Effect of quality antenatal care service on the continuum of maternal and newborn health care services; a follow up study at public health facilities of Bahir-dar city administration; North West Ethiopia
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Date
2018-05
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Addis Ababa Universty
Abstract
Background: In Ethiopia, more than 62 % of pregnant women attend antenatal care (ANC) at
least once and it is an opportunity for reaching pregnant women with a number of interventions
that may be vital to their health and the well-being of their infants. However data on the extent to
which providers utilize these opportunities remain limited especially in developing countries.
Ethiopia is one of the countries that experiences relatively high ANC coverage and high maternal
and neonatal mortality. This paradox urges the need to investigate the linkage between ANC
service quality and continuum of maternal and newborn health care services.
Objective: To assess the effect of antenatal care service quality on the continuum of maternal
and newborn health care services at public health facilities of Bahir Dar City Administration.
Method: A facility based prospective follow up study was conducted among 970 first ANC
visit pregnant women with gestational age ≤16weeks selected by systematic sampling technique
(k=3). Women were followed from their first ANC visit till six weeks after delivery.
Longitudinal data on the quality of ANC service was collected through structured observation
checklist during consultation with ANC providers during each of the four ANC visits. ANC
service was considered as acceptable quality if women received ≥75th percentile of the essential
ANC services. Exit interview just after their fourth ANC visit was carried out to assess the
satisfaction of pregnant women on ANC services they received and another exit interview was
also conducted at 6 weeks after birth when women come to immunize their child to assess the
essential newborn care practices that their babies received from a provider and/or woman; and
whether or not they started to use postpartum modern family planning. If a woman does not
come to the health facility for immunization, the data collectors traced her based on the address
registered during her first ANC visit.
For the assessment of health facility delivery, postpartum modern family planning use and
essential newborn care practices, completed data were obtained from 823 women where as for
the assessment of birth weight, it was obtained from 718 women since those women who gave
birth at home and those who deliver a premature or still birth baby were excluded due to the fact
that data on birth weight could not be obtained and as it might be affected by the underlying
conditions respectively.
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Generalized Estimating Equation (GEE) was carried out to control cluster effect among women
who received ANC in the same facility. The model fitness was checked by observing the
difference of the -2 log likelihood ratio between the null model and the model with independent
variables; linear regression assumptions were also checked by graphical and/or statistical
methods accordingly. In addition, Multi co linearity diagnosis was also carried out using
variance inflation factor (VIF).
Based on Hosmer and Lemeshow applied logistic regression guide a p-value <0.2 was
considered to select eligible variables for multivariable regression analyses and p-value <0.05
was considered to identify statistically significant predictor variables for the outcome of interest.
Results: Among 823 pregnant women who completed follow up, only about one-fourth (27.6%)
(95% CI =24.5%, 30.5%) received acceptable quality ANC services. The odds of giving birth at
health facility among pregnant women who received acceptable ANC service quality was about
3.38 times higher than pregnant women who received un acceptable quality ANC service
(AOR=3.38, 95% CI: 1.67, 6.83). Being urban dweller (AOR = 9.91, 95% CI: 2.52, 38.91),
being younger age (AOR = 3.69, 95% CI: 1.44, 9.49); Secondary school and above educational
status of pregnant women (AOR = 6.83, 95% CI; 3.33, 13.97) were also positively associated
with Health facility delivery.
However, primary school educational status of women has no significant difference in the use of
institutional delivery compared to those women who cannot read and write.
The magnitude of low birth weight (<2500grams) among 718 babies delivered at the health
facility was 7.8% (95%CI= 6.0%, 9.7%) with 1.4% versus 10.5% among those who received
acceptable and not acceptable ANC services quality respectively (P-value<0.001); frequency of
maternal nutritional advice (β= 0.147, 95%CI= 0.11, 0.19), iron-folic acid supplementation (β= -
0.358, 95%CI= -0.476,-0.240), tetanus toxoid vaccination (β= 0.609, 95%CI= 0.316, 0.903),
maternal educational status (β= 0.079, 95%CI= 0.06, 0.10) and parity (β= -0.174, 95%CI= 0.24,
0.11) were determinants for birth weight.
About 22.7% of pregnant women were counseled about postpartum family planning at least once
during their four ANC visits. The magnitude of postpartum modern family planning use within 6
weeks after delivery among the study women was 157 (19.1%) with 95%CI (16.4%, 21.9%). The
odds of postpartum modern family planning use within 6 weeks after birth among women who
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were counseled about postpartum family planning at their third or fourth visit was 3.5 times
higher compared to those who were not counselled at any of their visits (AOR=3.5; 95%
CI:2.19,5.49). Being satisfied with ANC services received (AOR= 4.12; 95% CI: 2.55, 6.66),
counseling on birth preparedness and complication readiness plan (AOR= 2.2; 95% CI: 1.32,
3.55), Being counselled on breast feeding (AOR= 1.8; 95% CI: 1.15, 2.82) and post natal care
use (AOR= 13.5; 95% CI: 8.24, 22.07) had also significant positive effect on postpartum modern
family planning use.
The composite index for good essential newborn care practice was only 13.7%, with 95% CI
(11.3%, 16.2%). About 24.7% versus 9.6% women who received acceptable and un acceptable
ANC service quality had good essential newborn care practices (X2=31.668, p<0.000). ANC
service quality (AOR= 2.31, 95% CI=1.47, 3.65), PNC use (AOR= 1.69, 95% CI=1.03, 2.79),
parity (AOR= 0.43 95% CI=0.27, 0.69) and age (AOR=3.94 95% CI=1.12, 13.91) of the women
were predictors for essential newborn care practice (ENBC) practice
Conclusion and recommendation:
The quality of ANC service was low and adherence to essential contents of ANC services was
also heterogeneous.
ANC service quality ensures normal birth weight outcome
Majority of the post partum women were at risk for closely spaced pregnancy; the risk increases
among those who were not counselled on FP
Good ENBC practice was significantly low; mainly due to problem related to clean cord care
Quality of ANC service matters continuum of maternal and newborn health care services more
than frequency of visit.
Therefore Maternal and newborn health programme managers and health providers need to
ensure continuity of care through maintaining the quality of ANC service by integrating maternal
and newborn health care services and through strengthening referral linkages between
community health workers (like health extension workers and health development armies) and
primary level of care for maternal and newborn care services.
In addition, the local authorities at each level of health sector or the nongovernmental
organizations working to improve maternal and newborn health need to provide training for
ANC providers and equip the necessary supplies for the provision of quality ANC service.
Description
Keywords
newborn health,pregnant women