Client Factors Affect Provider Adherence to Guidelines during First Antenatal Care in Public Health Facilities, Ethiopia: A Multi-Center Cross-Sectional Study

Abstract

BACKGROUND፡ Timely entry to an antenatal care with a healthcare provider who follows a set of national guidelines is assumed to ensure higher levels of client satisfaction. It is also expected to improve perinatal outcomes. Little is known about the level of adherence of Ethiopian providers to these guidelines. Therefore, this study aims to assess the proportion of clients who received complete (100%) provider adherence to antenatal care guidelines at the first visit and client associated factors in Gondar Town.METHODS: A cross-sectional study of 834 study participants was conducted in public health facilities of Gondar Town in Ethiopia. An 18 point checklist was used to observe provider adherence to the first antenatal care visit guidelines. Descriptive statistics and multivariable binary logistic regression model were done by using STATA 14 software.RESULT: The proportion of clients who received the complete provider’s adherence to the first antenatal care guideline was 32.25% (95% CI: 29.1-35.5). The mean adherence score was 16.78%. Women who had prior history of pregnancy and/or birthrelated complications (AOR = 1.58; 95%CI: 1.04-2.04) and late antenatal care booking at gestational week 16 or greater (AOR =1.45; 95%CI: 1.03-2.03) were significantly associated with clients receiving complete providers’ adherence to the first antenatal guideline.CONCLUSIONS: We found the level of adherence to national antenatal care guidelines during first visit as surprisingly low. When considering to upgrade the guidelines to the actual WHO guideline of eight visits, we recommend that refresher training be provided regularly to help staff understand the importance of following the guidelines as closely as possible. Perhaps, we need to learn more from the health care providers themselves about their reasons for not following the guidelines.

Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis

“…The current study demonstrates that the odds of the utilization of early ANC visits were 13% less likely among women whose households were headed by the male as compared to their counterparts. This finding was in agreement with other study findings at which husbands' permission had a tremendous impact on the utilization and timing of ANC services [62][63][64]. Another study done by Mulat G., et al noted that the odds of using ANC visits were more likely among womens' who had autonomy on their healthcare decision-making as compared to their counterparts [65].…”

Provider-perceived benefits and constraints of complete adherence to antenatal care guideline among public health facilities, Ethiopia: A qualitative study

“…Although participants acknowledged the benefits of using ANC guideline, their level of adherence to national ANC guideline during first visit as it was surprisingly low at the four study facilities [ 27 ]. Through our findings, we have learned more from the participants themselves about their reasons for not following the guideline.…”

“…More than one in four (26%) Ethiopian women do not receive any ANC visits at all, and even those who receive it do not get quality services due to providers’ inability to adhere to focused ANC guideline [ 18 , 26 ]. As an example, a cross-sectional study done in Gondar town indicated that only 32% of women received complete providers’ adherence to national ANC guideline during the first visit [ 27 ]. However, the reasons for the poor adherence to ANC guideline are not well known.…”

Effect of complete adherence to antenatal care guideline during first visit on maternal and neonatal complications during the intrapartum and postpartum periods: a prospective cohort study in Northwest Ethiopia

“…The observation checklist, scoring criteria and the entire method for the baseline of the cohort study have been described elsewhere. 20 …”

“…The observation checklist, scoring criteria and the entire method for the baseline of the cohort study have been described elsewhere. 20 Covariates Several explanatory variables were included as covariates. These include a range of maternal socio-demographic variables such as maternal age, residence, religion, marital status, educational level and employment status.…”