher obesity prevalence among groups with lower education level, has occurred among men and women in urban and rural areas of Mexico.DesignCross-sectional series of nationally representative surveys (1988, 1999, 2006, 2012 and 2016). The association between education and obesity was investigated over the period 1988–2016. Effect modification of the education–obesity association by household wealth was tested.SettingMexico.SubjectsWomen (n 54 816) and men (n 20 589) aged 20–49 years.ResultsIn both urban and rural areas, the association between education and obesity in women varied by level of household wealth in the earlier surveys (1988, 1999 and 2006; interaction P<0·001). In urban areas in 1988, one level lower education was associated (prevalence ratio; 95 % CI) with 45 % higher obesity prevalence among the richest women (1·45; 1·24, 1·69), whereas among the poorest the same education difference was protective (0·84; 0·72, 0·99). In the latest surveys (2012, 2016), higher education was protective across all wealth groups. Among men, education level was not associated with obesity in urban areas; there was a direct association in rural areas. Wealth did not modify the association between education and obesity.ConclusionThe reversal of the educational gradient in obesity among women occurred once a threshold level of household wealth was reached. Among men, there was no evidence of a reversal of the gradient. Policies must not lose sight of the populations most vulnerable to the obesogenic environment.

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What influences home delivery among women who live in urban areas? Analysis of 2014 Ghana Demographic and Health Survey data

PLoS ONE ◽

10.1371/journal.pone.0244811 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0244811

Author(s):

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Eugene Budu ◽

Ebenezer Agbaglo ◽

Francis Appiah ◽

...

Keyword(s):

Antenatal Care ◽

Health Survey ◽

Rural Areas ◽

Urban Areas ◽

Wealth Quintile ◽

Home Delivery ◽

Northern Region ◽

Demographic And Health Survey ◽

Factors Associated ◽

At Home

Background In Ghana, home delivery among women in urban areas is relatively low compared to rural areas. However, the few women who deliver at home in urban areas still face enormous risk of infections and death, just like those in rural areas. The present study investigated the factors associated with home delivery among women who live in urban areas in Ghana. Materials and methods Data for this study was obtained from the 2014 Ghana Demographic and Health Survey. We used data of 1,441 women who gave birth in the 5 years preceding the survey and were dwelling in urban areas. By the use of Stata version 14.2, we conducted both descriptive and multivariable logistic regression analyses. Results We found that 7.9% of women in urban areas in Ghana delivered at home. The study revealed that, compared to women who lived in the Northern region, women who lived in the Brong Ahafo region [AOR = 0.38, CI = 0.17–0.84] were less likely to deliver at home. The likelihood of home delivery was high among women in the poorest wealth quintile [AOR = 2.02, CI = 1.06–3.86], women who professed other religions [AOR = 3.45; CI = 1.53–7.81], and those who had no antenatal care visits [AOR = 7.17; 1.64–31.3]. Conversely, the likelihood of home delivery was lower among women who had attained secondary/higher education [AOR = 0.30; 0.17–0.53], compared to those with no formal education. Conclusion The study identified region of residence, wealth quintile, religion, antenatal care visits, and level of education as factors associated with home delivery among urban residents in Ghana. Therefore, health promotion programs targeted at home delivery need to focus on these factors. We also recommend that a qualitative study should be conducted to investigate the factors responsible for the differences in home delivery in terms of region, as the present study could not do so.

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Determinants of BCG vaccination coverage in Ethiopia: a cross-sectional survey

BMJ Open ◽

10.1136/bmjopen-2018-023634 ◽

2019 ◽

Vol 9 (2) ◽

pp. e023634 ◽

Cited By ~ 3

Author(s):

Asmamaw Ketemaw Tsehay ◽

Getasew Tadesse Worku ◽

Yihun Mulugeta Alemu

Keyword(s):

Vaccination Coverage ◽

Rural Areas ◽

Urban Areas ◽

Wealth Index ◽

Outcome Variable ◽

Antenatal Visit ◽

Sampling Frame ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Bcg Vaccination

ObjectiveThe objective of this study is to assess the determinants of BCG vaccination in Ethiopia from 2016 Ethiopia Demographic and Health Survey (EDHS).SettingSince Ethiopia has nine regional states and two administrative cities, sample was taken from all the divisions. The population-based sample was intended to provide estimates of key indicators for the country.ParticipantThe sampling frame used for the 2016 EDHS is the Ethiopia Population and Housing Census. From 15 683 women recorded in EDHS dataset, women with no child (n=10 379) were excluded from the study. Therefore, the total sample size for this study was 5304 women. The outcome variable was BCG immunisation status of children.ResultOut of the study participants (n=5304), the majority were in between 20 and 34 years of age (73.8%). The median age of the respondents was 28.4 (SD=±6.5) years old. Prevalence of BCG vaccination was 63.6% (n=3373) and BCG vaccination coverage in urban residents was higher (88%) than rural residents (57.3%). Mothers’ age between 20 up to 34 (Adjusted odds ratio (AOR)=1.48; 95% CI: 1.13 to 1.93) and between 35 up to 49 (AOR=1.83; 95% CI: 1.35 to 2.46) were more likely to vaccinate their child’s than those mothers’ age less than 20. Mothers settled in urban areas were two times more likely to vaccinate their child’s than those living in rural areas (AOR=1.94; 95% CI: 1.45 to 2.60). Mothers with greater antenatal visits show higher BCG vaccination, Antenatal Care (ANC) 4 and above (AOR=3.48; 95% CI: 2.91 to 4.15). BCG vaccination is higher for mothers delivered at non-governmental organisation health facility than home (AOR=2.9; 95% CI: 1.69 to 4.96). Maternal occupation and wealth index also had a significant association with BCG vaccination.ConclusionBCG vaccination coverage, in this study, was lower and determinant factors for BCG vaccination were residence, mother’s age, place of delivery, mother’s antenatal visit, wealth index and mother’s occupation.

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Socio Demographic Determinants of Delivery Practice in Rural Women of Bangladesh

Delta Medical College Journal ◽

10.3329/dmcj.v1i2.15917 ◽

2013 ◽

Vol 1 (2) ◽

pp. 42-45 ◽

Cited By ~ 1

Author(s):

Meherunnessa Begum ◽

Khondoker Bulbul Sarwar ◽

Nasreen Akther ◽

Rokshana Sabnom ◽

Asma Begum ◽

...

Keyword(s):

Maternal Health ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Cross Sectional Study ◽

Home Delivery ◽

Reproductive Age ◽

Cross Sectional ◽

Mortality And Morbidity ◽

At Home

Background: Every year, world wide, 200 million women become pregnant. The development of urban areas allowed women to receive more care and treatment. However, in rural areas such measures are not available to every woman. Data on delivery practice of rural woman may help the social and public health planners and decision makers to minimize and prevent maternal mortality and morbidity ensuring safe motherhood.Objective: The aim of the study was to observe the delivery practice of rural women of Bangladesh. Materials and method: A cross-sectional study was conducted and data were collected from Dhamrai upazila, Dhaka, Bangladesh in April 2008. Total 159 women of reproductive age group at least having one child were selected purposively to elicit information on various demographic, socioeconomic, cultural and selected programmatic variables including maternal health care and delivery practices. Results: Among the respondents about 55% were literate. Majority (80%) of the respondents delivered at home and most of the them (71%) felt that home delivery was comfortable where as about 29% of the respondents were compelled to deliver at home due to family decision and financial constraint. Among the deliveries about 82% occurred normally and 18.2% were by cesarean section. A considerable percentage of deliveries (49%) were attended by traditional birth attendants. Blade was used for cutting umbilical cord in majority of the cases (74%) who delivered at home. Most of the respondents (90%) took ante natal check up and about 74% were vaccinated by tetanus toxoid. Conclusion: The results of the study suggest that a lot of work is still to do for the policy makers and health planners to target, plan, develop and deliver maternal health services to the rural women of Bangladesh. DOI: http://dx.doi.org/10.3329/dmcj.v1i2.15917 Delta Med Col J. Jul 2013;1(2):42-45

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Interaction between sex and rurality on the prevalence of diabetes in Guyana: a nationally representative study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001349 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001349

Author(s):

Calvin Ke ◽

Shamdeo Persaud ◽

Kavita Singh ◽

Brian Ostrow ◽

Gerald Lebovic ◽

...

Keyword(s):

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Fasting Blood Glucose ◽

Cross Sectional Study ◽

Diabetes Prevalence ◽

Cross Sectional ◽

Glucose Testing ◽

Representative Study ◽

Nationally Representative

IntroductionDiabetes prevalence has never been measured in Guyana. We conducted a nationally representative cross-sectional study to estimate the prevalence of diabetes and pre-diabetes, and the association between sex and diabetes.Research design and methodsIn 2016, the Ministry of Public Health led Guyana’s first national STEPS survey among adults aged 18–69 years. Half of the participants were randomly selected for hemoglobin A1c and fasting blood glucose testing. We estimated the prevalence of diabetes and pre-diabetes and measured the association between sex and diabetes prevalence using logistic regression to compute adjusted ORs.ResultsWe included 805 adults (511 women, 294 men, mean age 41.8 (SD 14.4) years). The national prevalence of diabetes was 18.1% (95% CI: 15.4% to 20.8%), with higher rates among women (21.4%, 95% CI: 18.0% to 24.7%) than men (15.1%, 95% CI: 10.9% to 19.3%). Sex-specific diabetes prevalence varied significantly across urban and rural areas (p=0.002 for interaction). In rural areas, diabetes was twice as common among women (24.1%, 95% CI: 20.1% to 28.2%) compared with men (11.8%, 95% CI: 7.7% to 15.9%). After adjusting for prespecified covariates, rural women had double the odds of diabetes compared with rural men (OR 2.1, 95% CI: 1.20 to 3.82). This prevalence pattern was reversed in urban areas (diabetes prevalence, women: 13.9%, 95% CI: 8.7% to 19.0%; men: 22.0%, 95% CI: 12.9% to 31.1%), with urban women having half the odds of diabetes compared with urban men (OR 0.4, 95% CI: 0.20 to 0.99). We estimated that nearly one-third of women and over a quarter of men had diabetes or pre-diabetes.ConclusionsThe burden of diabetes in Guyana is considerably higher than previously estimated, with an unexpectedly high prevalence among women—particularly in rural areas.

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Do urban areas still have advantages over rural areas in antenatal care discontinuity in Sub-Saharan Africa?

Net Journal of Social Sciences ◽

10.30918/njss.92.21.011 ◽

2021 ◽

Vol 9 (2) ◽

pp. 27-35

Author(s):

Franklin Bouba Djourdebbé ◽

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Rural Areas ◽

Urban Areas ◽

Sub Saharan Africa ◽

Health Policies ◽

Antenatal Visit ◽

Urban Rural ◽

Health Survey Data ◽

Sub Saharan

In sub-Saharan Africa, among the small proportion of women who had at least one antenatal visit, many of them no longer return to ensure continuity of antenatal care. This antenatal care discontinuity is a matter of serious concern for maternal health. Using Demographic and Health Survey data collected between 2000 and 2016 in 26 sub-Saharan countries, this study aims to analyse urban/rural differences in antenatal care discontinuity. Although in the majority of countries, urban areas have considerable advantages in terms of antenatal care continuity, there are countries where urban/rural differences are not significant, as well as atypical countries (Rwanda, Gambia and Zambia) where antenatal care discontinuity is higher in urban areas compared to rural areas. This study is a contribution to tackle the complex disparities in the discontinuity of care during pregnancy in maternal health policies in sub-Saharan Africa. Keywords: Maternal health, antenatal care, urban, rural, sub-Saharan Africa.

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Trends in the socioeconomic patterning of overweight/obesity in India: a repeated cross-sectional study using nationally representative data

BMJ Open ◽

10.1136/bmjopen-2018-023935 ◽

2018 ◽

Vol 8 (10) ◽

pp. e023935 ◽

Cited By ~ 18

Author(s):

Shammi Luhar ◽

Poppy Alice Carson Mallinson ◽

Lynda Clarke ◽

Sanjay Kinra

Keyword(s):

Higher Education ◽

Rural Women ◽

Rural Areas ◽

Urban Areas ◽

Cross Sectional Study ◽

Obesity Prevalence ◽

Sectional Study ◽

Cross Sectional ◽

Men And Women ◽

Nationally Representative

ObjectivesWe aimed to examine trends in prevalence of overweight/obesity among adults in India by socioeconomic position (SEP) between 1998 and 2016.DesignRepeated cross-sectional study using nationally representative data from India collected in 1998/1999, 2005/2006 and 2015/2016. Multilevel regressions were used to assess trends in prevalence of overweight/obesity by SEP.Setting26, 29 and 36 Indian states or union territories, in 1998/99, 2005/2006 and 2015/2016, respectively.Participants628 795 ever-married women aged 15–49 years and 93 618 men aged 15–54 years.Primary outcome measureOverweight/obesity defined by body mass index >24.99 kg/m2.ResultsBetween 1998 and 2016, overweight/obesity prevalence increased among men and women in both urban and rural areas. In all periods, overweight/obesity prevalence was consistently highest among higher SEP individuals. In urban areas, overweight/obesity prevalence increased considerably over the study period among lower SEP adults. For instance, between 1998 and 2016, overweight/obesity prevalence increased from approximately 15%–32% among urban women with no education. Whereas the prevalence among urban men with higher education increased from 26% to 34% between 2005 and 2016, we did not observe any notable changes among high SEP urban women between 1998 and 2016. In rural areas, more similar increases in overweight/obesity prevalence were found among all individuals across the study period, irrespective of SEP. Among rural women with higher education, overweight/obesity increased from 16% to 25% between 1998 and 2016, while the prevalence among rural women with no education increased from 4% to 14%.ConclusionsWe identified some convergence of overweight/obesity prevalence across SEP in urban areas among both men and women, with fewer signs of convergence across SEP groups in rural areas. Efforts are therefore needed to slow the increasing trend of overweight/obesity among all Indians, as we found evidence suggesting it may no longer be considered a ‘diseases of affluence’.

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