Fagbamigbe Adeniyi Francis, Mashabe Baitshephi, Lepetu Lornah, Abel Clearance
Department of Mathematics and Statistical Sciences, Botswana International University of Science and Technology, Palapye, Botswana.
Department of Epidemiology and Medical Statistics, University of Ibadan, Ibadan, Nigeria.
Int J Womens Health. 2017 Oct 30;9:807-819. doi: 10.2147/IJWH.S138329. eCollection 2017.
Child and maternal mortality and morbidity remain among the top global health challenges despite various efforts and multitude of resources directed to improving this situation over time. This study assessed trend of the timings of first antenatal care (ANC) visit in Nigeria and also identified the risk factors associated with it.
The data obtained from three consecutive Nigerian Demographic and Health Surveys in 2003, 2008, and 2013 were pooled. We focused on the ANC attendance history during the current pregnancies or the last pregnancies within 5 years preceding the survey irrespective of how the pregnancy ended. The gestational age at time of first ANC visit was computed as the survival time, while others who did not attend ANC were censored. Basic descriptive statistics and survival analysis methods were used to analyze the data.
A total of 45,690 pregnancies were studied, of which 70% were from rural areas. Mothers were mostly (45%) aged 25-34 years and 47.1% had no formal education, while only 37.9% were involved in decisions on the use of health care facility. Prevalence of ANC use was 60.5% in 2008 and 65.8% in both 2003 and 2013. Less than one-third (32.3%) of the women accessed ANC within first 3 months of pregnancy, with highest rate (41.7%) among women with higher education and those from North Central Nigeria (42.7%). The hazard of the timing of first ANC visit was higher in years 2003 and 2013 than in 2008.
Initiation of ANC visit in Nigeria is generally late with most women making first visit during second trimester, with significant variations across the years studied. The increase in coverage of ANC recorded in 2003 and 2013 was not accompanied by earlier commencement of ANC visit. Maternal health stakeholders should do more to ensure that all pregnant women start ANC visit earlier.
尽管长期以来为改善这种状况付出了各种努力并投入了大量资源，但儿童和孕产妇死亡率及发病率仍然是全球主要的健康挑战。本研究评估了尼日利亚首次产前检查（ANC）就诊时间的趋势，并确定了与之相关的风险因素。
汇总了从2003年、2008年和2013年连续三次尼日利亚人口与健康调查中获得的数据。我们关注的是当前妊娠期间或调查前5年内最后一次妊娠期间的ANC就诊历史记录（无论妊娠结局如何）。首次ANC就诊时的孕周被计算为生存时间，而其他未进行ANC检查的则被视为截尾数据。使用基本描述性统计和生存分析方法对数据进行分析。
共研究了45,690例妊娠，其中70%来自农村地区。母亲大多（45%）年龄在25 - 34岁之间，47.1%没有接受过正规教育，而只有37.9%的人参与了关于使用医疗机构的决策。2008年ANC的使用率为60.5%，2003年和2013年均为65.8%。不到三分之一（32.3%）的女性在怀孕的前三个月内进行了ANC检查，其中受过高等教育的女性比例最高（41.7%），来自尼日利亚中北部的女性比例为42.7%。2003年和2013年首次ANC就诊时间的风险高于2008年。
在尼日利亚，ANC就诊开始时间普遍较晚，大多数女性在孕中期才进行首次就诊，在所研究的不同年份之间存在显著差异。2003年和2013年记录的ANC覆盖率增加并未伴随着ANC就诊的更早开始。孕产妇健康利益相关者应做出更多努力，以确保所有孕妇更早开始进行ANC就诊。
