Status of the latest 2016 World Health Organization recommended frequency of antenatal care contacts in Sierra Leone: a nationally representative survey

Abstract

Background Timely and increased frequency of quality antenatal care (ANC) contacts is one of the key strategies aimed at decreasing maternal and neonatal deaths. In 2016, the World Health Organization (WHO) revised the ANC guidelines to recommend at least eight ANC contacts instead of four. This study aimed to determine the proportion of women who received eight or more ANC contacts and associated factors in Sierra Leone. Methods We used Sierra Leone Demographic and Health Survey (UDHS) 2019 data of 5,432 women aged 15 to 49 years who had a live birth, within three years preceding the survey. Multistage stratified sampling was used to select study participants. We conducted multivariable logistic regression to identify factors associated with utilisation of eight or more ANC contacts using SPSS version 25 complex samples package. Results Out of 5,432 women, 2,399 (44.8%) (95% CI: 43.1–45.7) had their first ANC contact in the first trimester and 1,197 (22.0%) (95% CI: 21.2–23.4) had eight or more ANC contacts. Women who had their first ANC contact after first trimester (adjusted odds ratio, aOR, 0.58, 95% CI 0.49–0.68) and women aged 15 to 19 years had less odds of having eight or more contacts (aOR 0.64, 95% CI 0.45 to 0.91). Working (aOR 1.33, 95%CI 1.10 to 1.62) and wealthier women had higher odds of having eight or more contacts compared to poorer ones and those not working respectively. Women residing in the southern region, those using internet and less parous (less than five) women were associated with higher odds of having eight or more ANC contacts. Women who had no big problem obtaining permission to go health facilities also had higher odds of having eight or more ANC contacts compared to those who had big problems. Conclusion Sierra Leone’s adoption of eight or more ANC contacts is low and less than half of the women initiate ANC in the first trimester. To ensure increased access to recommended ANC visits, timely ANC should be encouraged. Attributes of women empowerment such as workings status, socio-economic status, and decision-making should also be emphasized.

Factors Associated with Late Antenatal Care Initiation for Pregnant Women Aged 15-49 Years in Sierra Leone Using the 2019 Demographic Health Survey

“…The percentage of early initiation of antenatal care in Sierra Leone from this study was low (44.76%) compared to women who initiated antenatal care after the third trimester (55.24%). This finding is consistent with a study in Sierra Leone (55.4%) conducted among women who had birthed in the last three years preceding the survey [10]. However, this study's prevalence of timely initiation of antenatal care is higher than those presented in Nigeria [11,12], Ethiopia [13,14] and lower than that reported in Ethiopia (46.8%) in a systematic review [15].…”

“…Several factors could account for this finding. The main reason could be due to the timing and non-completion of the implementation of the new ANC policy in Sierra Leone at the time of the start of the DHS survey [10]. Also, structural issues like inadequate roads and transit networks to healthcare institutions may contribute to the low usage of antenatal care.…”

“…This is an unusual finding considering that the Western region of Sierra Leone is the most developed, has the liveliest economy, and has the biggest concentration of trained workers and medical facilities [20]. However, the Western regions are seeing an increase in the number of urban poor, who are unable to get adequate healthcare due to their high level of living and unequal access to social facilities [10]. Additionally, the established staff issues in metropolitan areas, such as inadequate delegation, favoritism, and a lack of autonomy, may have an impact on the level of service provided by public health facilities, which further reduces the number of people who can access healthcare [20].…”

“…This study included socioeconomic and demographic determinants, obstetric factors, institutional factors and sociocultural factors of ANC timely initiation based on evidence from available literature and data. The socioeconomic and demographic variables were used: (1) maternal age, (2) residence, (3) region, (4) type of residence (urban/rural), ( 5) sex of household head, (6) marital status, (7) educational level, (8) wealth index, (9) internet exposure, (10) exposure to newspaper, (11) exposure to radio, (12) exposure to television, and (13) household size. The obstetric and institutional factors employed: (1) Parity (2) Distance to the healthcare facility.…”

Multilevel modelling of factors associated with eight or more antenatal care contacts in low and middle-income countries: findings from national representative data

“…Women aged 25–34 years and 35–49 years had higher odds of eight or more ANC visit than 15–24 years. Similarly women aged 15–19 years had a less likelihood of having eight or more ANC contacts than above 20 years 26 . This could be due to the fear of social eye and stigma in younger pregnant 7 .…”