Mkandawire Paul, Atari Odwa, Kangmennaang Joseph, Arku Godwin, Luginaah Isaac, Etowa Josephine
Institute of Interdisciplinary Studies, Human Rights Program, Carleton University, 1125 Colonel By Drive, Ottawa, ON K1S 5B6, Canada.
Department of Geography, Nipissing University, 100 College Drive, Box 5002, North Bay, ON, P1B 8L7, Canada.
Midwifery. 2019 Jan;68:30-38. doi: 10.1016/j.midw.2018.08.017. Epub 2018 Aug 31.
With antenatal care (ANC) coverage now widely seen as a success story in Sub-Sahara Africa (SSA), attention has begun to shift towards exploring the full life-saving potential that ANC holds.
This study examines association between pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda, where ANC coverage is nearly universal.
We use survival analysis and apply the lognormal model in Stata SE 15 to compute time ratios (TR) that provide a direct metric for time to first ANC check-up.
Despite nearly universal coverage, only 25% of pregnant mothers start ANC within the timeframe recommended by WHO. Women with unintended pregnancies are even more likely to delay ANC (TR = 11.4%, Z = 2.48, p < 0.05) than women with intended pregnancies. The effect of pregnancy intention on time to first ANC accentuates when we control for parity in the hazard models. There is also educational divide, with early start of ANC limited to pregnant women with secondary education or higher. Interaction effects suggest significant interaction between parity (≥ 4) and unintended pregnancy (TR = 11.1%, Z = -2.07, p < 0.05) on gestational age at first ANC. Other predictors of time to first ANC are contact with health care provider and perceived barriers.
With near universal coverage, the next big challenge to harness the full life-saving potential of ANC in Rwanda would be ramping up prompt start of prenatal care, timeliness of successive checkup intervals, and adherence to recommended number of visits, as opposed to simply increasing attendance. Preventing unwanted pregnancies in multiparous mothers through family planning would also significantly to the goal of universal ANC coverage in Rwanda.
产前保健（ANC）覆盖率如今在撒哈拉以南非洲（SSA）被广泛视为一个成功案例，人们的注意力已开始转向探索产前保健所具备的全部挽救生命的潜力。
本研究考察了卢旺达首次产前保健（ANC）就诊时的妊娠意愿与孕周之间的关联，该国的产前保健覆盖率近乎普及。
我们使用生存分析，并在Stata SE 15中应用对数正态模型来计算时间比（TR），该时间比为首次产前检查的时间提供了一个直接度量指标。
尽管覆盖率近乎普及，但只有25%的孕妇在世界卫生组织建议的时间范围内开始接受产前保健。意外怀孕的女性比有意怀孕的女性更有可能推迟产前保健（时间比=11.4%，Z=2.48，p<0.05）。当我们在风险模型中控制产次时，妊娠意愿对首次产前保健时间的影响会更加明显。此外还存在教育差异，只有受过中等及以上教育的孕妇才会较早开始接受产前保健。交互作用表明，产次（≥4）与意外怀孕之间在首次产前保健时的孕周方面存在显著交互作用（时间比=11.1%，Z=-2.07，p<0.05）。首次产前保健时间别的预测因素是与医疗保健提供者的接触以及感知到的障碍。
鉴于覆盖率近乎普及，要在卢旺达充分发挥产前保健的挽救生命潜力，下一个重大挑战将是加快产前保健的及时启动、后续检查间隔的及时性以及坚持建议的就诊次数，而不是仅仅增加就诊率。通过计划生育防止多产母亲意外怀孕，也将对卢旺达实现普遍产前保健覆盖率的目标有显著帮助。
