Determinants of timing, adequacy and quality of antenatal care in Rwanda: a cross-sectional study using demographic and health surveys data

Abstract

Background Antenatal care (ANC) is a recommended intervention to lessen maternal and neonatal mortality. The increased rate in ANC coverage in most Sub-Saharan African countries is not considerably reducing the maternal and neonatal mortality. This disconnection has raised concerns to study further the trend and determinants of the ANC timing and quality. We aimed to assess the determinants and trend of the timing, the adequacy and the quality of antenatal care in Rwanda. Method A population-based cross-sectional study design. We used data from the 2010,2015 and 2020 Rwanda demographic and health surveys (RDHS). The study included 18,034 women aged 15–49 years. High quality ANC is when a woman had her first ANC visit within 3 months of pregnancy, had 4 or more ANC visits, received services components of ANC during the visits by a skilled provider. Bivariate analysis and multivariable logistic regression were used to assess the ANC (timing and adequacy), the quality of the content of ANC services and the associated factors. Results The uptake of antenatal services increased in the last 15 years. For instance, the uptake of adequate ANC was 2219(36.16%), 2607(44.37%) and 2925(48.58%) respectively for 2010;2015 and 2020 RDHS. The uptake of high quality ANC from 205(3.48%) in 2010 through 510(9.47%) in 2015 to 779(14.99%) in 2020. Women with unwanted pregnancies were less likely to have timely first ANC (aOR:0.76;95%CI:0.68,0.85) compared to planned pregnancies, they were also less likely to achieve a high-quality ANC (aOR: 0.65;95%CI:0.51,0.82) compared to the planned pregnancies. Mothers with a secondary and higher education were 1.5 more likely to achieve a high-quality ANC (aOR:1.50;95%CI:1.15,1.96) compared to uneducated mothers. Increasing maternal age is associated with reduced odds of update of ANC component services (aOR:0.44;95%CI:0.25,0.77) for 40 years and above when referred to teen mothers). Conclusion Low-educated mothers, advanced maternal age, and unintended pregnancies are the vulnerable groups that need to be targeted in order to improve ANC-related indicators. One of the credible measures to close the gap is to strengthen health education, promote family planning, and promote service utilization.

Adequacy of Antenatal Care at Ministry of Health Facilities in Jeddah, Saudi Arabia: A Cross-Sectional Study

“…This finding is relatively lower than that reported in the United States at 75% [7]. However, it was noticeably higher than that found in Rwanda and Ethiopia at 43% and 3%, respectively [8,11].…”

Contents of antenatal care services in Afghanistan: findings from the national health survey 2018

“…Our findings showed that the likelihood of receiving 5–8 ANC services was significantly greater for pregnant women who could read and write. This finding may not be unexpected as previous studies in LMICs demonstrated the importance of women’s education for the increased utilization of health services during ANC visits [ 47 – 49 ]. The ability to read and write is often associated with higher levels of exposure to reading educational materials, watching television, and listening to the radio, which can facilitate understanding of health information and enabling pregnant women to make informed decisions about their health.…”

How do household living conditions and gender-related decision-making influence child stunting in Rwanda? A population-based study

“…Rwanda has made significant efforts to reduce mortality in children <5 years through various interventions, including increasing the number of antenatal care visits, involving community health workers, and implementing community-based health insurance schemes [31]. However, low birth weight and hygiene-related diseases remain prevalent in the country [32]. In our study, we found that birth weight was lower for stunted children compared with non-stunted children.…”