Determinants of maternal health care and birth outcome in the Dande Health and Demographic Surveillance System area, Angola

Abstract

Objectives Maternal health care improvement and reduction of maternal and child mortality are priorities of the global health agenda. In Angola, maternal mortality remains high and the risk of pregnancy-related death was 1 in 32 during 2015. This study aims to identify demographic and social factors influencing antenatal care and health facility delivery among women in Dande and to understand their impact on birth outcomes. Methods This study is based on community–based longitudinal data collected by the Dande Health and Demographic Surveillance System between 2009 and 2015. Data on pregnancy outcomes (10,289 outcomes of 8,066 women) were collected for all reported pregnancies, including sociodemographic information, health services utilisation and women’s reproductive history. Logistic regression was used to investigate the determinants of birth outcomes, antenatal care attendance and institutionalised delivery. Findings Of the 10,289 pregnancy outcomes, 98.5% resulted in live births, 96.8% attended antenatal care, and 82.5% had four or more visits. Yet, 50.7% of the women delivered outside a health facility. Antenatal care attendance was a determinant of birth outcomes (stillbirth: unadjusted OR = 0.34 95% CI = 0.16–0.70; abortion: OR = 0.07 95% CI = 0.04–0.12). Older women, with lower education, living at a greater distance of a health facility and in rural areas, were less likely to use maternal health care. Having had previous pregnancies, namely resulting in live births, also decreased the likelihood of health care utilization by pregnant women. Conclusions The study identifies relevant social determinants for the utilisation of antenatal care, place of delivery and their impact on birth outcome, thereby providing insight on how best to address inequities in health care utilization.

Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya

“…The odds of having at least four ANC visits during pregnancy was significantly lower among women who were not married. Studies have shown that both economic status and dynamics regarding the distribution of power influence the use of maternal health services [64]. High birth order was also associated with a lower likelihood of utilising ANC4.…”

HIV, HBV and syphilis screening in antenatal care in Lubango, Angola

“…There are only a few reports about ANC in Angola. [3][4][5] To our knowledge, this is the first one about ANC infection screening. We characterised ANC screening rates for HIV, HBV and syphilis among 500 parturient women admitted between October 2016 to September 2017 to the Irene Neto Maternity service in Lubango, Huíla, the second most populous province of Angola (Oliveira et al, 2020, accepted to Sex Transm Infect).…”

Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey

“…Studies conducted by a number of scholars in Africa have identified socio-economic factors such as maternal education, household wealth status, sub-national region, and place of residence as predictors of the utilization of ANC services [13][14][15][16][17][18][19]. Literature in Angola show maternal health service, including ANC, can be affected by socio-economic factors such as maternal education, maternal age, household economic status, place of residence, distance to facility, parity and previous adverse pregnancy outcomes [20,21].…”

“…There is little evidence in Angola about determinants of utilization of ANC services [20,21] and the extent of socio-economic and geographically related inequalities are largely unknown. Context-based evidence is necessary to provide targeted interventions that reduce health inequities among sub-groups [27].…”