Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010

Abstract

BackgroundEarly initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda.MethodsThis is a cross-sectional study using data collected during the 2010 Rwanda DHS from 6,325 women age 15–49 that had at least one birth in the last five years. Factors associated with delayed ANC were identified using a multivariable logistic regression model using manual backward stepwise regression. Analysis was conducted in Stata v12 applying survey commands to account for the complex sample design.ResultsSeveral factors were significantly associated with delayed ANC including having many children (4–6 children, OR = 1.42, 95% CI: 1.22, 1.65; or more than six children, OR = 1.57, 95% CI: 1.24, 1.99); feeling that distance to health facility is a problem (OR = 1.20, 95% CI: 1.04, 1.38); and unwanted pregnancy (OR = 1.41, 95% CI: 1.26, 1.58). The following were protective against delayed ANC: having an ANC at a private hospital or clinic (OR = 0.29, 95% CI: 0.15, 0.56); being married (OR = 0.85, 95% CI: 0.75, 0.96), and having public mutuelle health insurance (OR = 0.81, 95% CI: 0.71, 0.92) or another type of insurance (OR = 0.33, 95% CI: 0.23, 0.46).ConclusionThis analysis revealed potential barriers to ANC service utilization. Distance to health facility remains a major constraint which suggests a great need of infrastructure and decentralization of maternal ANC to health posts and dispensaries. Interventions such as universal health insurance coverage, family planning, and community maternal health system are underway and could be part of effective strategies to address delays in ANC.

Time And Number of Antenatal Visits in Low Socio-Economic Population: Outcomes And Related Factors

“…Recently published data have shown that increased use of iron and reduced anemia are directly proportional to good quality antenatal care, with 6 or more visits starting early in the pregnancy [12,20]. However, in the current study, no relationship was seen between anemia rates and the number of antenatal care visits or the time of presentation (p>0.05).…”

“…Participation in antenatal care was lower in those with a low level of education, even though healthcare was provided and accessible. Higher participation in antenatal care has been observed in groups with a relatively better socio-cultural and educational level in under-developed populations [8,12,13]. The association of level of education with the number of visits and early presentation can be explained by various factors, including greater overall health awareness, earlier realization of pregnancy, and use of related resources [14,15].…”

Late initiation of antenatal care and its determinants: a hospital based cross-sectional study

“…Independent studies conducted in USA and some African countries reported that there is significant relationship between late ANC and being planned pregnancy. [16][17][18]22,28 Parity is also reported as a significant predictor of late initiation of ANC in studies done in UK, 20 Zambia, 17 Rwanda 22 and Ethiopia. 28 Besides, similar studies conducted in USA and Malawi revealed that maternal education has significant effect on receiving late ANC.…”

“…14,19 However, studies conducted in developed countries revealed lower proportions (4.4% to 27.3% % in USA, about 15% in UK and 41% in Australia) whereas some African studies reported comparable or higher values (53% in Ethiopia, 61.1% in Rwanda, 70.3% in Zambia, 81% in Nigeria, more than 70% in Tanzania and Malawi). 5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam.…”

“…5,[16][17][18][20][21][22][23][24][25] Utilization of different cut-off points in defining late initiation of ANC could explain these discrepancies (first trimester or 12 completed weeks was used in USA and UK studies, 16 weeks in Ethiopian, Zambian, Tanzanian and Malawi studies, and second/third trimester in some studies). 5,[16][17][18][19][20]22,24,25 The proportions of pregnant women who initiate ANC before 4 months of gestation among neighboring and ASEAN countries were 40.4% in Bangladesh, 32.2% in Cambodia, 56.9% in India, 78.6% in Indonesia, 37.5% in Nepal, 46.9% in Pakistan, 56.1% in the Philippines and 65% in Vietnam. 26 Differences in culture or socioeconomic status or health knowledge including awareness on the importance of early booking for ANC or education level among study populations, or differences in time of study or study area whether urban or rural may also be responsible.…”