Maternity Care Services Utilization and Factors Associated with Institutional Delivery Among Postpartum Women in Dabat Demographic and Health Survey Site, Northwest Ethiopia: A Community Based Baseline Survey for MNCH Surveillance

Background Maternal continuum of care is identified to have a greatest impact on maternal and child survival. However, there is a wide variation in maternal health services utilization from place to place in Ethiopia. Therefore, knowing antenatal care, labor and delivery, and postnatal care uptake has paramount importance to take interventions. Methods A community-based cross-sectional survey was conducted among 1626 postpartum women. Descriptive statistics were done to characterize the study population and utilization of antenatal care, institutional delivery, and postnatal care services. Logistic regression analysis was employed to identify factors associated with institutional delivery. Results Nearly eighty percent, (79.7%, 95% CI: 77.7, 81.6), of women attended at least one antenatal care visit at any health facility. However, only less than one third (31.4%) used all the recommended antenatal care (ANC). About half, 820 (49.2%: 95% CI: 46.7, 51.8) women delivered their child in health institution. About half, 822 (50.6%, 95% CI: 48.2, 52.9) of postpartum women who participated in this study had at least one postnatal care (PNC) visit at health facilities. Being urban resident (AOR=8.18, 95%CI: 4.69, 14.26)), respondents of higher educational status (AOR= 4.99, 95%CI: 2.51, 9.90), being Orthodox Christian (AOR= 2.35, 95%CI: 1.15, 4.79), getting TT vaccination during pregnancy (AOR=1.54, 95%CI: 1.06, 2.23), and antenatal care utilization (AOR=2.97, 95%CI: 2.06, 4.27) were predictors for health facility/institutional delivery. Conclusions Though a significant proportion of the study participants initiated antenatal care, utilization of all the recommended antenatal care visits, facility delivery, and postnatal care services were low. Health professionals need to use the first antenatal care visit as a golden opportunity to attract and maintain pregnant women for the subsequent maternal health care services.

Timing of first antenatal care visits and number of items of antenatal care contents received and associated factors in Ethiopia: multilevel mixed effects analysis

Background Receiving quality antenatal care (ANC) from skilled providers is essential to ensure the critical health circumstances of a pregnant woman and her child. Thus, this study attempted to assess which risk factors are significantly associated with the timing of antenatal care and the number of items of antenatal care content received from skilled providers in recent pregnancies among mothers in Ethiopia. Methods The data was extracted from the Ethiopian Demographic and Health Survey 2016. A total of 6645 mothers were included in the analysis. Multilevel mixed-effects logistic regression analysis and multilevel mixed Negative binomial models were fitted to find the factors associated with the timing and items of the content of ANC services. The 95% Confidence Interval of Odds Ratio/Incidence Rate Ratio, excluding one, was reported as significant. Results About 20% of the mothers initiated ANC within the first trimester, and only 53% received at least four items of antenatal care content. Being rural residents (IRR = 0.82; 95%CI: 0.75–0.90), wanting no more children (IRR = 0.87; 95%CI: 0.79–0.96), and the husband being the sole decision maker of health care (IRR = 0.88; 95%CI: 0.81–0.96), were associated with reduced items of ANC content received. Further, birth order of six or more (IRR = 0.74; 95%CI: 0.56–0.96), rural residence (IRR = 0.0.41; 95%CI: 0.34–0.51), and wanting no more children (IRR = 0.61; 95%CI: 0.48–0.77) were associated with delayed antenatal care utilization. Conclusions Rural residences, the poorest household wealth status, no education level of mothers or partners, unexposed to mass media, unwanted pregnancy, mothers without decision-making power, and considerable distance to the nearest health facility have a significant impact on delaying the timing of ANC visits and reducing the number of items of ANC received in Ethiopia. Mothers should start an antenatal care visit early to ensure that a mother receives all of the necessary components of ANC treatment during her pregnancy.

Number of Antenatal Care Utilization and Associated Factors Among Pregnant Women in Ethiopia: Zero-Inflated Poisson Regression of 2019 Intermediate Ethiopian Demography Health Survey.

Background The frequency of antenatal care enhances the effectiveness of the program to reduce maternal and child mortality and morbidity. The aim of the study was to determine the number of antenatal care and associated factors in Ethiopia by using 2019 intermediate EDHS. Methods Secondary data analysis was done on 2019 intermediate EDHS. A total of 3,916.6 weighted pregnant women were included in the analysis. Zero-inflated Poisson regression analysis was done by Stata version 14.0. Incident rate ratio and odds ratio with a 95% confidence interval were used to show the strength and direction of the association. Result About one thousand six hundred eighty eight (43.11%) women were attending four and more antenatal care during current pregnancy. Attending primary education (IRR= 1.115, 95% CI: 1.061, 1.172), secondary education (IRR=1.211, 95% CI: 1.131, 1.297) and higher education (IRR=1.274, 95% CI: 1.177, 1.378), reside in poorer household wealth index (IRR= 1.074, 95% CI: 1.01, 1.152), middle household wealth index (IRR= 1.095, 95% CI: 1.018, 1.178), rich household wealth index (IRR=1.129, 95% CI: 1.05, 1.212) and richer household wealth index (IRR=1.186, 95% CI: 1.089, 1.29) increases the number of antenatal care utilization. The frequency of antenatal care was less likely become zero among women attending primary (AOR=0.434, 95% CI: 0.346, 0.545), secondary (AOR=0.113, 95% CI: 0.053, 0.24), higher educational level (AOR=0.052, 95% CI: 0.007, 0.367) in the inflated part. Conclusion The number of antenatal care utilization is low in Ethiopia. Being rural, poorest household index, uneducated and single were factors associated with low number of antenatal care and not attending antenatal care at all. Improving the educational coverage and wealth status of women is important to increase coverage of antenatal care.

Magnitude and determinants of adequate antenatal care service utilization among mothers in Southern Ethiopia

Background Mortality from preventable pregnancy-related complications remains high in Ethiopia. Antenatal care remains a major public health intervention that prevents maternal and neonatal mortality. Thus, this study aimed to assess the magnitude and determinants of adequate antenatal care utilization in Southern Ethiopia. Methods A community-based cross-sectional study was conducted between November and December 2019. A systematic random sampling technique was used to select 670 women. Data were collected using a pre-tested structured questionnaire administered with a digital survey tool (open data kit) and directly exported to STATA version 15 for analysis. Descriptive statistics followed by a multivariable logistic regression analysis were performed. Both crude and adjusted odds ratios (ORs) with 95% confidence intervals were reported. Results The magnitude of adequate antenatal care utilization was 23.13%. Tertiary and above education (AOR,4.15;95%CI: 1.95, 8.83), having the best friend who used maternal care (AOR,2.01;95%CI: 1.18,3.41), husband support (AOR,3.84; 95%CI: 1.05, 14.08), high wealth index (AOR,3.61; 95%CI: 1.86, 6.99), follow-up in private health facilities (AOR, 2.27;95% CI:1.33, 3.88), having a history of risky pregnancy (AOR,2.59; 95%CI: 1.55, 4.35), and planned pregnancy (AOR,2.60;95% CI: 1.35, 4.99) were significant determinants of overall adequate ANC service utilization. Conclusion The utilization of adequate antenatal care services is quite low. The study findings suggest that interventions should be in place to improve husband’s support, social networks, and women’s education. There is also a need to counsel women to utilize family planning.

Magnitude and Determinants of Antenatal Care Utilization in Kandahar City, Afghanistan

Background. Women’s and children’s health is a crucial public health concern that epitomizes the universal platform for Sustainable Development Goals (SDGs). Appropriate and timely care during pregnancy can improve maternal and child health. Objectives. The present study aimed at determining the magnitude and determinants of antenatal care services’ utilization in Kandahar city. Methods. A community-based cross-sectional study involving 850 women with at least one delivery in the last 2 years was carried out in Kandahar city from January to February 2021. Questionnaires to record information on sociodemographic, reproductive, and antenatal care- (ANC-) related characteristics were administered. Data were analyzed using SPSS 21.00 statistical software. We used descriptive statistics such as frequency and percentages to present the data. Determinants of antenatal care services’ utilization were determined using a multivariable logistic regression model. Results. Among all study participants, 589 (69.3%, 95% confidence interval (CI) = 66.0%–72.4%) of study participants utilized antenatal care services at least once. However, only 22% of the women were utilizing the recommended ≥4 ANC visits. Factors that remained significantly associated with antenatal care services’ utilization in multivariable analysis included women’s educational status (adjusted odds ratio (AOR) = 2.0, 95% CI: 1.0–4.3), pregnancy intention (AOR = 2.1, 95% CI: 1.1–3.4), and place of residence (AOR = 1.7, 95% CI: 1.1–2.6). Conclusion. This study has found high rates (vs. the national level) of antenatal care services’ utilization among women who had at least one delivery in the last 2 years. However, the rate of recommended ≥4 ANC visits was low. Factors determining antenatal care utilization such as educational status of the mother, pregnancy intention, and place of residence hold the key to address the issue of ANC services lower utilization and consequently improve maternal and fetal health.

Spatial distribution and associated factors of antenatal care utilization in Ethiopia in 2019: Spatial and multilevel analysis

Background: Antenatal care utilization key to reduces pregnant women death and preparing women for birth. In Ethiopian antenatal care utilization was still not meet health sector transformation plan. There was also regional variation of antenatal care services in the country. Therefore, current study was aimed to explore spatial distribution and associated factors of antenatal care utilization in Ethiopia based on the nationally representative EMDHS data.Methods: Secondary data analysis was done on 2019 Ethiopian mini demographic and health survey (EMDHS) data. ArcGIS 10.7 statistical software were used for spatial analysis. Bernoulli model was fitted by applying Kulldorff methods using the StatsCan 9.6.1 software to analyze the purely spatial clusters of ANC utilization. For associated factor mixed effect multilevel logistic regression was fitted. Inter class correlation (ICC), Median odds ratio (MOR), proportional change variance (PVC) and Deviance used for model comparison and fitness. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to declare significant factors of antenatal care utilization.Results: The prevalence of antenatal care utilization in Ethiopia was 75% [95 CI: 73%, 76%] in this study. The spatial distribution of antenatal car utilization was non-random across the country with Global Moran’s Index value of 0.032, and significant P-value(p<0.05). For associated factor secondary and higher education were 4.2 and 6 time greater than that of no formal education women with AOR of 4.2(1.99-8.66) and 6 (1.62-22) respectively. The odds of richest households were 4.2 times AOR (1.08-2.3) and the odds of married, windowed, and divorced women were 6, 8 and 4.4 time more that of single women respectively in utilizing ANC. The odd of women utilizing ANC was 4.2 times AOR (6.25-10.62). Conclusion: The spatial distribution of ANC utilization in Ethiopia is non-random. Maternal education, marital status, wealth index, place of delivery, pregnancy status region and community women education were significant predicter of antenatal care utilization in Ethiopia. Government and non-governmental organization should scale up maternal health services to low-rate area(hotspot) and poorest women.

Developing targeted client communication messages to pregnant women in Bangladesh: a qualitative study

Background Timely and appropriate evidence-based practices during antenatal care improve maternal and neonatal health. There is a lack of information on how pregnant women and families perceive antenatal care in Bangladesh. The aim of our study was to develop targeted client communication via text messages for increasing antenatal care utilization, as part of an implementation of an electronic registry for maternal and child health. Methods Using a phenomenological approach, we conducted this qualitative study from May to June 2017 in two sub-districts of Chandpur district, Bangladesh. We selected study participants by purposive sampling. A total of 24 in-depth interviews were conducted with pregnant women (n = 10), lactating women (n = 5), husbands (n = 5), and mothers-in-law (n = 4). The Health Belief Model (HBM) was used to guide the data collection. Thematic analysis was carried out manually according to the HBM constructs. We used behavior change techniques to inform the development of targeted client communication based on the thematic results. Results Almost no respondents mentioned antenatal care as a preventive form of care, and only perceived it as necessary if any complications developed during pregnancy. Knowledge of the content of antenatal care (ANC) and pregnancy complications was low. Women reported a variety of reasons for not attending ANC, including the lack of information on the timing of ANC; lack of decision-making power; long-distance to access care; being busy with household chores, and not being satisfied with the treatment by health care providers. Study participants recommended phone calls as their preferred communication strategy when asked to choose between the phone call and text message, but saw text messages as a feasible option. Based on the findings, we developed a library of 43 automatically customizable text messages to increase ANC utilization. Conclusions Pregnant women and family members had limited knowledge about antenatal care and pregnancy complications. Effective health information through text messages could increase awareness of antenatal care among the pregnant women in Bangladesh. This study presents an example of designing targeted client communication to increase antenatal care utilization within formal scientific frameworks, including a taxonomy of behavior change techniques. Trial registration ISRCTN69491836. Registered on December 06, 2018. Retrospectively registered.

Determinants of completing recommended antenatal care utilization in sub-Saharan from 2006 to 2018: evidence from 36 countries using Demographic and Health Surveys

Background Every day in 2017, approximately 810 women died from preventable causes related to pregnancy and childbirth, with 99% of these maternal deaths occurring in low and lower-middle-income countries. Sub-Saharan Africa (SSA) alone accounts for roughly 66%. If pregnant women gained recommended ANC (Antenatal Care), these maternal deaths could be prevented. Still, many women lack recommended ANC in sub-Saharan Africa. This study aimed at determining the pooled prevalence and determinants of recommended ANC utilization in SSA. Methods We used the most recent standard demographic and health survey data from the period of 2006 to 2018 for 36 SSA countries. A total of 260,572 women who had at least one live birth 5 years preceding the survey were included in this study. A meta-analysis of DHS data of the Sub-Saharan countries was conducted to generate pooled prevalence, and a forest plot was used to present it. A multilevel multivariable logistic regression model was fitted to identify determinants of recommended ANC utilization. The AOR (Adjusted Odds Ratio) with their 95% CI and p-value ≤0.05 was used to declare the recommended ANC utilization determinates. Results The pooled prevalence of recommended antenatal care utilization in sub-Saharan Africa countries were 58.53% [95% CI: 58.35, 58.71], with the highest recommended ANC utilization in the Southern Region of Africa (78.86%) and the low recommended ANC utilization in Eastern Regions of Africa (53.39%). In the multilevel multivariable logistic regression model region, residence, literacy level, maternal education, husband education, maternal occupation, women health care decision autonomy, wealth index, media exposure, accessing health care, wanted pregnancy, contraceptive use, and birth order were determinants of recommended ANC utilization in Sub-Saharan Africa. Conclusion The coverage of recommended ANC service utilization was with high disparities among the region. Being a rural residence, illiterate, low education level, had no occupation, low women autonomy, low socioeconomic status, not exposed to media, a big problem to access health care, unplanned pregnancy, not use of contraceptive were determinants of women that had no recommended ANC utilization in SSA. This study evidenced the existence of a wide gap between SSA regions and countries. Special attention is required to improve health accessibility, utilization, and quality of maternal health services.