Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries
Identifieur interne : 003802 ( Ncbi/Merge ); précédent : 003801; suivant : 003803Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries
Auteurs : Ghada Saad Addad [Liban] ; Jocelyn Dejong [Liban] ; Nancy Terreri ; María Clara Restrepo Éndez [Brésil] ; Jamie Perin [États-Unis] ; Lara Vaz [États-Unis] ; Holly Newby [États-Unis] ; Agbessi Amouzou [États-Unis] ; Aluísio Jd Barros [Brésil] ; Jennifer Bryce [États-Unis]Source :
- Journal of Global Health [ 2047-2978 ] ; ????.
Abstract
Antenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop–off in use between ANC1+ and ANC4+, and explores inequalities in women’s use of ANC services. It also identifies determinants of utilization and describes countries’ ANC–related policies, and programs.
We performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women’s education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country–based informants.
Each country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence–based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women’s education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman’s education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify.
Secondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub–groups, all countries can benefit from specific in–country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women’s perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.
Url:
DOI: 10.7189/jogh.06.010404
PubMed: 27231540
PubMed Central: 4871063
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p>Antenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop–off in use between ANC1+ and ANC4+, and explores inequalities in women’s use of ANC services. It also identifies determinants of utilization and describes countries’ ANC–related policies, and programs.</p>
</sec>
<sec><title>Methods</title>
<p>We performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women’s education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country–based informants.</p>
</sec>
<sec><title>Results</title>
<p>Each country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence–based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women’s education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman’s education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify.</p>
</sec>
<sec><title>Conclusion</title>
<p>Secondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub–groups, all countries can benefit from specific in–country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women’s perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.</p>
</sec>
</div>
</front>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">J Glob Health</journal-id>
<journal-id journal-id-type="iso-abbrev">J Glob Health</journal-id>
<journal-id journal-id-type="publisher-id">JGH</journal-id>
<journal-title-group><journal-title>Journal of Global Health</journal-title>
</journal-title-group>
<issn pub-type="ppub">2047-2978</issn>
<issn pub-type="epub">2047-2986</issn>
<publisher><publisher-name>Edinburgh University Global Health Society</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27231540</article-id>
<article-id pub-id-type="pmc">4871063</article-id>
<article-id pub-id-type="publisher-id">jogh-06-010404</article-id>
<article-id pub-id-type="doi">10.7189/jogh.06.010404</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Articles</subject>
</subj-group>
</article-categories>
<title-group><article-title>Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries</article-title>
<alt-title alt-title-type="running-head">Saad–Haddad et al. Antenatal care utilization survey data</alt-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Saad–Haddad</surname>
<given-names>Ghada</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>DeJong</surname>
<given-names>Jocelyn</given-names>
</name>
<xref ref-type="aff" rid="aff1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Terreri</surname>
<given-names>Nancy</given-names>
</name>
<xref ref-type="aff" rid="aff2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Restrepo–Méndez</surname>
<given-names>María Clara</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Perin</surname>
<given-names>Jamie</given-names>
</name>
<xref ref-type="aff" rid="aff4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vaz</surname>
<given-names>Lara</given-names>
</name>
<xref ref-type="aff" rid="aff5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Newby</surname>
<given-names>Holly</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Amouzou</surname>
<given-names>Agbessi</given-names>
</name>
<xref ref-type="aff" rid="aff6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Barros</surname>
<given-names>Aluísio JD</given-names>
</name>
<xref ref-type="aff" rid="aff3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bryce</surname>
<given-names>Jennifer</given-names>
</name>
<xref ref-type="aff" rid="aff7"><sup>7</sup>
</xref>
</contrib>
<aff id="aff1"><label>1</label>
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon</aff>
<aff id="aff2"><label>2</label>
Independent consultant</aff>
<aff id="aff3"><label>3</label>
Federal University of Pelotas, Pelotas, Brazil</aff>
<aff id="aff4"><label>4</label>
Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA</aff>
<aff id="aff5"><label>5</label>
Save the Children, Washington D.C., USA</aff>
<aff id="aff6"><label>6</label>
Division of Data, Research and Policy, United Nations Children’s Fund, New York City, NY, USA</aff>
<aff id="aff7"><label>7</label>
Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA</aff>
</contrib-group>
<author-notes><corresp id="cor1"><bold>Correspondence to:</bold>
Ghada Saad–Haddad
Faculty of Health Sciences
American University of Beirut
Beirut, Lebanon
<email xlink:href="gs29@aub.edu.lb">gs29@aub.edu.lb</email>
</corresp>
</author-notes>
<pub-date date-type="pub" publication-format="print"><month>6</month>
<year>2016</year>
</pub-date>
<pub-date date-type="pub" publication-format="electronic"><day>25</day>
<month>2</month>
<year>2016</year>
</pub-date>
<volume>6</volume>
<issue>1</issue>
<elocation-id>010404</elocation-id>
<permissions><copyright-statement>Copyright © 2016 by the Journal of Global Health. All rights reserved.</copyright-statement>
<copyright-year>2016</copyright-year>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/2.5/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><sec><title>Background</title>
<p>Antenatal care (ANC) is critical for improving maternal and newborn health. WHO recommends that pregnant women complete at least four ANC visits. Countdown and other global monitoring efforts track the proportions of women who receive one or more visits by a skilled provider (ANC1+) and four or more visits by any provider (ANC4+). This study investigates patterns of drop–off in use between ANC1+ and ANC4+, and explores inequalities in women’s use of ANC services. It also identifies determinants of utilization and describes countries’ ANC–related policies, and programs.</p>
</sec>
<sec><title>Methods</title>
<p>We performed secondary analyses using Demographic Health Survey (DHS) data from seven Countdown countries: Bangladesh, Cambodia, Cameroon, Nepal, Peru, Senegal and Uganda. The descriptive analysis illustrates country variations in the frequency of visits by provider type, content, and by household wealth, women’s education and type of residence. We conducted a multivariable analysis using a conceptual framework to identify determinants of ANC utilization. We collected contextual information from countries through a standard questionnaire completed by country–based informants.</p>
</sec>
<sec><title>Results</title>
<p>Each country had a unique pattern of ANC utilization in terms of coverage, inequality and the extent to which predictors affected the frequency of visits. Nevertheless, common patterns arise. Women having four or more visits usually saw a skilled provider at least once, and received more evidence–based content interventions than women reporting fewer than four visits. A considerable proportion of women reporting four or more visits did not report receiving the essential interventions. Large disparities exist in ANC use by household wealth, women’s education and residence area; and are wider for a larger number of visits. The multivariable analyses of two models in each country showed that determinants had different effects on the dependent variable in each model. Overall, strong predictors of ANC initiation and having a higher frequency (4+) of visits were woman’s education and household wealth. Gestational age at first visit, birth rank and preceding birth interval were generally negatively associated with initiating visits and with having four or more visits. Information on country policies and programs were somewhat informative in understanding the utilization patterns across the countries, although timing of adoption and actual implementation make direct linkages impossible to verify.</p>
</sec>
<sec><title>Conclusion</title>
<p>Secondary analyses provided a more detailed picture of ANC utilization patterns in the seven countries. While coverage levels differ by country and sub–groups, all countries can benefit from specific in–country assessments to properly identify the underserved women and the reasons behind low coverage and missed interventions. Overall, emphasis needs to be put on assessing the quality of care offered and identifying women’s perception to the care as well as the barriers hindering utilization. Country policies and programs need to be reviewed, evaluated and/or implemented properly to ensure that women receive the recommended number of ANC visits with appropriate content, especially, poor and less educated women residing in rural areas.</p>
</sec>
</abstract>
<counts><page-count count="20"></page-count>
</counts>
</article-meta>
</front>
</pmc>
<affiliations><list><country><li>Brésil</li>
<li>Liban</li>
<li>États-Unis</li>
</country>
<region><li>District de Columbia</li>
<li>Maryland</li>
<li>État de New York</li>
</region>
<settlement><li>Washington (district de Columbia)</li>
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<name sortKey="Bryce, Jennifer" sort="Bryce, Jennifer" uniqKey="Bryce J" first="Jennifer" last="Bryce">Jennifer Bryce</name>
<name sortKey="Newby, Holly" sort="Newby, Holly" uniqKey="Newby H" first="Holly" last="Newby">Holly Newby</name>
<name sortKey="Vaz, Lara" sort="Vaz, Lara" uniqKey="Vaz L" first="Lara" last="Vaz">Lara Vaz</name>
</country>
</tree>
</affiliations>
</record>
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