Determinants of first trimester attendance at antenatal care clinics in the Amazon region of Peru: A case-control study

Abstract

ObjectiveTo identify determinants which influence the timing of the first antenatal care (ANC) visit in pregnant women.DesignRetrospective matched nested case-control study.SettingTwo health centres, Belén and 6 de Octubre, in the Peruvian Amazon.PopulationAll pregnant women who had attended ANC during the years 2010, 2011, and 2012.MethodsAll cases (819 women initiating ANC in their first trimester) were selected from ANC registries from 2010 to 2012. A random sample of controls (819 women initiating ANC in their second or third trimester) was matched 1:1 to cases on health centre and date of first ANC visit. Data were obtained from ANC registries. Conditional logistic regression analyses were performed.Main outcome measureCase-control status of each woman determined by the gestational age at first ANC visit.ResultsCases had higher odds of: 1) being married or cohabiting (aOR = 1.69; 95% CI: 1.19, 2.41); 2) completing secondary school or attending post-secondary school (aOR = 1.45; 95% CI: 1.02, 2.06); 3) living in an urban environment (aOR = 1.79; 95% CI: 1.04, 3.10) and 4) having had a previous miscarriage (aOR = 1.56; 95% CI: 1.13, 2.15), compared to controls. No statistically significant difference in odds was found for parity (aOR = 1.08; 95% CI: 0.85, 1.36).ConclusionsThis study provides empirical evidence of determinants of first ANC attendance. These findings are crucial to the planning and timing of local interventions, like deworming, aimed at pregnant women so that they can access and benefit fully from all government-provided ANC services.

Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries

“…Strategies to increase ANC contacts must target these women. Our findings were consistent with other studies [1,[24][25][26][27][28]: one of them examined coverage and timing of ANC among the poor in Mesoamerican countries and showed that education, parity and marital status were factors predicting timely ANC initiation [24]. Similarly, Gupta et al looked at utilization of antenatal care in Tanzania between 1990 and 2010 and found that urban residence, lower birth order and ANC initiation before four months of gestation were associated with utilization of at least four antenatal care visits [1].…”

Barriers for pregnant women living in rural, agricultural villages to accessing antenatal care in Cambodia: A community-based cross-sectional study combined with a geographic information system

“…Enabling pregnant women to continuously receive ANC, skilled birth attendance at delivery, and postnatal care (PNC) are reported to have a significant positive impact on overall MNCH indicators [ 7 ]. In particular, receiving ANC has been shown to be one of, if not the best, indicator of positive pregnancy outcomes, significantly contributing to the reduction of maternal morbidity and mortality [ 5 , 8 ]. ANC are used to identify pregnancy risks and provide care for pregnant women who might be susceptible to a wide variety of potentially fatal conditions such as HIV, malaria, tuberculosis, anemia, and malnutrition [ 5 , 9 , 10 ].…”

The timing and quality of antenatal care received by women attending a primary care centre in Iquitos, Peru: A facility exit survey

“…The proportion of women initiating their ANC in their first trimester, although higher than previous reports from Iquitos (32.5%) and other developing countries, is lower than the national figure (79.8%) [6,16,[32][33][34][35][36][37][38]. This could be due to the Amazonian culture in Iquitos, resulting in some women visiting practitioners of traditional Amazonian medicine before accessing ANC later in pregnancy [16,39].…”

“…As well as women missing appointments, the lower proportion of women attending according to the MoHP schedule could be due to delayed initiation of ANC, resulting in an absence of appointments in earlier gestational windows. Community health promotion and education activities could be implemented within Iquitos to encourage more women to access ANC in their first trimester to meet WHO recommendations and encourage subsequent appointments to be attended according to the MoHP schedule [16,40]. Trials of conditional cash transfer systems as an incentive for attending ANC have also been successful in improving rates of women attending antenatal appointments in Peru [49].…”

“…One study observed that in the regional capital of Iquitos, 32.5% of 2647 women initiated their ANC in their first trimester. Another study reported that an average of six antenatal appointments were attended during the pregnancies of 3191 postpartum women in Iquitos-the recommended minimum by the Ministry of Health, Peru (MoHP) [16][17][18]. Whether the appointments were attended within the MoHP recommended gestational ages was not clear.…”