Antenatal Care Adequacy in Three Provinces of Vietnam: Long an, Ben Tre, and Quang Ngai

Abstract

Vietnam has high numbers of maternal and infant mortality and morbidity. Each year, 1,500 women die and 45,000 others become disabled as a result of pregnancy and childbirth complications. 1 There were 37,700 neonatal deaths in Vietnam in 1999. 2 The maternal mortality rate is 165 per 100,000 live births 3 and the infant mortality rate is around 30 per 1,000 live births. 4,5 Antenatal care (ANC) has been proven to be effective in preventing pregnancy adverse outcomes. 6 For ANC to be effective, women should have enough visits at appropriate times, with sufficient ANC content. The World Health Organization (WHO) recommends four visits at the 4th, 6th or 7th, 8th, and 9th month for women in developing countries. 7 The Vietnamese government recommends three visits, one during each trimester. 8 WHO recommends three basic components of ANC content: (1) biomedical assessment based on medical history, physical examination, and laboratory tests; (2) health promotion; and (3) care provision. 7 To measure ANC adequacy, many indicators and indices have been developed in the world. Single indicators are any ANC, number of ANC visits, and duration of pregnancy at entry to ANC. Complex indices that combine number of ANC visits and duration of pregnancy at first visit are the Kessner index, 9 the Graduated Index of Prenatal Care Utilization, 10 the Adequacy of Prenatal Care Utilization Index, 11 and the Prenatal Care Evidence-Based Index. 12 These indices are suitable for developed countries because of the high cutoff points. There has been a modified index in the Philippines with the lower cutoff point of five visits and initial visit within the first three months, 13 but this index might not be suitable for other less developed countries like Vietnam. Editor's note: This paper by Drs. Trinh, Dibley, and Byles shows with clarity the benefit of antenatal care and improved outcomes in maternal and infant morbidity and mortality. The data set used, which goes up to 1999, also suggests an improving trend in infant mortality as the economy grows and the GDP increases. These rates of improvement are at a rate of about 7% annually. In fact, infant mortality rates have changed dramatically in the last two decades in Vietnam.

Late Entry into Antenatal Care in a Southern Rural Area of Vietnam and Related Factors

“…Moreover, minorities usually have their own languages, which makes it difficult to communicate with health educators, leading to a lack of knowledge about ANC. Educational level was also correlated with the time of first ANC attendance, as observed in other studies in Vietnam [21] and in other countries [19,32,33]. Women with a higher level of education are more likely to appreciate the importance of early entry than the less educated ones.…”

“…A widely-used model in numerous studies exploring the usage of health care services is the Andersen Health Seeking Behavior model [20]; it has also been particularly used in several studies on ANC [17,21,22]. Nonetheless, there is limited information on the factors related to late entry into ANC in Vietnam and a theoretical health seeking behavior model as a framework for the analysis of these related factors has not yet been published.…”

Determinants of Time of Start of Prenatal Care and Number of Prenatal Care Visits During Pregnancy Among Nepalese Women

“…However, the effects of smoking were lost when the models were adjusted for the other socio-demographic factor. Previous studies have shown that smokers practice less healthy care behaviors in general and in prenatal care in particular [33,34]. On the contrary, it seems that among Nepali women smoking does not play a significant role in participation in prenatal care.…”

Individual and Contextual Determinants of Adequate Maternal Health Care Services in Kenya

“…A woman was classified as having adequate use of ANC if she visited an ANC clinic at least three times during the course of her pregnancy, with the initial visit taking place within the first four months of the pregnancy (Trinh, Dibley, and Byles 2006). A woman was considered as having received DC if her delivery was at a health facility under the supervision or assistance of a trained health professional.…”