Barriers to early prenatal care in South Africa

Haddad, Devin; Makin, J.D.; Pattinson, Robert Clive; Forsyth, Brian W.C.

doi:10.1016/j.ijgo.2015.06.041

Cited by 19 publications

(31 citation statements)

References 17 publications

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“…Other studies [39,40] showed that women do not attend ANC because they are not familiar OR Odds ratio, CI Confidence interval a statistically significant at 1% level of significance, b significant at 5% level of significance c All estimates (OR, CI) are weighted using sampling weights, sampling unit and strata available in the 2014-15 DHS data or do not understand the value of ANC especially those who did not experience any complications in their prior pregnancy or those whose pregnancy is their first (primigravida). Contrary to previous findings on ANC utilization [22,41,42], age and wealth group were not significantly associated with the outcome in our analysis. However, we kept these variables in the model based on a priori knowledge [41] and included the interaction term between these two variables in the model for sensitivity analysis.…”

Section: Demographic and Socio-economic Status Factorscontrasting

confidence: 99%

“…Employment status was a protective factor from inadequate ANC visits which is consistent with previous findings [21]. Women who are employed might be more informed and have financial autonomy to access health care compared to unemployed women as many other studies have reported [4,21,42].…”

Section: Demographic and Socio-economic Status Factorssupporting

confidence: 89%

“…Although other studies showed that women's poverty is linked to ANC services utilization [37,42], this might not be the case in Rwanda due to the community-based health insurance (CBHI) scheme, commonly known as mituelle de Sante. We found that 72% of women were insured through CBHI which gave women access to ANC services at the lowest price or no cost.…”

Section: Demographic and Socio-economic Status Factorsmentioning

confidence: 99%

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Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

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Background: Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda. Methods: This study is cross-sectional using secondary data from the 2014-15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15-49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.Results: Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results. Conclusion: The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

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Section: Demographic and Socio-economic Status Factorscontrasting

confidence: 99%

Section: Demographic and Socio-economic Status Factorssupporting

confidence: 89%

Section: Demographic and Socio-economic Status Factorsmentioning

confidence: 99%

See 1 more Smart Citation

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Nisingizwe

Tuyisenge

Hategeka

et al. 2020

BMC Pregnancy Childbirth

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“…Although reasons for poor access were not assessed, likely factors include stigma (real or perceived), and concomitant disrespect and abuse meted out by health workers [32–34]. The especially low levels of attendance at HCHC, the Hillbrow site, where most residents are foreign nationals [35], suggests that xenophobia within the health system might be deterring women who are not South African from seeking health care [36, 37].…”

Section: Discussionmentioning

confidence: 99%

Attendance at antenatal clinics in inner-city Johannesburg, South Africa and its associations with birth outcomes: analysis of data from birth registers at three facilities

et al. 2017

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BackgroundAntenatal care (ANC) clinics serve as key gateways to screening and treatment interventions that improve pregnancy outcomes, and are especially important for HIV-infected women. By disaggregating data on access to ANC, we aimed to identify variation in ANC attendance by level of care and across vulnerable groups in inner-city Johannesburg, and document the impact of non-attendance on birth outcomes.MethodsThis record review of routine health service data involved manual extraction of 2 years of data from birth registers at a primary-, secondary- and tertiary-level facility within inner-city Johannesburg. Information was gathered on ANC attendance, HIV testing and status, pregnancy duration, delivery mode and birth outcomes. Women with an unknown attendance status were considered as not having attended clinic, but effects of this assumption were tested in sensitivity analyses. Multiple logistic regression was used to identify associations between ANC attendance and birth outcomes.ResultsOf 31,179 women who delivered, 88.7% (27,651) had attended ANC (95% CI = 88.3–89.0). Attendance was only 77% at primary care (5813/7543), compared to 89% at secondary (3661/4113) and 93% at tertiary level (18,177/19,523). Adolescents had lower ANC attendance than adults (85%, 1951/2295 versus 89%, 22,039/24,771). Only 37% of women not attending ANC had an HIV test (1308/3528), compared with 93% of ANC attenders (25,756/27,651). Caesarean section rates were considerably higher in women who had attended ANC (40%, 10,866/27,344) than non-attenders (13%, 422/3360). Compared to those who had attended ANC, non-attenders were 1.6 fold more likely to have a preterm delivery (95% CI adjusted odds ratio [aOR] = 1.4–1.8) and 1.4 fold more likely to have a stillbirth (aOR 95% CI = 1.1–1.9). Similar results were seen in analyses where missing data on ANC attendance was classified in different ways.ConclusionInner-city Johannesburg has an almost 5% lower ANC attendance rate than national levels. Attendance is particularly concerning in the primary care clinic that serves a predominantly migrant population. Adolescents had especially low rates, perhaps owing to stigma when seeking care. Interventions to raise ANC attendance, especially among adolescents, may help improve birth outcomes and HIV testing rates, bringing the country closer to achieving maternal and child health targets and eliminating HIV in children.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4347-z) contains supplementary material, which is available to authorized users.

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“…It is widely acknowledged that access to biomedical health care remains elusive to many patients, especially the poor and rural dwellers in Ghana and the subregion (Aikins & Marks, 2007;Helmchen & Lo Sasso, 2010;Powell-Jackson, Hanson, Whitty, & Ansah, 2014). Scholars and researchers criticize the structure of biomedical care, and opine its inability to reach the mass is due to social distance, economic and financial constraints, and the uneven distribution of health and medical resources in this part of the world (Haddad, Makin, Pattinson, & Forsyth, 2015;Harris et al, 2011;Jørgensen, 2008;Kissah-Korsah, 2008;Mills et al, 2012). For instance, research in the 1980s and early 1990s observed a drastic fall in the use of biomedical care among Ghanaians due to the introduction of user fees during the structural adjustment era (Anyinam, 1994;Asenso-Okyere et al, 1998;Nyonator & Kutzin, 1999).…”

Section: A Triple-systems Model Approach To Medical/health Pluralism mentioning

confidence: 99%

An Assessment of Care-Seeking Behavior in Asikuma-Odoben-Brakwa District: A Triple Pluralistic Health Sector Approach

Amegbor

2017

Sage Open

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Discussions and studies on Ghana's pluralistic health care system usually ignore or downplay self-care as a crucial sector in this system of care. In view of this, this study uses a triple sector approach of the pluralistic health care system as advocated by Kleinman to assess care-seeking behaviors of residents in the Asikuma-Odoben-Brakwa District (Ghana). The results of cross-tabulation analysis demonstrate that respondents' general care-seeking behavior is different from the type of care sought for last illness before the study. Data for the study were obtained from 227 urban and rural respondents in the study district in 2013. The findings indicate that factors such as geographic location, health insurance, and perception of the cost of professional care had a bearing on residents' general care-seeking behavior. However, age, sex, relationship status, economic status, and proximity to nearest biomedical care service influenced the type of treatment sought for last illness. The approach use of the study demonstrates that self-care remains a general avenue of care for residents, whereas in times of severe illness, respondents often rely on professional biomedical care. The use of professional indigenous care services is generally low due to the financial burden associated with its use.

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Barriers to early prenatal care in South Africa

Cited by 19 publications

References 17 publications

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Attendance at antenatal clinics in inner-city Johannesburg, South Africa and its associations with birth outcomes: analysis of data from birth registers at three facilities

An Assessment of Care-Seeking Behavior in Asikuma-Odoben-Brakwa District: A Triple Pluralistic Health Sector Approach

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