Keywords
Antenatal Care
Utilization
Pregnant women
Borama
Somaliland
Utilization
Pregnant women
Borama
Somaliland
Abstract
Background: Antenatal care which is known as care given during pregnancy, is essential for diagnosing and treating complications that could endanger the lives of mother and child. Although most obstetric life-threatening conditions can be prevented through early and frequent access to antenatal care services the risk of dying from pregnancy-related causes is higher in Somaliland.
Objective: the objective of this study was to determine the frequency and timing of antenatal care utilization and factors influencing it among reproductive-age women.
Methods: A population-based cross-sectional survey was conducted among 330 randomly selected mothers who gave birth in the past two years in Borama, Somaliland.
Result: Although a significant number of women utilized antenatal care in their pregnancy only 31.1% initiated the first visit within the first trimester and 48.3% received less than the recommended four visits. Fewer antenatal care visits were significantly associated with age (OR=3.018; CI=1.264-7.207), gravida (OR=3.295; CI=1.200-9.045), and gestation age (OR=1.737; CI=1.013-2.979). Early marriage (OR=0.495; CI=0.252-0.973), and large family size (OR=3.952; CI=1.330-11.742) were associated with delay of early commencement of the antenatal care.
Conclusion: Higher probability of delay in antenatal care and fewer visits were obtained in women who were young, got pregnant multiple times, married at a young age, and had a large family size. Based on our findings, uplifting the socioeconomic status and literacy level of women through community-based education and developing strategies that would take the determining factors into account may contribute to improved and adequate utilization of antenatal care.
References
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[19] Dairo MD, Owoyokun KE. Factors affecting the utilization of antenatal care services in Ibadan, Nigeria. Benin Journal of Postgraduate Medicine 2011;12(1). doi: doi:10.4314/bjpm.v12i1.63387.
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[22] Tran TK, Gottvall K, Nguyen HD, Ascher H, Petzold M. Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam. BMC Health Serv. Res. 2012;12(40). doi: 10.1186/1472-6963-12-40.
[23] Onoh R, Umerora O, Agwu U, Ezegwui H, Ezeonu P, Onyebuchi A. Pattern and determinants of antenatal booking at abakaliki southeast Nigeria. Ann. Med. Health Sci. Res. 2012;2(2):169–175. doi: 10.4103/2141-9248.105666.
[24] Ekholuenetale M, Nzoputam CI, Barrow A, Onikan A. Women’s enlightenment and early antenatal care initiation are determining factors for the use of eight or more antenatal visits in Benin: further analysis of the Demographic and Health Survey. J. Egypt. Public Health Assoc. 2020;95(13). doi: 10.1186/s42506-020-00041-2.
[25] Terefe AN, Gelaw AB. Determinants of antenatal care visit utilization of child-bearing mothers in Kaffa, Sheka, and Bench Maji zones of SNNPR, Southwestern Ethiopia. Heal. Serv. Res. Manag. Epidemiol 2019;6 doi:10.1177/2333392819866620.
[26] Tuladhar H, Dhakal N. Impact of Antenatal Care on Maternal and Perinatal utcome: A Study at Nepal Medical College Teaching Hospital. Nepal J. Obstet. Gynaecol 2012;6(2):37–43 doi: 10.3126/njog.v6i2.6755.
[27] Beeckman K, Louckx F, Putman K. Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health 2010;10(527):1-9. doi: 10.1186/1471-2458-10-527.
[28] Santhya KG, Ram U, Acharya R, Jejeebhoy SJ, Ram F, Singh A. Associations between early marriage and young women’s marital and reproductive health outcomes: evidence from India. Int. Perspect. Sex. Reprod. Health 2010;36(3):132–139. doi: 1 0.1363/ipsrh.36.132.10.
[29] Godha D, Gage AJ, Hotchkiss DR, Cappa C. Predicting maternal health care use by age at marriage in multiple countries. J. Adolesc. Heal. 2016;58(5):504–511. doi: 10.1016/j.jadohealth.2016.01.001.
[30] Tolefac PN, Halle-Ekane GE, Agbor VN, Sama CB, Ngwasiri C, and Tebeu PM. Why do pregnant women present late for their first antenatal care consultation in Cameroon?. Matern. Heal. Neonatol. Perinatol 2017;3(29). doi: 10.1186/s40748-017-0067-8.
[31] Ochako R, Gichuhi W. Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya. Reprod. Health 2016;13(1):1–8. doi: 10.1186/s12978-016-0168-2.
[32] Weldemariam S, Damte A, Endris K, Palcon M, Tesfay K, Berhe A, Araya T, Hagos H, Gebrehiwot H. Late antenatal care initiation: The case of public health centers in Ethiopia. BMC Res. Notes 2018;11(1):1–6. doi: 10.1186/s13104-018-3653-6.
[33] Weldearegawi G. G, Teklehaimanot B. F, Gebru H. T, Gebrezgi Z. A, Tekola K. B, and Baraki M. F. Determinants of late antenatal care follow up among pregnant women in Easter zone Tigray, Northern Ethiopia, unmatched case-control study. BMC Res. Notes 2019;12(1):1–9. doi: 10.1186/s13104-019-4789-8.
[34] Gong E, Dula J, Alberto C, De Albuquerque A, Steenland M, Fernandes Q, Cuco RM, Sequeira S, Chicumbe S, Gudo ES, McConnell M. Client experiences with antenatal care waiting times in southern Mozambique. BMC Health Serv. Res 2019;19(1) 538. doi: 10.1186/s12913-019-4369-6.
[2] World Health Organization, Maternal Health and Safe Motherhood Programme. Mother-baby package : implementing safe motherhood in countries : Practical Guide. Geneva: World Health Organization; 1996.
[3] World Health Organization, Department of Making Pregnancy Safer. Standards for maternal and neonatal care. Geneva: World Health Organization; 2006.
[4] Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15(1):1-42. doi: 10.1046/j.1365-3016.2001.0150s1001.x.
[5] World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016.
[6] Wang W, Alva S, Wang S, Fort A. Level and trends in the use of maternal health services in developing countries. DHS Comparative Reports No. 26. Calverton, Maryland, USA: ICF Macro; 2011.
[7] Directorate of National Statistics, Federal Government of Somalia. The Somali Health and Demographic Survey. 2020
[8] Jiwani SS, Amouzou-Aguirre A, Carvajal L, Chou D, Keita Y, Moran AC, Requejo J, Yaya S, Vaz LM, Boerma T. Timing and number of antenatal care contacts in low and middle-income countries: Analysis in the Countdown to 2030 priority countries. J Glob Health 2020;10(1):010502. doi: 10.7189/jogh.10.010502.
[9] Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244-60. doi: 10.1111/j.1365-2648.2007.04532.x.
[10] Magadi MA, Madise NJ, Rodrigues RN. Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med. 2000;51(4):551-61. doi: 10.1016/s0277-9536(99)00495-5.
[11] Pell C, Meñaca A, Were F, Afrah NA, Chatio S, Manda-Taylor L, Hamel MJ, Hodgson A, Tagbor H, Kalilani L, Ouma P, Pool R. Factors affecting antenatal care attendance: results from qualitative studies in Ghana, Kenya and Malawi. PLoS One 2013;8(1):e53747. doi: 10.1371/journal.pone.0053747.
[12] Saad-Haddad G, DeJong J, Terreri N, Restrepo-Méndez MC, Perin J, Vaz L, Newby H, Amouzou A, Barros AJ, Bryce J. Patterns and determinants of antenatal care utilization: analysis of national survey data in seven countdown countries. J Glob Health 2016;6(1):010404. doi: 10.7189/jogh.06.010404.
[13] United Nations Population Fund. Population estimation survey for the 18 pre-war regions of Somalia. Nairobi, Kenya; 2013.
[14] UNICEF Somalia and Somaliland Ministry of Planning and National Development. Somaliland Multiple Indicator Cluster Survey, Final Report. Nairobi, Kenya; 2011
[15] Gebresilassie B, Belete T, Tilahun W, Berhane B, Gebresilassie S. Timing of first antenatal care attendance and associated factors among pregnant women in public health institutions of Axum town, Tigray, Ethiopia 2017: a mixed design study. BMC Pregnancy Childbirth 2019;19(340):1–11. doi: 10.1186/s12884-019-2490-5.
[16] Edgard-Marius O, Charles SJ, Jacques S, Justine GC-C, Virginie MA, Ibrahim MA, Laurent OT. Determinants of low antenatal care services utilization during the first trimester of pregnancy in Southern Benin rural setting. Universal Journal of Public Health 2015;3(5):220–228. doi:10.13189/ujph.2015.030507.
[17] Yanagisawa S, Oum S, Wakai S. Determinants of skilled birth attendance in rural Cambodia. Trop Med Int Health 2006;11(2):238-51. doi: 10.1111/j.1365-3156.2005.01547.x.
[18] Roy MP, Mohan U, Singh SK, Singh VK, Srivastava AK. Determinants of utilization of antenatal care services in rural lucknow, India. J Family Med Prim Care 2013;2(1):55-59. doi:10.4103/2249-4863.109946.
[19] Dairo MD, Owoyokun KE. Factors affecting the utilization of antenatal care services in Ibadan, Nigeria. Benin Journal of Postgraduate Medicine 2011;12(1). doi: doi:10.4314/bjpm.v12i1.63387.
[20] Islam MR, Odland JO. Determinants of antenatal and postnatal care visits among Indigenous people in Bangladesh: a study of the Mru community. Rural Remote Health 2011;11(2)1672
[21] Feijen-de Jong EI, Jansen DE, Baarveld F, van der Schans CP, Schellevis FG, Reijneveld SA. Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review. Eur J Public Health 2012;22(6):904-13. doi: 10.1093/eurpub/ckr164.
[22] Tran TK, Gottvall K, Nguyen HD, Ascher H, Petzold M. Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam. BMC Health Serv. Res. 2012;12(40). doi: 10.1186/1472-6963-12-40.
[23] Onoh R, Umerora O, Agwu U, Ezegwui H, Ezeonu P, Onyebuchi A. Pattern and determinants of antenatal booking at abakaliki southeast Nigeria. Ann. Med. Health Sci. Res. 2012;2(2):169–175. doi: 10.4103/2141-9248.105666.
[24] Ekholuenetale M, Nzoputam CI, Barrow A, Onikan A. Women’s enlightenment and early antenatal care initiation are determining factors for the use of eight or more antenatal visits in Benin: further analysis of the Demographic and Health Survey. J. Egypt. Public Health Assoc. 2020;95(13). doi: 10.1186/s42506-020-00041-2.
[25] Terefe AN, Gelaw AB. Determinants of antenatal care visit utilization of child-bearing mothers in Kaffa, Sheka, and Bench Maji zones of SNNPR, Southwestern Ethiopia. Heal. Serv. Res. Manag. Epidemiol 2019;6 doi:10.1177/2333392819866620.
[26] Tuladhar H, Dhakal N. Impact of Antenatal Care on Maternal and Perinatal utcome: A Study at Nepal Medical College Teaching Hospital. Nepal J. Obstet. Gynaecol 2012;6(2):37–43 doi: 10.3126/njog.v6i2.6755.
[27] Beeckman K, Louckx F, Putman K. Determinants of the number of antenatal visits in a metropolitan region. BMC Public Health 2010;10(527):1-9. doi: 10.1186/1471-2458-10-527.
[28] Santhya KG, Ram U, Acharya R, Jejeebhoy SJ, Ram F, Singh A. Associations between early marriage and young women’s marital and reproductive health outcomes: evidence from India. Int. Perspect. Sex. Reprod. Health 2010;36(3):132–139. doi: 1 0.1363/ipsrh.36.132.10.
[29] Godha D, Gage AJ, Hotchkiss DR, Cappa C. Predicting maternal health care use by age at marriage in multiple countries. J. Adolesc. Heal. 2016;58(5):504–511. doi: 10.1016/j.jadohealth.2016.01.001.
[30] Tolefac PN, Halle-Ekane GE, Agbor VN, Sama CB, Ngwasiri C, and Tebeu PM. Why do pregnant women present late for their first antenatal care consultation in Cameroon?. Matern. Heal. Neonatol. Perinatol 2017;3(29). doi: 10.1186/s40748-017-0067-8.
[31] Ochako R, Gichuhi W. Pregnancy wantedness, frequency and timing of antenatal care visit among women of childbearing age in Kenya. Reprod. Health 2016;13(1):1–8. doi: 10.1186/s12978-016-0168-2.
[32] Weldemariam S, Damte A, Endris K, Palcon M, Tesfay K, Berhe A, Araya T, Hagos H, Gebrehiwot H. Late antenatal care initiation: The case of public health centers in Ethiopia. BMC Res. Notes 2018;11(1):1–6. doi: 10.1186/s13104-018-3653-6.
[33] Weldearegawi G. G, Teklehaimanot B. F, Gebru H. T, Gebrezgi Z. A, Tekola K. B, and Baraki M. F. Determinants of late antenatal care follow up among pregnant women in Easter zone Tigray, Northern Ethiopia, unmatched case-control study. BMC Res. Notes 2019;12(1):1–9. doi: 10.1186/s13104-019-4789-8.
[34] Gong E, Dula J, Alberto C, De Albuquerque A, Steenland M, Fernandes Q, Cuco RM, Sequeira S, Chicumbe S, Gudo ES, McConnell M. Client experiences with antenatal care waiting times in southern Mozambique. BMC Health Serv. Res 2019;19(1) 538. doi: 10.1186/s12913-019-4369-6.