Association between utilization and quality of antenatal care with stillbirths in four tertiary hospitals in a low‐income urban setting

Abstract

Introduction About 2.6 million stillbirths per year occur globally with 98% occurring in low‐ and middle‐income countries including Kenya, where an estimated 35 000 stillbirths occur annually. Most studies have focused on the direct causes of stillbirth. The aim of this study was to determine the association between antenatal care utilization and quality with stillbirth in a Kenyan set up. This information is key when planning strategies to reduce the stillbirth burden. Material and methods This was a case‐control study in four urban tertiary hospitals carried out between August 2018 and April 2019. A total of 214 women with stillbirths (cases) and 428 with livebirths (controls) between 28 and 42 weeks were enrolled. Information was obtained through interviews and data abstracted from medical records. Antenatal care utilization was assessed by the proportions of women not attending antenatal care; booking first antenatal care visit in first trimester and not making the requisite four antenatal care visits. Quality of antenatal care was assessed using individual surrogate indicators (antenatal profile testing, weight/blood pressure/urinalysis testing in each antenatal visit, utilization of early obstetric ultrasound, completeness of antenatal records) and a codified indicator made up of seven parameters (attending antenatal care, booking first antenatal care in the first trimester, making four or more antenatal visits, having all antenatal profile tests, having a complete antenatal record, having blood pressure and weight measured at all visits). The association between antenatal care utilization and quality with stillbirth was assessed using univariate and multivariate analysis using logistic regression. Statistical significance was defined as a two‐tailed P value ≤ .05. Results Women with stillbirth were likely to have a parity ≥4 (19.6% vs 12.6%, P = .02), have an obstetric complication (36% vs 8.6%, P = .001) and have a medical disorder (5.6% vs 1.6%, P = .01). The odds of a stillbirth were four times higher among those who did not attend antenatal care ( odds ratio [OR] 4.1, 95% confidence interval [CI] 1.6‐10, P < .003). Compared with four antenatal care visits, those who had one or two visits had higher odds of a stillbirth: OR 2.96 (95% CI 1.4‐6.1), P = .003, and OR 2.9 (95% CI 1.7‐5), P = .003, respectively. As per the individual surrogate indicators, the likelihood of a stillbirth was lower in women who received good quality antenatal care: Hemoglobin testing (OR 0.6, 95% CI 0.4‐0.8, P = .03), blood group test (OR 0.4, 95% CI 0.2‐0.6, P < .001), HIV test (OR 0.3, 95% CI 0.2‐0.5, P = .001), venereal disease research laboratory test (OR 0.2, 95% CI 0.1‐0.4, P = .001), weight measurement (OR 0.7, 95% CI 0.5‐1.0, P = .047). As per the composite indicator, the quality of antenatal care was poor across the board and there was no association between this surrogate indicator and stillbirth. Conclusions Lack of antenatal care, attending fewer than four antenatal visits and poor quality antenatal care as ...

Timing of perinatal death; causes, circumstances, and regional variations among reviewed deaths in Ethiopia

“…The study also revealed that as the number of ANC visits increases the risk of having an unknown time of stillbirth decreases. The finding was concurrent with previous studies conducted in Ethiopia [ 67 , 68 ], Kenya [ 69 ], and Nepal [ 40 ]. The plausible explanation might be related to the frequent ANC visits’ ability in identifying potential risk factors that contribute to stillbirth [ 70 ].…”

Assessment of quality of antenatal care services in public sector facilities in India

“…The inadequacy of and inequity in quality of antenatal care (ANC) services is increasingly receiving attention. [1][2][3][4][5][6][7] The key elements of ANC services captured under the facility surveys also indicate inadequate quality of care provision. 8 Concerns about the quality of ANC services have also been reported from India, primarily based on the retrospective data collected under the National Family Health Survey.…”

“…The inadequacy of and inequity in quality of antenatal care (ANC) services is increasingly receiving attention 1–7. The key elements of ANC services captured under the facility surveys also indicate inadequate quality of care provision 8.…”

Impact of Poverty on Health

“…However, primary prevention is considered the cornerstone in preventing the spread of the disease [34][35][36]. This would describe the much higher prevalence of deaths from HIV/AIDS in developing countries compared to developed countries and even the higher deaths in the developed countries among poor people who have limited aces to health care facilities [37][38][39][40][41][42]. This fact is evident in maps 1 and 2 quoted from the WHO website 2017, especially compared to the extreme poverty presented earlier (Figure 3), where Africa carries the primary disease burden and deaths from the disease [43].…”