Ante-Natal Care Utilization and Comparison of Obstetric Performance of Pregnant Women Attending Tertiary and Secondary/Primary Health Facilities in South West Nigeria.

Background: The successful outcome of any pregnancy depends on a well formulated and implemented ANC, which to a larger extent also depends on its functional and operational continuum of care, that is affordable, accessible and of high quality during and after pregnancy and childbirth. Defective ANC, in terms of coverage and quality, has been shown to be associated with unfavourable pregnancy outcome.

Objective: To determine the maternal and perinatal outcome(Obstetric performance) of booked and referred pregnant women who though, booked for ANC in lower health care facilities but were delivered at our facility.

Methods: The is a retrospective and cross-sectional study conducted at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria from the 1st of January 2017 to 31st of December 2018.

Results: The booked were significantly older than the unbooked (29.4±5.0 vs 28.5±5.5; P=0.001), while 47.6% and 35.3 % were nulliparous in the study and control groups respectively. Majority of the booked (69.3%) and the unbooked (59.3%) were aged 25-34 years. The mean Apgar scores at one minute were 7.0±2.0 and 4.7±3.1(P<0.001) for the booked and unbooked respectively while at five minutes they were 8.6±1.9 and 6.4±3.6 (P<0.001) for the booked and unbooked respectively and the differences were statistically significant at one and five minutes. The proportion of maternal deaths were higher among the unbooked than the booked (2.6% vs 0.4%; P<0.001), maternal morbidity ( 8.1% vs 2.5%; P<0.001) and fetal deaths (40.6% vs 6.3%; P<0.001) CONCLUSION: In all the indices and parameters compared between the two groups the unbooked patients (control) performed poorly and this is surprising despite the huge resources extended to secondary and primary health care delivery services in Nigeria.