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BMC Pregnancy and Childbirth

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Open Access 01-12-2021 | Care | Research article

Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data

Authors: Phoebe Miller, Patience A. Afulani, Sabine Musange, Felix Sayingoza, Dilys Walker

Published in: BMC Pregnancy and Childbirth | Issue 1/2021

Abstract

Background

Research suggests that women’s experience of antenatal care is an important component of high-quality antenatal care. Person-centered antenatal care (PCANC) reflects care that is both respectful of, and responsive to, the preferences, needs, and values of pregnant women. Little is known in Rwanda about either the extent to which PCANC is practiced or the factors that might determine its use. This is the first study to quantitatively examine the extent of and the factors associated with PCANC in Rwanda.

Methods

We used quantitative data from a randomized control trial in Rwanda. A total of 2150 surveys were collected and analyzed from 36 health centers across five districts. We excluded women who were less than 16 years old, were referred to higher levels of antenatal care or had incomplete survey responses. Both bivariate and multivariate logistic regression analyses were used to test the hypothesis that certain participant characteristics would predict high PCANC.

Results

PCANC level was found to be sub-optimal with one third of women leaving antenatal care (ANC) with questions or confused and one fourth feeling disrespected. In bivariate analysis, social support, greater parity, being in the traditional care (control group), and being from Burera district significantly predict high PCANC. Additionally, in the multivariate analysis, being in the traditional care group and the district in which women received care were significantly associated with PCANC.

Conclusions

This quantitative analysis indicates sub-optimal levels of PCANC amongst our study population in Rwanda. We find lower levels of PCANC to be regional and defined by the patient characteristics parity and social support. Given the benefits of PCANC, improvements in PCANC through provider training in Rwanda might promote an institutional culture shift towards a more person-centered model of care.

Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2019.

Carroli G, Rooney C, Villar J. How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol. 2001;15(s1):1–42. https://doi.org/10.1046/j.1365-3016.2001.0150s1001.x.CrossRefPubMed

Bauserman M, Lokangaka A, Thorsten V, Tshefu A, Goudar SS, Esamai F, et al. Risk factors for maternal death and trends in maternal mortality in low-and middle-income countries: a prospective longitudinal cohort analysis. Reprod Health. 2015;12(S2):S5. https://doi.org/10.1186/1742-4755-12-S2-S5.CrossRefPubMedPubMedCentral

Van den Broek NR, Graham WJ. Quality of care for maternal and newborn health: the neglected agenda. BJOG Int J Obstet Gynaecol. 2009;116:18–21. https://doi.org/10.1111/j.1471-0528.2009.02333.x.CrossRef

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

Say L, Raine R. A systematic review of inequalities in the use of maternal health care in developing countries: examining the scale of the problem and the importance of context. Bull World Health Organ. 2007;85(10):812–9. https://doi.org/10.2471/BLT.06.035659.CrossRefPubMedPubMedCentral

Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D. Advancing a conceptual model to improve maternal health quality: the person-centered care framework for reproductive health equity. Gates Open Research. 2017;1. https://doi.org/10.12688/gatesopenres.12756.1.

Bhutta ZA, Salam RA, Lassi ZS, Austin A, Langer A. Approaches to improve quality of care (QoC) for women and newborns: conclusions, evidence gaps and research priorities. Reprod Health. 2014;11(S2):S5 https://doi.org/10.1186/1742-4755-11-S2-S5.CrossRef

Afulani PA, Buback L, Essandoh F, Kinyua J, Kirumbi L, Cohen CR. Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions. BMC Health Serv Res. 2019;19(1):684. https://doi.org/10.1186/s12913-019-4476-4.CrossRefPubMedPubMedCentral

10.

Afulani PA, Diamond-Smith N, Golub G, Sudhinaraset M. Development of a tool to measure person-centered maternity care in developing settings: validation in a rural and urban Kenyan population. Reprod Health. 2017;14(1):118. https://doi.org/10.1186/s12978-017-0381-7.CrossRefPubMedPubMedCentral

11.

Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for women using routine intrapartum services: a systematic review. Reprod Health. 2018;15(1):23. https://doi.org/10.1186/s12978-018-0466-y.CrossRefPubMedPubMedCentral

12.

Afulani PA, Moyer CA. Accountability for respectful maternity care. Lancet. 2019;394(10210):1692–3. https://doi.org/10.1016/S0140-6736(19)32258-5.CrossRefPubMed

13.

Chukwuma A, Wosu AC, Mbachu C, Weze K. Quality of antenatal care predicts retention in skilled birth attendance: a multilevel analysis of 28 African countries. BMC Pregnancy Childbirth. 2017;17(1):152. https://doi.org/10.1186/s12884-017-1337-1.CrossRefPubMedPubMedCentral

14.

Adjiwanou V, LeGrand T. Does antenatal care matter in the use of skilled birth attendance in rural Africa: a multi-country analysis. Soc Sci Med. 2013 Jun 1;86:26–34. https://doi.org/10.1016/j.socscimed.2013.02.047.CrossRefPubMed

15.

Afulani PA, Moyer C. Explaining disparities in use of skilled birth attendants in developing countries: a conceptual framework. PLoS One. 2016;11(4):e0154110. https://doi.org/10.1371/journal.pone.0154110.CrossRefPubMedPubMedCentral

16.

Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth. Boston: USAID-TRAction Project, Harvard School of Public Health; 2010.

17.

Abuya T, Warren CE, Miller N, Njuki R, Ndwiga C, Maranga A, et al. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PLoS One. 2015;10(4):e0123606. https://doi.org/10.1371/journal.pone.0123606.CrossRefPubMedPubMedCentral

18.

Kujawski S, Mbaruku G, Freedman LP, Ramsey K, Moyo W, Kruk ME. Association between disrespect and abuse during childbirth and women’s confidence in health facilities in Tanzania. Matern Child Health J. 2015;19(10):2243–50. https://doi.org/10.1007/s10995-015-1743-9.CrossRefPubMed

19.

Bohren MA, Vogel JP, Hunter EC, Lutsiv O, Makh SK, Souza JP, et al. The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review. PLoS Med. 2015;12(6):e1001847. https://doi.org/10.1371/journal.pmed.1001847.CrossRefPubMedPubMedCentral

20.

Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, et al. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016;388(10056):2176–92. https://doi.org/10.1016/S0140-6736(16)31472-6.CrossRefPubMed

21.

Freedman LP, Ramsey K, Abuya T, Bellows B, Ndwiga C, Warren CE, et al. Defining disrespect and abuse of women in childbirth: a research, policy and rights agenda. Bull World Health Organ. 2014;92(12):915–7. https://doi.org/10.2471/BLT.14.137869.CrossRefPubMedPubMedCentral

22.

Rosen HE, Lynam PF, Carr C, Reis V, Ricca J, Bazant ES, et al. Direct observation of respectful maternity care in five countries: a cross-sectional study of health facilities in east and southern Africa. BMC Pregnancy Childbirth. 2015;15(1):306. https://doi.org/10.1186/s12884-015-0728-4.CrossRefPubMedPubMedCentral

23.

Solnes Miltenburg A, van Pelt S, Meguid T, Sundby J. Disrespect and abuse in maternity care: individual consequences of structural violence. Reproductive Health Matters. 2018;26(53):88–106. https://doi.org/10.1080/09688080.2018.1502023.CrossRefPubMed

24.

Afulani PA. Rural/urban and socioeconomic differentials in quality of antenatal care in Ghana. PLoS One. 2015;10(2):e0117996. https://doi.org/10.1371/journal.pone.0117996.CrossRefPubMedPubMedCentral

25.

Joshi C, Torvaldsen S, Hodgson R, Hayen A. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth. 2014;14(1):94. https://doi.org/10.1186/1471-2393-14-94.CrossRefPubMedPubMedCentral

26.

Manzi A, Nyirazinyoye L, Ntaganira J, Magge H, Bigirimana E, Mukanzabikeshimana L, et al. Beyond coverage: improving the quality of antenatal care delivery through integrated mentorship and quality improvement at health centers in rural Rwanda. BMC Health Serv Res. 2018;18(1):136. https://doi.org/10.1186/s12913-018-2939-7.CrossRefPubMedPubMedCentral

27.

Sharma J, Leslie HH, Kundu F, Kruk ME. Poor quality for poor women? Inequities in the quality of antenatal and delivery care in Kenya. PLoS One. 2017;12(1):e0171236. https://doi.org/10.1371/journal.pone.0171236.CrossRefPubMedPubMedCentral

28.

Rurangirwa AA, Mogren I, Ntaganira J, Govender K, Krantz G. Quality of antenatal care services in Rwanda: assessing practices of health care providers. BMC Health Serv Res. 2018;18(1):865. https://doi.org/10.1186/s12913-018-3694-5.CrossRefPubMedPubMedCentral

29.

Sayinzoga F, Lundeen T, Gakwerere M, Manzi E, Nsaba YD, Umuziga MP, et al. Use of a facilitated group process to design and implement a group antenatal and postnatal care program in Rwanda. J Midwifery Women’s Health. 2018;63(5):593–601. https://doi.org/10.1111/jmwh.12871.CrossRef

30.

Gallo V, Egger M, McCormack V, Farmer PB, Ioannidis JP, Kirsch-Volders M, et al. Strengthening the reporting of observational studies in epidemiology–molecular epidemiology (STROBE-ME): an extension of the STROBE statement. Mutagenesis. 2012;27(1):17–29. https://doi.org/10.1093/mutage/ger039.CrossRefPubMed

31.

Sheferaw ED, Mengesha TZ, Wase SB. Development of a tool to measure women’s perception of respectful maternity care in public health facilities. BMC Pregnancy Childbirth. 2016;16(1):67. https://doi.org/10.1186/s12884-016-0848-5.CrossRefPubMedPubMedCentral

32.

Musange SF, Butrick E, Lundeen T, Santos N, Firdaus HA, Benitez A, et al. Group antenatal care versus standard antenatal care and effect on mean gestational age at birth in Rwanda: protocol for a cluster randomized controlled trial. Gates Open Research. 2019;3:1548. https://doi.org/10.12688/gatesopenres.13053.1.CrossRefPubMedPubMedCentral

33.

Afulani PA, Sayi TS, Montagu D. Predictors of person-centered maternity care: the role of socioeconomic status, empowerment, and facility type. BMC Health Serv Res. 2018;18(1):360. https://doi.org/10.1186/s12913-018-3183-x.CrossRefPubMedPubMedCentral

34.

Afulani PA, Phillips B, Aborigo RA, Moyer CA. Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India. Lancet Glob Health. 2019;7(1):e96–109. https://doi.org/10.1016/S2214-109X(18)30403-0.CrossRefPubMed

35.

Nizeyimana P, Lee KW, Sim S. A study on the classfication of households in Rwanda based on factor scores. 한국데이터정보과학회지 2018;29(2):547–555.

36.

Salomon A, Ishaku S, Kirk KR, Warren CE. Detecting and managing hypertensive disorders in pregnancy: a cross-sectional analysis of the quality of antenatal care in Nigeria. BMC Health Serv Res. 2019;19(1):411. https://doi.org/10.1186/s12913-019-4217-8.CrossRefPubMedPubMedCentral

37.

Mukamurigo J, Dencker A, Ntaganira J, Berg M. The meaning of a poor childbirth experience–a qualitative phenomenological study with women in Rwanda. PLoS One. 2017;12(12):e0189371. https://doi.org/10.1371/journal.pone.0189371.CrossRefPubMedPubMedCentral

38.

Mukamurigo JU, Berg M, Ntaganira J, Nyirazinyoye L, Dencker A. Associations between perceptions of care and women’s childbirth experience: a population-based cross-sectional study in Rwanda. BMC Pregnancy Childbirth. 2017;17(1):1–7.CrossRef

39.

Ishola F, Owolabi O, Filippi V. Disrespect and abuse of women during childbirth in Nigeria: a systematic review. PLoS One. 2017;12(3):e0174084. https://doi.org/10.1371/journal.pone.0174084.CrossRefPubMedPubMedCentral

40.

Kruk ME, Kujawski S, Mbaruku G, Ramsey K, Moyo W, Freedman LP. Disrespectful and abusive treatment during facility delivery in Tanzania: a facility and community survey. Health Policy Plan. 2018;33(1):e26–33. https://doi.org/10.1093/heapol/czu079.CrossRefPubMed

41.

Kabeer N. Resources, agency, achievements: reflections on the measurement of women's empowerment. Dev Chang. 1999;30(3):435–64. https://doi.org/10.1111/1467-7660.00125.CrossRef

42.

Tran TK, Nguyen CT, Nguyen HD, Eriksson B, Bondjers G, Gottvall K, et al. Urban-rural disparities in antenatal care utilization: a study of two cohorts of pregnant women in Vietnam. BMC Health Serv Res. 2011;11(1):120. https://doi.org/10.1186/1472-6963-11-120.CrossRefPubMedPubMedCentral

43.

Saksena P, Antunes AF, Xu K, Musango L, Carrin G. Impact of mutual health insurance on access to health care and financial risk protection in Rwanda. Geneva: World Health Report; 2010.

Title: Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data
Authors: Phoebe Miller
Patience A. Afulani
Sabine Musange
Felix Sayingoza
Dilys Walker
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Pregnancy and Childbirth / Issue 1/2021
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-021-03747-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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