Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010

BMC Pregnancy and Childbirth

Bethany L Hedt-Gauthier³  Joseph Ntaganira²  Dana R Thomson³  Felix Sayinzoga¹  Leonidas Banamwana¹  Francisca Mujawase⁴  Fabien Munyaneza²  Anatole Manzi² 

[1] Ministry of Health, Government of Rwanda, Kigali, Rwanda;University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda;Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA;Development Alternatives Incorporated, United States Agency for International Development, Kigali, Rwanda

关键词: Predictors;    Rwanda;    Demographic survey;    Delayed;    Antenatal care;   

Others  :  1125599
DOI  :  10.1186/1471-2393-14-290

 received in 2014-03-09, accepted in 2014-08-12,  发布年份 2014

【 摘 要 】

Background

Early initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda.

Methods

This is a cross-sectional study using data collected during the 2010 Rwanda DHS from 6,325 women age 15–49 that had at least one birth in the last five years. Factors associated with delayed ANC were identified using a multivariable logistic regression model using manual backward stepwise regression. Analysis was conducted in Stata v12 applying survey commands to account for the complex sample design.

Results

Several factors were significantly associated with delayed ANC including having many children (4–6 children, OR = 1.42, 95% CI: 1.22, 1.65; or more than six children, OR = 1.57, 95% CI: 1.24, 1.99); feeling that distance to health facility is a problem (OR = 1.20, 95% CI: 1.04, 1.38); and unwanted pregnancy (OR = 1.41, 95% CI: 1.26, 1.58). The following were protective against delayed ANC: having an ANC at a private hospital or clinic (OR = 0.29, 95% CI: 0.15, 0.56); being married (OR = 0.85, 95% CI: 0.75, 0.96), and having public mutuelle health insurance (OR = 0.81, 95% CI: 0.71, 0.92) or another type of insurance (OR = 0.33, 95% CI: 0.23, 0.46).

Conclusion

This analysis revealed potential barriers to ANC service utilization. Distance to health facility remains a major constraint which suggests a great need of infrastructure and decentralization of maternal ANC to health posts and dispensaries. Interventions such as universal health insurance coverage, family planning, and community maternal health system are underway and could be part of effective strategies to address delays in ANC.

【 授权许可】

   
2014 Manzi et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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