AI Article Synopsis
- The study aimed to identify key factors that influence maternal care, focusing on the interconnectedness of enrollment in antenatal care (ANC), frequency of ANC visits, and the use of skilled birth attendance (SBA).
- Conducted across 25 health facilities in Kenya, the research involved 5,879 low-income pregnant women and utilized various regression models to analyze the data, revealing that delayed ANC enrollment reduces visit frequency and that more visits correlate with increased likelihood of skilled care during birth.
- The findings suggest a chain reaction effect in maternal care where timely enrollment boosts ANC visits, which in turn supports the use of skilled assistance during childbirth, emphasizing the need to improve overall maternal healthcare access and early engagement for better outcomes.
Article Abstract
Objectives: To examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated.
Design: A facility-based prospective cohort study.
Setting: 25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega.
Participants: A total of 5 879 low-income pregnant women aged 13-49 years.
Outcome Measures: Ordinary least squares, Poisson and logistic regression models were employed, to predict three key determinants of the continuum of maternal care: (i) the week of enrolment at the clinic for antenatal care (ANC), (ii) the total number of ANC visits and (iii) utilisation of skilled birth attendance (SBA). The interrelationship between the three outcome variables was assessed with structural equation modeling.
Results: Each week of delayed enrolment in ANC reduced the number of ANC visits by 3% (incidence rate ratio=0.967, 95% CI 0.965 to 0.969). A higher number of ANC visits increased the relative probability of using SBA (odds ratio=1.28, 95% CI 1.22 to 1.34). The direct association between late enrolment and SBA was positive (odds ratio=1.033, 95% CI 1.02 to 1.04). Predisposing factors (age, household head's education), enabling factors (wealth, shorter distance, rural area) and need factors (risk level of pregnancy, multigravida) were positively associated with adherence to ANC.
Conclusion: The results point towards a domino-effect and underscore the importance of enhancing the full continuum of maternal care. A larger number of ANC visits increases SBA, while early initiation of the care journey increases the number of ANC visits, thereby indirectly supporting SBA as well. These beneficial pathways counteract the direct link between enrolment and SBA, which is partly driven by pregnant teenagers who both enrol late and are at heightened risk of complications, stressing the need for specific attention to this vulnerable population.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8765038 | PMC |
| http://dx.doi.org/10.1136/bmjopen-2021-050670 | DOI Listing |
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