Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

Abstract

Background Over the last decade, progress in reducing maternal mortality in Rwanda has been slow, from 210 deaths per 100,000 live births in 2015 to 203 deaths per 100,000 live births in 2020. Access to quality antenatal care (ANC) can substantially reduce maternal and newborn mortality. Several studies have investigated factors that influence the use of ANC, but information on its quality is limited. Therefore, this study aimed to identify the determinants of quality antenatal care among pregnant women in Rwanda using a nationally representative sample. Methods We analyzed secondary data of 6,302 women aged 15–49 years who had given birth five years prior the survey from the Rwanda Demographic and Health Survey (RDHS) of 2020 data. Multistage sampling was used to select RDHS participants. Good quality was considered as having utilized all the ANC components. Multivariable logistic regression was conducted to explore the associated factors using SPSS version 25. Results Out of the 6,302 women, 825 (13.1%, 95% CI: 12.4–14.1) utilized all the ANC indicators of good quality ANC); 3,696 (60%, 95% CI: 58.6–61.1) initiated ANC within the first trimester, 2,975 (47.2%, 95% CI: 46.1–48.6) had 4 or more ANC contacts, 16 (0.3%, 95% CI: 0.1–0.4) had 8 or more ANC contacts. Exposure to newspapers/magazines at least once a week (aOR 1.48, 95% CI: 1.09–2.02), lower parity (para1: aOR 6.04, 95% CI: 3.82–9.57) and having been visited by a field worker (aOR 1.47, 95% CI: 1.23–1.76) were associated with more odds of receiving all ANC components. In addition, belonging to smaller households (aOR 1.34, 95% CI: 1.10–1.63), initiating ANC in the first trimester (aOR 1.45, 95% CI: 1.18–1.79) and having had 4 or more ANC contacts (aOR 1.52, 95% CI: 1.25–1.85) were associated with more odds of receiving all ANC components. Working women had lower odds of receiving all ANC components (aOR 0.79, 95% CI: 0.66–0.95). Conclusion The utilization of ANC components (13.1%) is low with components such as having at least two tetanus injections (33.6%) and receiving drugs for intestinal parasites (43%) being highly underutilized. Therefore, programs aimed at increasing utilization of ANC components need to prioritize high parity and working women residing in larger households. Promoting use of field health workers, timely initiation and increased frequency of ANC might enhance the quality of care.

Multilevel analysis of quality of antenatal care and associated factors among pregnant women in Ethiopia: a community based cross-sectional study

“…Furthermore, pregnant women who had received at least four ANC visits had the quality of ANC compared with mothers who had received below four ANC visits. This finding agreed with the report from Southern Ethiopia,18 and Rwanda 53. It might be that women who visit four or more ANC have a greater chance of getting extensive health education sessions, have improved rapport with ANC providers and are more likely to get and recognise quality of ANC and report it positively 54 55.…”

“…This finding agreed with the report from Southern Ethiopia, 18 and Rwanda. 53 It might be that women who visit four or more ANC have a greater chance of getting extensive health education sessions, have improved rapport with ANC providers and are more likely to get and recognise quality of ANC and report it positively. 54 55 Furthermore, the frequent contact between the ANC provider and the pregnant woman also promotes a sense of trust and confidence in the services as well as enhances the familiarity of the pregnant woman with the health system.…”

“… 56 This ensures that women to freely share information with skilled providers and that further ANC components can be served as a result. 53 57 …”

“…Furthermore, the frequent contact between the ANC provider and the pregnant woman also promotes a sense of trust and confidence in the services as well as enhances the familiarity of the pregnant woman with the health system 56. This ensures that women to freely share information with skilled providers and that further ANC components can be served as a result 53 57…”

Continuum of maternal and newborn health in Sierra Leone: a 2019 national survey

“…These include integrated and uninterrupted antenatal care (ANC), skill birth attendance (SBA), and postnatal care (PNC) packages as critical strategies in reducing maternal and neonatal mortality and morbidity [13]. Timely ANC contacts are meant to effect birth preparedness, enable identification and treatment of illness during pregnancy [14][15][16]. Having skilled birth attendance from qualified and experienced professionals assures safe delivery with the necessary drugs and supplies for effective prevention, management of emergencies and also for referral in case of any obstetric complications [6,17].…”