Determinants of access to antenatal care and birth outcomes in Kumasi, Ghana

Abstract

This study aimed to investigate factors that influence antenatal care utilization and their association with adverse pregnancy outcomes (defined as low birth weight, stillbirth, preterm delivery or small for gestational age) among pregnant women in Kumasi. A quantitative cross-sectional study was conducted of 643 women aged 19-48 years who presented for delivery at selected public hospitals and private traditional birth attendants from July-November 2011. Participants’ information and factors influencing antenatal attendance were collected using a structured questionnaire and antenatal records. Associations between these factors and adverse pregnancy outcomes were assessed using chi-square and logistic regression. Nineteen percent of the women experienced an adverse pregnancy outcome. For 49% of the women, cost influenced their antenatal attendance. Cost was associated with increased likelihood of a woman experiencing an adverse outcome (adjusted OR = 2.15; 95% CI = 1.16-3.99; p = 0.016). Also, women with >5 births had an increased likelihood of an adverse outcome compared with women with single deliveries (adjusted OR = 3.77; 95% CI = 1.50-9.53; p = 0.005). The prevalence of adverse outcomes was lower than previously reported (44.6% - 19%). Cost and distance were associated with adverse outcomes after adjusting for confounders. Cost and distance could be minimized through a wider application of the Ghana National Health Insurance Scheme.

Mobilising faith-based and lay leaders to address antenatal care outcomes in northern Ghana

“…Initiation of ANC in the first trimester allows for early identification of potential underlying conditions that could increase maternal and child morbidity and mortality (e.g. control of anaemia, prevention of malaria complications, and identification and treatment of sexually transmitted infections -see Asundep et al 2013;Campbell and Graham 2006;Lincetto et al 2006). Good quality and regularity of ANC visits allow for the provision of a variety of services, including pregnancy-induced hypertension, micronutrient supplementation, and tetanus immunisation, which have been shown to be effective in improving pregnancy and neonatal outcomes (Carroli, Rooney, and Villar 2001).…”

“…Many factors have been shown to affect the successful uptake of early and regular ANC, including maternal and paternal education levels, maternal employment status, household economic status, distance to health facility, parity and maternal age (Ahmed et al 2010;Asundep et al 2013;Pell et al 2013;Simkhada et al 2008). Organisational barriers to accessing life-saving maternal, neonatal, and child health (MNCH) services have been documented, including providers' attitudes and the services offered (Speizer, Story, and Singh 2014).…”

“…However, wide variability in early and regular ANC attendance exists in Ghana, with the Northern region demonstrating the lowest uptake of these behaviours (Ghana Statistical Service, Ghana Health Service, and ICF International 2015;Pell et al 2013;Speizer, Story, and Singh 2014). Data from a knowledge, attitudes, and practice survey conducted as part of unpublished formative research in the East Mamprusi district in the Northern region showed that 80% of mothers with children aged 0 to 23 months received four or more ANC visits and only 50% reported that their first visit took place during the first trimester (Tuli, Wilcox, and Catholic Relief Services 2015).Many factors have been shown to affect the successful uptake of early and regular ANC, including maternal and paternal education levels, maternal employment status, household economic status, distance to health facility, parity and maternal age (Ahmed et al 2010;Asundep et al 2013;Pell et al 2013;Simkhada et al 2008). Organisational barriers to accessing life-saving maternal, neonatal, and child health (MNCH) services have been documented, including providers' attitudes and the services offered (Speizer, Story, and Singh 2014).…”

“…Organisational barriers to accessing life-saving maternal, neonatal, and child health (MNCH) services have been documented, including providers' attitudes and the services offered (Speizer, Story, and Singh 2014). The costs of accessing ANC services, including cost of transportation, services, and equipment, have also been shown to be important barriers to ANC utilisation in SSA, and Ghana in particular (Asundep et al 2013). Ghana instituted its National Health Insurance Scheme (NHIS) in 2003 -with a primary objective to limit cost as a barrier to accessing MNCH services.…”

“…The interaction term, programme area*round of data collection, indicated the effect of the CoC in the context of the EPPICS standard activities. Covariates, including maternal age, education, parity, employment status, ethnicity, and distance from nearest health facility, were selected based on the literature (Ahmed et al 2010;Amoah et al 2016;Asundep et al 2013;Pell et al 2013;Simkhada et al 2008), and were included in all models. To examine the relationship between programme area and round of data collection, the interaction was plotted using the margins command in Stata 13.0.…”