Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda

Abstract

Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing countries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number "#REC REF 2012-117" before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 -24 years (mean age,

The burden of hypertensive disorders of pregnancy in Africa: A systematic review and meta‐analysis

“…First, most studies included in this review were hospital‐based unlike reports from other settings, suggesting that the prevalence of HDP in Africa may have been overestimated as pregnant women in limited resource settings seem less likely to utilize ANC and emergency obstetric care services when they develop or have a history of pregnancy‐related complications . However, since many forms of HDP (GH, CH, and PE without severe features), may be clinically unapparent at onset, a significant number of pregnant women with subclinical HDP could also have been missed by studies included in this report, in a context where utilization of ANC and institutional delivery services is relatively low . Yet, among pregnant women who attend ANC in Africa, the timing of visits, considered as a practical way of preventing adverse pregnancy outcomes, is not always adequate; even when adequate, the quality of ANC care is often suboptimal, as blood pressure and proteinuria measurement may not be routinely available .…”

“…28,29 However, since many forms of HDP (GH, CH, and PE without severe features), may be clinically unapparent at onset, 6 a significant number of pregnant women with subclinical HDP could also have been missed by studies included in this report, in a context where utilization of ANC and institutional delivery services is relatively low. 30,31 Yet, among pregnant women who attend ANC in Africa, the timing of visits, considered as a practical way of preventing F I G U R E 1 Meta-analysis of the prevalence of overall hypertensive disorders of pregnancy adverse pregnancy outcomes, is not always adequate 33 ; even when adequate, the quality of ANC care is often suboptimal, as blood pressure and proteinuria measurement may not be routinely available. 34 Second, the uneven distribution of risk factors for HDP between high-income countries and Africa, where women are more frequently of low socioeconomic background, are more likely to have a maternal infection or anemia, 16 could partly explain the higher rate of HDP in the region.…”

Are women in Uganda gaining adequate gestational weight? A prospective study in low income urban Kampala

“…Unfortunately, this study did not collect data on number of antenatal visits. However, existing data show that several factors are responsible for maternal health outcomes in Sub Saharan Africa [29, 30]. …”

Modelling Excess Zeros in Count Data with Application to Antenatal Care Utilisation

“…In recent years, ANC utilisation is about 4% in sub-Saharan Africa, and there has been slower progress in improvements compared with other regions (Lincetto et al, 2010). In South Sudan, about two-fifths of the women utilised ANC (Mugo, Dibley & Agho, 2015) while majority of women did not receive optimum number of ANC visits in Ethiopia (Kawungezi et al, 2015). Less than half (49%) of the pregnant women in sub-Saharan Africa utilised ANC facility despite the fact that WHO recommends a minimum of four ANC visits (Kawungezi et al, 2015).…”

“…In South Sudan, about two-fifths of the women utilised ANC (Mugo, Dibley & Agho, 2015) while majority of women did not receive optimum number of ANC visits in Ethiopia (Kawungezi et al, 2015). Less than half (49%) of the pregnant women in sub-Saharan Africa utilised ANC facility despite the fact that WHO recommends a minimum of four ANC visits (Kawungezi et al, 2015). In Nigeria, maternal mortality has been described as a vital indicator for women's programmes as well as reproductive health programmes (NPC & ICT, 2014).…”