Fagbamigbe Adeniyi Francis, Idemudia Erhabor Sunday
School of Research and Postgraduate Studies (SoRPS), Faculty of Human and Social Sciences, North West University, Mafikeng, South Africa.
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
BMC Pregnancy Childbirth. 2015 Apr 17;15:95. doi: 10.1186/s12884-015-0527-y.
In Nigeria, over one third of pregnant women do not attend Antenatal Care (ANC) service during pregnancy. This study evaluated barriers to the use of ANC services in Nigeria from the perspective of non-users.
Records of the 2199 (34.9%) respondents who did not use ANC among the 6299 women of childbearing age who had at least one child within five years preceding the 2012 National HIV/AIDS and Reproductive Health Survey (NARHS Plus II), were used for this analysis. The barriers reported for not visiting any ANC provider were assessed vis-à-vis respondents' social demographic characteristics, using multiple response data analysis techniques and Pearson chi-square test at 5% significance level.
Of the mothers who did not use ANC during five years preceding the survey, rural dwellers were the majority (82.5%) and 57.3% had no formal education. Most non-users (96.5%) were employed while 93.0% were currently married. North East with 51.5% was the geographical zone with highest number of non-users compared with 14.3% from the South East. Some respondents with higher education (2.0%) and also in the wealthiest quintiles (4.2%) did not use ANC. The reasons for non-use of ANC varied significantly with respondents' wealth status, educational attainment, residence, geographical locations, age and marital status. Over half (56.4%) of the non-users reported having a problem with getting money to use ANC services while 44.1% claimed they did not attend ANC due to unavailability of transport facilities. The three leading problems: "getting money to go", "Farness of ANC service providers" and "unavailability of transport" constituted 44.3% of all barriers. Elimination of these three problems could increase ANC coverage in Nigeria by over 15%.
Non-use of ANC was commonest among the poor, rural, currently married, less educated respondents from Northern Nigeria especially the North East zone. Affordability, availability and accessibility of ANC providers are the hurdles to ANC utilization in Nigeria. Addressing financial and other barriers to ANC use, quality improvement of ANC services to increase women's satisfaction and utilization and ensuring maximal contacts among women, society, and ANC providers are surest ways to increasing ANC coverage in Nigeria.
在尼日利亚，超过三分之一的孕妇在孕期未接受产前保健（ANC）服务。本研究从非使用者的角度评估了尼日利亚使用ANC服务的障碍。
在2012年全国艾滋病毒/艾滋病及生殖健康调查（NARHS Plus II）前五年内至少育有一个子女的6299名育龄妇女中，2199名（34.9%）未使用ANC服务的受访者记录被用于本分析。针对未就诊于任何ANC服务提供者所报告的障碍，采用多响应数据分析技术和5%显著性水平的Pearson卡方检验，根据受访者的社会人口特征进行评估。
在调查前五年内未使用ANC服务的母亲中，农村居民占多数（82.5%），57.3%未接受过正规教育。大多数非使用者（96.5%）有工作，93.0%目前已婚。东北地区非使用者数量最多，占51.5%，而东南部为14.3%。一些受过高等教育（2.0%）以及处于最富有五分位数的受访者（4.2%）也未使用ANC服务。未使用ANC服务的原因因受访者的财富状况、教育程度、居住地、地理位置、年龄和婚姻状况而有显著差异。超过一半（56.4%）的非使用者报告称使用ANC服务缺钱，44.1%称因交通不便未接受ANC服务。三个主要问题：“没钱前往”、“ANC服务提供者距离远”和“交通不便”占所有障碍的44.3%。消除这三个问题可使尼日利亚的ANC覆盖率提高超过15%。
在尼日利亚，尤其是东北地区，贫困、农村、已婚、受教育程度较低的受访者中，未使用ANC服务的情况最为普遍。ANC服务提供者的可负担性、可及性和可达性是尼日利亚ANC服务利用的障碍。解决ANC服务使用的经济和其他障碍，提高ANC服务质量以增加妇女的满意度和利用率，并确保妇女、社会和ANC服务提供者之间的最大程度接触，是提高尼日利亚ANC覆盖率的最可靠方法。
