Socio-economic disadvantage and quality Antenatal Care (ANC) in Sierra Leone: Evidence from Demographic and Health Survey

Abstract

Introduction Reduction of maternal mortality remains a global priority as highlighted by the third Sustainable Development Goal (SDG). This is critical in the case of Sierra Leone as the country is one of three (3) countries with the highest maternal mortality ratio globally, thus 1,120 per 100,000 live births. The approximate lifetime risk of maternal mortality in the country is 1 in 17, relative to 1 in 3,300 in high-income countries. These raise doubt about the quality of the continuum of maternal healthcare in the country, particularly antenatal care and as a result, the objective of the present study is to investigate the association between socio-economic disadvantage and quality antenatal care service utilisation as well as associated correlates in Sierra Leone. Materials and methods The study used data from the most recent Demographic and Health Survey (DHS) of Sierra Leone. Only women who had given birth in the five years preceding the survey were included, which is 6,028. Quality antenatal care was defined as receipt of recommended ANC services including uptake of recommended pregnancy drugs (e.g. Fansidar and iron supplement); injections (e.g. tetanus injection) and having some samples (e.g. blood and urine sample) and health status indicators (e.g. blood pressure) taken. An index was created from these indicators with scores ranging from 0 to 6. The scores 0 to 5 were labelled as “incomplete” and 6 was labelled as “complete” and this was used to create a dummy variable. In analysing the data, descriptive analysis was done using chi-square test as well as an inferential analysis using bivariate and multivariate models. Results Socio-economic disadvantaged [1.46 (1.09, 1.95), place of residence [2.29 (1.43, 3.67)], frequency of listening to radio [1.58 (1.20, 2.09)], health insurance coverage [3.48 (1.40, 8.64)], getting medical help for self: permission to go [0.53(0.42, 0.69) were seen to have significant relationship with quality of ANC utilized by women during pregnancy. Also, women Mende ethnicity are more likely to utilise quality ANC compared to women from the Temne ethnicity [2.58 (1.79, 3.72)]. Conclusion Policy makers could consider measures to boost patronage of quality ANC in Sierra Leone by targeting the socio-economically disadvantaged women. Targeting these sub-groups with pro- maternal and child health (MCH) interventions would help Sierra Leone achieve Goal 3 of the SDGs.

Poor coverage of quality-adjusted antenatal care services: a population-level assessment by visit and source of antenatal care services in Bihar state of India

“… 14 , 26 Previous studies on inequities in ANC contacts have highlighted that those in the lowest SES experience both a limited coverage as well as poor quality of services. 12 , 18 , 24 , 25 , 26 This is also true in our population as women belonging to the lowest wealth index quartile reported the least number of ANC visits, had the highest utilisation of VHND for ANC visit 1, and received the least coverage of quality-adjusted ANC services. The pattern of Q-ANC coverage by the number of ANC visit offers an interesting insight that the relative advantage of a higher Q-ANC coverage for women in the highest wealth index quartile disappeared in the 3rd and 4th ANC visits.…”

“… 23 Currently, there is a significant gap in the understanding of quality-adjusted coverage at the population-level for each ANC visit and by the source of ANC services that can provide specific guidance to improve quality of ANC services, and to address the equity gaps in access to quality ANC services. 12 , 21 , 24 , 25 , 26…”

“…27 In addition to the poor coverage of 4+ ANC visits, concerns have been raised about the quality of ANC services in India. 14 , 17 , 19 , 25 , 28 , 29 The Government of India has initiated a program to increase the coverage and quality ANC services, 30 wherein pregnant woman are examined and appropriately investigated by a physician across the public health facilities. 30 In this background, we report on the quality-adjusted coverage of ANC services in a population-based assessment from the Indian state of Bihar, which was reported to have 4 +ANC coverage at 25.2% as per NFHS-5.…”

Socio-economic status and pregnancy complications and their impact on antenatal care services provided at home and Upazila health complex

“…This service includes several potential activities such as discussing nutrition, facilities during pregnancy and delivery, checking up on the health condition of mothers and infants, etc. Despite these facilities, some of the Sub-Saharan African (SSA) countries still do not provide quality antenatal care to pregnant mothers [ 12 ] because women in these countries do not get social and economic advantages which cause maternal death due to pregnancy. Though antenatal care cannot estimate obstetrical exigencies, it is regarded as an important outline of any secured child delivery process and pregnancy knowledge of serious complications can lead women to take proper steps in this case.…”

The Potential Impact of Socioeconomic Status on Maternal Health, Tamil Nadu, India: A Prospective Observational Study.

“…The study reveals a significant correlation between socioeconomic status and abortion incidence, with abortion rates being highest (64%) in the upper-lower socioeconomic class (Class 4) and lowest (0.9%) in the upper socioeconomic class, demonstrating statistical significance with a P-value of 0.0005. Likewise, Dickson et al reported that 25% of females with a primary education level had a history of abortion, with 73% belonging to economically disadvantaged families [9]. Norsker et al found a similar trend, indicating a 1.15 times increased risk of abortions in lowincome families [10].…”