Determinants of frequency and contents of antenatal care visits in Bangladesh: Assessing the extent of compliance with the WHO recommendations

Abstract

BackgroundIn addition to the number of antenatal care (ANC) visits, the items of ANC services covered by ANC visits greatly influence the effectiveness of the ANC services. Recently the World Health Organization (WHO) recommended not only to achieve a minimum of eight ANC visits, but also to use a core set of items of ANC services for safe motherhood. This study examined the levels and determinants of frequency and contents of ANC visits in Bangladesh and thus assessed the level of compliance with the WHO recommended number and the content of ANC services during pregnancy in Bangladesh.MethodsThe data for the study come from the 2014 Bangladesh Demographic and Health Survey (BDHS), which covereda nationally representative sample of 17,863 ever-married women aged 15–49 years. Data derived from 4,627 mothers who gave birth in the three years preceding the survey constituted the study subjects. Descriptive, inferential and multivariate statistical techniques were used for data analysis.ResultsOn average, mothers received less than three (2.7 visits) ANC visits and only 6% receive the recommended eight or more ANC visits. About 22% of the mothers received all the prescribed basic items of ANC services. About one-fifth (21%) of the mothers never received ANC visits and thus no items of ANC services. Measurement of blood pressure was the most common item received during ANC visit as reported by 69% mothers. Blood test was the least received item (43%). Significant positive association was found between frequency of ANC visits and receiving the increased number of items of ANC services. High socio-economic status, low parity, living in urban areas and certain administrative regions, planned pregnancies, having media exposure, visiting skilled providers for ANC services and visit to public or NGO health facilities are associated with frequent ANC visits and receiving higher number of items of ANC contents.ConclusionAn unsatisfactory level of coverage of and content of ANC visits have been observed in Bangladesh. Further investigation is needed to identify the causes of under-utilization of ANC services in Bangladesh. A greater understanding of the identified risk factors and incorporating them into short and long term strategies would help improve the coverage and contents and thus quality of ANC services in Bangladesh.

Modelling the number of antenatal care visits in Bangladesh to determine the risk factors for reduced antenatal care attendance

“…The number of ANC visits (a non-negative integer) is the target response variable for which this study aims to identify a proper count regression model. A number of explanatory variables at individual (woman), household, community, and regional levels have been considered based on recent studies on ANC utilization [6,9,13]. The bivariate relationship of the explanatory variables with the number of ANC visits were examined first by a developing simple PR model for each of the explanatory variables.…”

“…Many studies have assessed the determinants of prenatal care attendance in Bangladesh, particularly focussing on the WHO guideline of taking at least four ANC visits [6][7][8][9], but only a few studies have assessed the determinants of the number of ANC visits in general [10][11][12][13]. It has been shown that there may be two separate processes that generate decisions regarding the use and frequency of prenatal care use [14,15].…”

“…It has been shown that there may be two separate processes that generate decisions regarding the use and frequency of prenatal care use [14,15]. Without distinguishing these generating processes, Poisson regression (PR) and negative binomial regression (NBR) models have been widely used to model the number of ANC visits in Bangladesh [12,13,16]. But these models may provide inconsistent regression coefficient, as overdispersion and excess zeros remain unaccounted for [17].…”

A new content-qualified antenatal care coverage indicator: development and validation of a score using national health surveys

“…Most other studies measuring the quality of ANC through scores also gave arbitrary weights for each item, and most often the same weight for each intervention included. [29][30][31][32] Others relied upon data driven approaches such as principal components analyses, 17,33 but this ignores any theory in terms of the weights assigned. We started with a theoretical construct, and then showed that it was consistent with principal components results.…”

Focussed antenatal care a possible opportunity towards safe motherhood

“…The Basic Antenatal Care (ANC) has emphasis on number of visits and hence not so popular with only an average 50% of mothers attend. [1][2][3][4][5] Over the years there have been so much socio cultural changes in the society and health care delivery system. Now we have adopted fully institutional deliveries by specialist birth attendants supported by free national ambulance service.…”