Research Unit, Foundation for Professional Development, Pretoria, South Africa.
Integrated Health Systems Strengthening Department, Foundation for Professional Development, Pretoria, South Africa.
PLoS One. 2018 Mar 8;13(3):e0191903. doi: 10.1371/journal.pone.0191903. eCollection 2018.
To investigate and compare determinates for delayed first presentation to antenatal care (ANC) services.
A cross-sectional study was conducted amongst pregnant women attending their first ANC visit in rural Capricorn District and peri-urban Tlokwe sub-district communities in South Africa. Data collection included questionnaires and medical record abstraction. Bivariate and multivariate analyses assessed factors associated with late ANC presentation.
We recruited 807 pregnant women. Of these, 51% of rural women and 28% of peri-urban women presented late for first ANC. Rural women were more likely to present late for first ANC (AOR = 2.65; 95% CI 1.98-3.55) and report barriers to accessing ANC services (P<0.0001). Late ANC presentation in rural communities was associated with being married (AOR = 2.36; 95% CI 1.33-4.19), employed (AOR = 1.90; 95% CI 1.03-3.50), <20 years of age (AOR = 2.19; 95% CI 1.10-4.37), and reporting an unplanned pregnancy (AOR = 2.21; 95% CI 1.40-3.50). Late presentation in peri-urban communities was associated with unplanned pregnancy (AOR = 1.67; 95% CI 1.01-2.74), being told to come back later to initiate ANC after presenting early (AOR 0.51; 95% CI 0.30-0.89) and being pregnant for the first time (AOR = 0.56; 95% CI 0.34-0.94).
Both rural and peri-urban women had high rates of late presentation for first ANC. However, women in the rural communities were more likely to present late. Unplanned pregnancy was an independent risk factor in both rural and peri-urban communities. Interventions around family planning, especially for adolescent girls and young women, are needed to improve early presentation for ANC.
调查和比较初次产前保健（ANC）服务延迟就诊的决定因素。
本横断面研究在南非摩羯座地区农村社区和特洛夸市郊区社区参加首次 ANC 检查的孕妇中进行。数据收集包括问卷调查和病历摘录。使用双变量和多变量分析评估与 ANC 就诊延迟相关的因素。
我们招募了 807 名孕妇。其中，农村妇女中有 51%和郊区妇女中有 28%首次 ANC 就诊延迟。农村妇女更有可能延迟首次 ANC 就诊（AOR=2.65；95%CI 1.98-3.55），并报告 ANC 服务获取方面的障碍（P<0.0001）。农村社区 ANC 就诊延迟与已婚（AOR=2.36；95%CI 1.33-4.19）、就业（AOR=1.90；95%CI 1.03-3.50）、年龄<20 岁（AOR=2.19；95%CI 1.10-4.37）和报告意外怀孕（AOR=2.21；95%CI 1.40-3.50）相关。郊区社区 ANC 就诊延迟与意外怀孕（AOR=1.67；95%CI 1.01-2.74）、首次就诊后被告知稍后再来启动 ANC（AOR 0.51；95%CI 0.30-0.89）和首次怀孕（AOR=0.56；95%CI 0.34-0.94）相关。
农村和郊区妇女首次 ANC 就诊均有较高的延迟就诊率。然而，农村社区的妇女更有可能延迟就诊。意外怀孕是农村和郊区社区的独立危险因素。需要围绕计划生育开展干预措施，特别是针对青少年女孩和年轻妇女，以改善 ANC 的早期就诊率。
