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BMC Pregnancy and Childbirth

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Open Access 01-12-2020 | Care | Research article

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Authors: Marie Paul Nisingizwe, Germaine Tuyisenge, Celestin Hategeka, Mohammad Ehsanul Karim

Published in: BMC Pregnancy and Childbirth | Issue 1/2020

Abstract

Background

Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda.

Methods

This study is cross-sectional using secondary data from the 2014–15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15–49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.

Results

Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results.

Conclusion

The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

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Reproductive, Maternal, Newborn, Child and Adolescent Health. World Bank. [cited 2018 Nov 29]. Available from: http://www.worldbank.org/en/topic/reproductivematernalchildhealth.

Ahmed I, Ali SM, Amenga-Etego S, Ariff S, Bahl R, Baqui AH, et al. Population-based rates, timing, and causes of maternal deaths, stillbirths, and neonatal deaths in South Asia and sub-Saharan Africa: a multi-country prospective cohort study. Lancet Glob Health. 2018;6(12):e1297–308.CrossRef

Kalipeni E, Iwelunmor J, Grigsby-Toussaint D. Maternal and child health in Africa for sustainable development goals beyond 2015. Glob Public Health. 2017;12(6):643–7.CrossRef

Amo-Adjei J, Tuoyire DA. Effects of planned, mistimed and unwanted pregnancies on the use of prenatal health services in sub-Saharan Africa: a multicountry analysis of demographic and health survey data. Tropical Med Int Health. 2016;21(12):1552–61.CrossRef

World Health Organization, editor. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: World Health Organization; 2016. p. 152.

Abou-Zahr I, Carla Lidia. II. Wardlaw, Tessa M. Antenatal care in developing countries: promises, achievements and missed opportunities ; an analysis of trends, levels and differentials, 1990-2001. Geneva: World Health Organization; 2003. https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/9241590947/en/.

Makate M, Makate C. The impact of prenatal care quality on neonatal, infant and child mortality in Zimbabwe: evidence from the demographic and health surveys. Health Policy Plan. 2017;32(3):395–404.PubMed

Lincetto, Ornella, Motherbesoane-Anoh Seipati, Gomez Patricia, Munjanja Stephen. Antenatal Care. [cited 2019 Mar 19]. Available from: https://www.who.int/pmnch/media/publications/aonsectionIII_2.pdf

World Health Organization. WHO | New guidelines on antenatal care for a positive pregnancy experience. [cited 2018 Nov 29]. Available from: http://www.who.int/reproductivehealth/news/antenatal-care/en/.

10.

Regassa N. Antenatal and postnatal care service utilization in southern Ethiopia: a population-based study. Afr Health Sci. 2011;11(3):390–7.PubMedPubMedCentral

11.

National Institute of Statistics of Rwanda, Rwanda, MEASURE DHS (Program), editors. Rwanda demographic and health survey, 2014–15: final report. Kigali, Rwanda : Rockville, Maryland, USA: National Institute of Statistics of Rwanda, Ministry of Finance and Economic Planning : Ministry of Health ; The DHS Program, ICF International; 2016. p. 615.

12.

Ataguba JE-O. A reassessment of global antenatal care coverage for improving maternal health using sub-Saharan Africa as a case study. PLoS One. 2018;13(10):e0204822.CrossRef

13.

The Sustainable Development Goals and Maternal Mortality. Maternal Health Task Force. 2017 [cited 2018 Nov 29]. Available from: https://www.mhtf.org/topics/the-sustainable-development-goals-and-maternal-mortality/.

14.

Binagwaho A, Farmer PE, Nsanzimana S, Karema C, Gasana M, de Dieu Ngirabega J, Ngabo F, Wagner CM, Nutt CT, Nyatanyi T, Gatera M. Rwanda 20 years on: investing in life. The Lancet. 2014;384(9940):371-5.

15.

WHO | Trends in maternal mortality: 1990 to 2015. WHO. [cited 2019 Mar 16]. Available from: http://www.who.int/reproductivehealth/publications/monitoring/maternal-mortality-2015/en/.

16.

Hagey J, Rulisa S, Pérez-Escamilla R. Barriers and solutions for timely initiation of antenatal care in Kigali, Rwanda: health facility professionals’ perspective. Midwifery. 2014;30(1):96–102.CrossRef

17.

Peters DH, Garg A, Bloom G, Walker DG, Brieger WR, Hafizur RM. Poverty and access to health care in developing countries. Ann N Y Acad Sci. 2008;1136:161–71.CrossRef

18.

Hanson C, Cox J, Mbaruku G, Manzi F, Gabrysch S, Schellenberg D, et al. Maternal mortality and distance to facility-based obstetric care in rural southern Tanzania: a secondary analysis of cross-sectional census data in 226 000 households. Lancet Glob Health. 2015;3(7):e387–95.CrossRef

19.

Kawungezi PC, AkiiBua D, Aleni C, Chitayi M, Niwaha A, Kazibwe A, et al. Attendance and utilization of antenatal care (ANC) services: multi-center study in upcountry areas of Uganda. Open J Prev Med. 2015;5(3):132–42.CrossRef

20.

Understanding the relationship between access to care and facility-based delivery through analysis of the 2008 Ghana Demographic Health Survey - Moyer - 2013 - International Journal of Gynecology & Obstetrics - Wiley Online Library. [cited 2019 Mar 12]. Available from: https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1016/j.ijgo.2013.04.005.

21.

Manzi A, Munyaneza F, Mujawase F, Banamwana L, Sayinzoga F, Thomson DR, et al. Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010. BMC Pregnancy Childbirth. 2014;14(1):290.CrossRef

22.

Beckmann CA, Buford TA, Witt JB. Perceived barriers to prenatal care services. MCN Am J Matern Child Nurs. 2000;25(1):43–6.CrossRef

23.

Rurangirwa AA, Mogren I, Nyirazinyoye L, Ntaganira J, Krantz G. Determinants of poor utilization of antenatal care services among recently delivered women in Rwanda; a population based study. BMC Pregnancy Childbirth. 2017 Dec [cited 2019 Mar 12];17(1). Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-017-1328-2.

24.

Aliyu AA, Dahiru T. Predictors of delayed Antenatal Care (ANC) visits in Nigeria: secondary analysis of 2013 Nigeria Demographic and Health Survey (NDHS). Pan Afr Med J. 2017 Mar 3 [cited 2018 Sep 27];26. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5429423/.

25.

Lee ES, Forthofer RN. Analyzing Complex Survey Data. SAGE; 2006. p. 108. file://Users/mpaul/Downloads/4c32c52c6ba653f1ac69eccc09afc408-original%20(1).pdf.

26.

Rao JNK, Scott AJ. On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Stat. 1984;12(1):46–60.CrossRef

27.

Liao D, Valliant R. Variance inflation factors in the analysis of complex survey data. Survey Methodology. 2012 Jun 1;38(1):53-62. https://www.rti.org/publication/variance-inflation-factors-analysis-complex-survey-data/fulltext.pdf.

28.

Koch GG, Freeman DH, Freeman JL. Strategies in the multivariate analysis of data from complex surveys. Int Stat Rev Rev Int Stat. 1975;43(1):59–78.CrossRef

29.

Lumley T, Scott A. AIC and BIC for modeling with complex survey data. J Surv Stat Methodol. 2015;3(1):1–18.CrossRef

30.

Hajian-Tilaki K. Receiver operating characteristic (ROC) curve analysis for medical diagnostic test evaluation. Casp J Intern Med. 2013;4(2):627–35.

31.

Austin PC. A tutorial and case study in propensity score analysis: an application to estimating the effect of in-hospital smoking cessation counseling on mortality. Multivar Behav Res. 2011;46(1):119–51.CrossRef

32.

Zheng X, Yang JS. Using Sample Weights in Item Response Data Analysis under Complex Sample Designs. In: van der Ark LA, Bolt DM, Wang W-C, Douglas JA, Wiberg M, editors. Quantitative Psychology Research. Cham: Springer International Publishing; 2016 [cited 2019 Mar 19]. p. 123–37. Available from: http://link.springer.com/10.1007/978-3-319-38759-8_10.CrossRef

33.

Kott PS. A design-sensitive approach to fitting regression models with complex survey data. Stat Surv 2018;12(0):1–17.CrossRef

34.

R: The R Project for Statistical Computing. [cited 2018 Oct 30]. Available from: https://www.r-project.org/.

35.

Archer KJ, Lemeshow S. Goodness-of-fit test for a logistic regression model fitted using survey sample data. Stata J. 2006;6(1):97–105.CrossRef

36.

Yao W, Li Z, Graubard BI. Estimation of ROC curve with complex survey data. Stat Med. 2015;34(8):1293–303.CrossRef

37.

Fagbamigbe AF, Idemudia ES. Barriers to antenatal care use in Nigeria: evidences from non-users and implications for maternal health programming. BMC Pregnancy Childbirth. 2015 Apr 17 [cited 2018 Nov 30];15. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4407543/.

38.

Adewuyi EO, Auta A, Khanal V, Bamidele OD, Akuoko CP, Adefemi K, et al. Prevalence and factors associated with underutilization of antenatal care services in Nigeria: a comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey. PLoS One. 2018;13(5):e0197324.CrossRef

39.

Wilunda C, Scanagatta C, Putoto G, Montalbetti F, Segafredo G, Takahashi R, et al. Barriers to utilisation of antenatal care services in South Sudan: a qualitative study in Rumbek North County. Reprod Health. 2017 May 22 [cited 2018 Nov 30];14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440928/.

40.

Tuyisenge G, Hategeka C, Kasine Y, Luginaah I, Cechetto D, Rulisa S. Mothers’ perceptions and experiences of using maternal health-care services in Rwanda. Women Health. 2019;59(1):68–84.CrossRef

41.

Titaley CR, Dibley MJ, Roberts CL. Factors associated with underutilization of antenatal care services in Indonesia: results of Indonesia demographic and health survey 2002/2003 and 2007. BMC Public Health. 2010;10(1):485.CrossRef

42.

Haddad DN, Makin JD, Pattinson RC, Forsyth BW. Barriers to early prenatal care in South Africa. Int J Gynecol Obstet. 2016;132(1):64–7.CrossRef

43.

Strategies towards universal health coverage in Rwanda: lessons learned from extending coverage through mutual health organizations | African Health Observatory. [cited 2018 Nov 30]. Available from: http://www.aho.afro.who.int/en/ahm/issue/17/reports/strategies-towards-universal-health-coverage-rwanda-lessons-learned-extending.

44.

World Bank Group to Strengthen Rwanda’s Social Protection System. World Bank. [cited 2018 Nov 30]. Available from: http://www.worldbank.org/en/news/press-release/2016/10/31/world-bank-group-to-strengthen-rwandas-social-protection-system.

45.

Exavery A, Kanté AM, Hingora A, Mbaruku G, Pemba S, Phillips JF. How mistimed and unwanted pregnancies affect timing of antenatal care initiation in three districts in Tanzania. BMC Pregnancy Childbirth. 2013;13(1):35.CrossRef

46.

Bahk J, Yun S-C, Kim Y, Khang Y-H. Impact of unintended pregnancy on maternal mental health: a causal analysis using follow up data of the Panel Study on Korean Children (PSKC). BMC Pregnancy Childbirth. 2015 Dec [cited 2018 Sep 23];15(1). Available from: http://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0505-4.

Title: Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?
Authors: Marie Paul Nisingizwe
Germaine Tuyisenge
Celestin Hategeka
Mohammad Ehsanul Karim
Publication date: 01-12-2020
Publisher: BioMed Central
Keyword: Care
Published in: BMC Pregnancy and Childbirth / Issue 1/2020
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-020-2775-8

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Springer Medicine

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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