Continuum of maternity care among rural women in Ethiopia: does place and frequency of antenatal care visit matter?

Abstract Introduction The ministry of health (MOH) of Ethiopia recommends 4 or more focused antenatal care (ANC) visits at health centre (HC) or at a higher level of health facility (HF). In Ethiopia, few studies investigated time dimension of maternal health continuum of care but lack data regarding place dimension and its effect on continuum of care. The aim of this study is to estimate effect of place of ANC-1 visit and adherence to MOH’s recommendations of MOH for ANC visits on continuum of care rural in Ethiopia. Methods We used data collected from 1431 eligible women included in the National Health Extension Program (HEP) assessment survey that covered 6324 households from 62 woredas in nine regions. The main outcome variable is continuum of care (CoC), which is the uptake of all recommended ANC visits, institutional delivery and postnatal care services. Following descriptive analysis, Propensity Score Matching was used to estimate the effect of place of ANC-1 visit on completion of CoC. Zero inflated Poisson regression was used to model the effect of adherence to MOH recommendation of ANC visits on intensity of maternal health continuum of care. Result Only 13.9% of eligible women completed the continuum of care, and place of first antenatal care (ANC) visit was not significantly associated with the completion of continuum of care (β = 0.04, 95% CI = -0.02, 0.09). Adherence of ANC visit to the MOH recommendation (at least 4 ANC visits at higher HFs than health posts (HPs)) increased the likelihood of higher intensity of continuum of care (aIRR = 1.29, 95% CI: 1.26, 1.33). Moreover, the intensity of continuum of care was positively associated with being in agrarian areas (aIRR = 1.17, 95% CI: 1.06, 1.29), exposed to HEP (IRR = 1.22, 95% CI: 1.16, 1.28), being informed about danger signs (aIRR = 1.14, 95% CI: 1.11, 1.18) and delivery of second youngest child at HF (IRR = 1.16, 95% CI: 1.13, 1.20). Increasing age of women was negatively associated with use of services (IRR = 0.90, 95% CI: 0.87, 0.94). Conclusion Completion of maternal health continuum of care is very low in Ethiopia, however most of the women use at least one of the services. Completion of continuum of care was not affected by place of first ANC visit. Adherence to MOH recommendation of ANC visit increased the intensity of continuum of care. Intensity of continuum of care was positively associated with residing in agrarian areas, HEP exposure, danger sign told, delivery of second youngest child at health facility. To boost the uptake of all maternal health services, it is crucial to work on quality of health facilities, upgrading the infrastructures of HPs and promoting adherence to MOH recommendations of ANC visit.

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Continuum of Maternity Care Among Rural Women in Ethiopia: Does Place and Frequency of Antenatal Care Visit Matter?

10.21203/rs.3.rs-672954/v1 ◽

2021 ◽

Author(s):

Tegene Legese Dadi ◽

Girmay Medhin ◽

Habtamu Kebebe Kasaye ◽

Getnet Mitike Kassie ◽

Mulusew Gerbaba Jebena ◽

...

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Health Facility ◽

Rural Women ◽

Descriptive Analysis ◽

Health Centre ◽

Continuum Of Care ◽

Maternal Health Services ◽

Outcome Variable ◽

Time Dimension

Abstract Introduction: The ministry of health (MOH) of Ethiopia recommends 4 or more focused antenatal care (ANC) visits at health centre or at a higher level of health facility. In Ethiopia, few studies investigated time dimension of maternal health continuum of care but lack data regarding place dimension and its effect on continuum of care. The aim of this study is to estimate effect of place of ANC-1 visit and adherence to MOH’s recommendations of MOH for ANC visits on continuum of care rural in Ethiopia. Method: We used data collected from 1431 eligible women included in the National Health Extension Program (HEP) assessment survey that covered 6364 households from 62 woredas in nine regions. The main outcome variable is continuum of care (CoC), which is the uptake of all recommended ANC visits, institutional delivery and postnatal care services. Following descriptive analysis of the collected data, Propensity Score Matching was used to estimate the effect of place of ANC-1 visit on completion of CoC, and Zero inflated Poisson regression was used to model the effect of adherence to MOH recommendation of ANC visits on intensity of maternal health continuum of care. Result: Only 13.9% of eligible women completed the continuum of care and place of first antenatal care (ANC) visit was not significantly associated with the completion of continuum of care (β = 0.04, 95%CI= -0.02, 0.09). Adherence of ANC visit to the MOH recommendation (at least 4 ANC visits at higher HFs than HPs) increased the likelihood of higher intensity of continuum of care (aIRR = 1.29, 95%CI: 1.26, 1.33). Moreover, the intensity of continuum of care was positively associated with being in agrarian areas (aIRR = 1.17, 95%CI: 1.06, 1.29), exposed to HEP (IRR = 1.22, 95%CI: 1.16, 1.28), being informed about danger signs (aIRR = 1.14, 95%CI: 1.11, 1.18) and delivery of 2nd youngest child at HF (IRR = 1.16, 95%CI: 1.13, 1.20). Increasing age of women was negatively associated with use of services (IRR = 0.90, 95%CI: 0.87, 0.94). Conclusion: Completion of maternal health continuum of care is very low in Ethiopia, however most of the women use at least one of the services. Completion of continuum of care was not affected by place of first ANC visit. Adherence to MOH recommendation of ANC visit increased the intensity of continuum of care. Intensity of continuum of care was positively associated with residing in agrarian areas, HEP exposure, danger sign told, delivery of 2nd youngest child at health facility. To boost the uptake of all maternal health services, it is crucial to work on quality of health facilities, upgrading the infrastructures of HPs and promoting adherence to MOH recommendations of ANC visit.

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Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

10.21203/rs.2.17266/v1 ◽

2019 ◽

Author(s):

Ruth Atuhaire

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Structural Equation ◽

First Trimester ◽

Maternal Health Services ◽

Facility Delivery ◽

Health Facility Delivery ◽

Mediating Factor

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

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Health Extension Workers Involvement in the Utilization of Focused Antenatal Care Service in Rural Sidama Zone, Southern Ethiopia: A Cross-Sectional Study

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819835138 ◽

2019 ◽

Vol 6 ◽

pp. 233339281983513 ◽

Cited By ~ 1

Author(s):

Achamyelesh Gebretsadik ◽

Million Teshome ◽

Mekdes Mekonnen ◽

Akalewold Alemayehu ◽

Yusuf Haji

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Multivariate Logistic Regression Analysis ◽

Maternal Health Services ◽

Child Health Services ◽

Outcome Variable ◽

Health Extension Workers ◽

Cross Sectional ◽

Focused Antenatal Care

Background: Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC). Methods: A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software. Results: The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244 (46.47%; 95% CI: 43.5-47.7%) of mothers. The FANC utilization was less likely among those who were illiterate (adjusted odds ratio [AOR]: .32; 95% CI: .18-.57) and those who attended first cycle (AOR: .41; 95% CI: .23-.74), those who attended secondary cycle (AOR: .47; 95% CI: .27-.82), primipara (AOR: 0.53; 95% CI: .35-.83), and those who gave birth at home (AOR: .66; 95% CI: .51-.84). Mothers who had knowledge of pregnancy danger signs (AOR: 1.42; 95% CI: 1.2-1.7) and exposure to mass media (AOR: 1.35; 95% CI: 1.1-1.66) were more likely to utilize FANC. Conclusions: FANC utilization in this study was low compared to other studies. The HEWs had a major contribution to the services. However, it is low when compared to the plan set by the state ministry of health. The existing health extension program could be strengthened by increasing the number of HEWs. Empowering rural mothers through continuous education program to enhance the utilization of maternal health services.

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Savings ownership and the use of maternal health services in Indonesia

Health Policy and Planning ◽

10.1093/heapol/czz094 ◽

2019 ◽

Vol 34 (10) ◽

pp. 752-761

Author(s):

Soyoon Weon ◽

David W Rothwell ◽

Shailen Nandy ◽

Arijit Nandi

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Care Delivery ◽

Maternal Health Services ◽

Reproductive Age ◽

Percentage Points ◽

The Impact ◽

Use Of Health Services

Abstract In low- and middle-income countries (LMICs), many women of reproductive age experience morbidity and mortality attributable to inadequate access to and use of health services. Access to personal savings has been identified as a potential instrument for empowering women and improving access to and use of health services. Few studies, however, have examined the relation between savings ownership and use of maternal health services. In this study, we used data from the Indonesian Family Life Survey to examine the relation between women’s savings ownership and use of maternal health services. To estimate the effect of obtaining savings ownership on our primary outcomes, specifically receipt of antenatal care, delivery in a health facility and delivery assisted by a skilled attendant, we used a propensity score weighted difference-in-differences approach. Our findings showed that acquiring savings ownership increased the proportion of women who reported delivering in a health facility by 22 percentage points [risk difference (RD) = 0.22, 95%CI = 0.08–0.37)] and skilled birth attendance by 14 percentage points (RD = 0.14, 95%CI = 0.03–0.25). Conclusions were qualitatively similar across a range of model specifications used to assess the robustness of our main findings. Results, however, did not suggest that savings ownership increased the receipt of antenatal care, which was nearly universal in the sample. Our findings suggest that under certain conditions, savings ownership may facilitate the use of maternal health services, although further quasi-experimental and experimental research is needed to address threats to internal validity and strengthen causal inference, and to examine the impact of savings ownership across different contexts.

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Maternal Health Care Among Refugees and Host Communities in Northern Uganda: Access, Quality, and Discrimination

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.626002 ◽

2021 ◽

Vol 2 ◽

Author(s):

Siri Aas Rustad ◽

Helga Malmin Binningsbø ◽

Haakon Gjerløw ◽

Francis Mwesigye ◽

Tony Odokonyero ◽

...

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Maternal Health Services ◽

Maternal Health Care ◽

Host Community ◽

Northern Uganda

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value < 0.05) but are 8% points more likely to give birth at a health facility (p-value < 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value < 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value < 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.

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Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

10.21203/rs.2.19108/v1 ◽

2019 ◽

Author(s):

Xiaojing Fan ◽

Meghan Bruce Kumar ◽

Zhongliang Zhou ◽

Ching-Hung Lee ◽

Duolao Wang ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Rural Women ◽

Healthcare Reform ◽

Urban Women ◽

Continuum Of Care ◽

Maternal Health Services ◽

Shaanxi Province ◽

Cross Sectional ◽

Generalised Linear Mixed Model

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: According to China’s policy defining CMHS, post-reform CMHS utilisation was higher in both rural and urban women. The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ2=20.64, P<0.001; rural: χ2=131.38, P<0.001). This finding is consistent when the WHO’s level of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ2=10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ2=2.57, P=0.109). The GLMM showed the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007) for urban women; it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of utilisation of the CMHS among both urban and rural women in Shaanxi Province. We expect that similar impacts might be observed in other settings in China and, if so, may provide lessons in policy design to other countries looking to reduce maternal and newborn mortality.

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Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

10.21203/rs.2.19108/v2 ◽

2020 ◽

Author(s):

Xiaojing Fan ◽

Meghan Bruce Kumar ◽

Zhongliang Zhou ◽

Ching-Hung Lee ◽

Duolao Wang ◽

...

Keyword(s):

National Health Service ◽

Maternal Health ◽

Health Services ◽

Rural Women ◽

Healthcare Reform ◽

Urban Women ◽

Continuum Of Care ◽

Maternal Health Services ◽

Shaanxi Province ◽

Cross Sectional

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation. Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation. Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ 2 =20.64, P<0.001; rural: χ 2 =131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ 2 =10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ 2 =2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural). Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women. Keywords: Healthcare Reform; Continuum of care for Maternal Health Services; Equity; National Health Service Surveys; China

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Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

10.21203/rs.2.19108/v3 ◽

2020 ◽

Author(s):

Xiaojing Fan ◽

Meghan Bruce Kumar ◽

Zhongliang Zhou ◽

Ching-Hung Lee ◽

Duolao Wang ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Rural Women ◽

Healthcare Reform ◽

Urban Women ◽

Continuum Of Care ◽

Maternal Health Services ◽

Shaanxi Province ◽

Cross Sectional ◽

Generalised Linear Mixed Model

Abstract Background: Continuum of care for maternal health services (CMHS) is a proven approach to improve health and safety for mothers and newborns. This study aims to explore the influence of China’s 2009 healthcare reform on improving the CMHS utilisation.Methods: This population-based cross-sectional quantitative study included 2332 women drawn from the fourth and fifth National Health Service Surveys of Shaanxi Province, conducted in 2008 and 2013 respectively, before and after China’s 2009 healthcare reform. A generalised linear mixed model (GLMM) was applied to analyse the influence of this healthcare reform on utilisation of CMHS. Concentration curves, concentration indexes and its decomposition method were used to analyse the equity of changes in utilisation.Results: This study showed post-reform CMHS utilisation was higher in both rural and urban women than the CMHS utilisation pre-reform (according to China’s policy defining CMHS). The rate of CMHS utilisation increased from 24.66% to 41.55% for urban women and from 18.31% to 50.49% for rural women (urban: χ2=20.64, P<0.001; rural: χ2=131.38, P<0.001). This finding is consistent when the WHO’s definition of CMHS is applied for rural women after reform (12.13% vs 19.26%; χ2=10.99, P=0.001); for urban women, CMHS utilisation increased from 15.70% to 20.56% (χ2=2.57, P=0.109). The GLMM showed that the rate of CMHS utilisation for urban women post-reform was five times higher than pre-reform rates (OR=5.02, 95%CL: 1.90, 13.31); it was close to 15 times higher for rural women (OR=14.70, 95%CL: 5.43, 39.76). The concentration index for urban women decreased from 0.130 pre-reform (95%CI: -0.026, 0.411) to -0.041 post-reform (95%CI: -0.096, 0.007); it decreased from 0.104 (95%CI: -0.012, 0.222) to 0.019 (95%CI: -0.014, 0.060) for rural women. The horizontal inequity index for both groups of women also decreased (0.136 to -0.047 urban and 0.111 to 0.019 for rural).Conclusions: China’s 2009 healthcare reform has positively influenced utilisation rates and equity of CMHS’s utilisation among both urban and rural women in Shaanxi Province. Addressing economic and educational attainment gaps between the rich and the poor may be effective ways to improve the persistent health inequities for rural women.

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Exploring COVID-19 Related Factors Influencing Antenatal Care Services Uptake: A Qualitative Study among Women in a Rural Community in Southwest Ethiopia

Journal of Primary Care & Community Health ◽

10.1177/2150132721996892 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199689

Author(s):

Shewangizaw Hailemariam ◽

Wubetu Agegnehu ◽

Misganaw Derese

Keyword(s):

Health Care ◽

Maternal Health ◽

Qualitative Study ◽

Antenatal Care ◽

Pregnant Women ◽

Health Facility ◽

Care Service ◽

Maternal Health Service ◽

Related Factors ◽

Factors Influencing

Introduction: Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia. Methods: A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software. Result: The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone. Conclusion: COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.

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Determinants of antenatal care visits and their impact on the choice of birthplace among mothers in Uganda: a systematic review

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2020.11.00492 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Shallon Atuhaire ◽

John Francis Mugisha

Keyword(s):

Antenatal Care ◽

Health Facility ◽

Rural Areas ◽

Health Workers ◽

Cochrane Review ◽

Maternal Health Services ◽

Economic Factors ◽

Sustainable Livelihood ◽

Intrinsic Factors ◽

Socio Economic Factors

Objective: The utilization of Antenatal Care (ANC) services to the recommended time by WHO is still low in developing countries. In Uganda, about 990,000 women become pregnant annually, 90 to 94% of whom attend at least the first ANC visit while 65% and 58% of them attend four or more times in urban and rural areas respectively with eventual health facility birth at about 62%, homebirth and TBA together at about 38%. The study determined antenatal care attendance and the mother’s choice of birthplace in Uganda. Materials and methods: Using electronic databases mainly Google Scholar, Science Direct, PubMed and African Journals Online, and journal articles of international Website, 70,195 articles were identified but only 19 met the Cochrane review inclusion criteria hence were reviewed. Results: Reviewed studies attribute a decline in antenatal care visits and subsequent choice of birthplace to institutional, demographic and socio-economic factors. The demographic factors are maternal age (mothers less than eighteen years are less likely to utilize maternal health services than those above), marital status, occupation, residency, distance from home to the health facility, and parity. The socio-economic factors are mothers’ and partners’ levels of education (less educated women and their partners are less likely to utilize ANC), household income which affects transportation and medical bills, cultural norms and taboos, patriarchy society, enrollment on ANC in the third trimester, and intrinsic factors of attending ANC such as obtaining ANC card to present in case of emergency. Institutional factors include quality of medical care, availability of logistics and supplies, and health workers’ influence in terms of attitude, referral, competences, and staffing. Conclusion: Pregnant women who attend ANC are more likely to deliver in the health facility than those who do not at all. To enable them to attend ANC to full term and have a health facility delivery, their empowerment for increased self-efficacy through education, sustainable livelihood training and provision of subsidized capital alongside partner involvement. The facilitation of health facilities would also attract them.

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