Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Health Data Science Group, Division of Population and Behavioural Sciences, School of Medicine, University of St Andrews, St Andrews, United Kingdom.
BMC Pregnancy Childbirth. 2021 May 25;21(1):402. doi: 10.1186/s12884-021-03837-y.
Nigeria has unimpressive maternal and child health indicators. Compliance with the WHO guidelines on the minimum number of antenatal care (ANC) contacts could improve these indicators. We assessed the compliance with WHO recommended standards on ANC contacts in Nigeria and identify the associated factors.
Nationally representative cross-sectional data during pregnancy of 21,785 most recent births within five years preceding the 2018 Nigeria Demographic Health Survey was used. The number of ANC contacts was categorised into "None", "1-3", "4-7" and "8 or more" contacts based on subsequent WHO guidelines. Descriptive statistics, bivariable and multivariable multinomial logistic regression was used at p = 0.05.
About 25 % of the women had no ANC contact, 58 % had at least 4 contacts while only 20 % had 8 or more ANC contacts. The highest rate of 8 or more ANC contacts was in Osun (80.2 %), Lagos (76.8 %), and Imo (72.0 %) while the lowest rates were in Kebbi (0.2 %), Zamfara (1.1 %) and Yobe (1.3 %). Respondents with higher education were twelve times (adjusted relative risk (aRR): 12.46, 95 % CI: 7.33-21.2), having secondary education was thrice (aRR: 2.91, 95 % CI: 2.35-3.60), and having primary education was twice (aRR: 2.17, 95 % CI: 1.77-2.66) more likely to make at least 8 contacts than those with no education. Respondents from households in the richest and middle wealth categories were 129 and 67 % more likely to make 8 or more ANC contacts compared to those from households in the lowest wealth category respectively. The likelihood of making 8 ANC contacts was 89 and 47 % higher among respondents from communities in the least and middle disadvantaged groups, respectively, compared to the most disadvantaged group. Other significant variables were spouse education, health care decision making, media access, ethnicity, religion, and other community factors.
Compliance with WHO guidelines on the minimum number of ANC contacts in Nigeria is poor. Thus, Nigeria has a long walk to attaining sustainable development goal's targets on child and maternal health. We recommend that the maternal and child health programmers should review existing policies and develop new policies to adopt, implement and tackle the challenges of adherence to the WHO recommended minimum of 8 ANC contacts. Women's education, socioeconomic status and adequate mobilization of families should be prioritized. There is a need for urgent intervention to narrow the identified inequalities and substantial disparities in the characteristics of pregnant women across the regions and states.
尼日利亚的母婴健康指标不尽如人意。遵循世界卫生组织（WHO）关于最低产前护理（ANC）次数的指南，可能会改善这些指标。我们评估了尼日利亚对 ANC 接触次数的最低标准，以及确定了相关因素。
利用 2018 年尼日利亚人口与健康调查之前五年内最近 21785 次生育的全国代表性横断面妊娠数据。根据随后的 WHO 指南，将 ANC 接触次数分为“无”、“1-3”、“4-7”和“8 次或更多”。使用描述性统计、双变量和多变量多项逻辑回归，p 值设为 0.05。
约 25%的妇女没有 ANC 接触，58%的妇女至少有 4 次接触，只有 20%的妇女有 8 次或更多 ANC 接触。8 次或更多 ANC 接触的最高比例出现在奥孙州（80.2%）、拉各斯州（76.8%）和伊莫州（72.0%），而在凯比州（0.2%）、赞法拉州（1.1%）和约贝州（1.3%）的比例最低。接受过高等教育的受访者的可能性是十二倍（调整后的相对风险（aRR）：12.46，95%CI：7.33-21.2），接受过中等教育的受访者的可能性是三倍（aRR：2.91，95%CI：2.35-3.60），接受过初等教育的受访者的可能性是两倍（aRR：2.17，95%CI：1.77-2.66）。与没有受过教育的受访者相比，受访者来自最富有和中等财富类别的家庭，进行至少 8 次 ANC 接触的可能性要高出 129%和 67%。与来自最贫困家庭的受访者相比，来自最贫困和中等劣势社区的受访者进行 8 次 ANC 接触的可能性分别高出 89%和 47%。其他重要变量包括配偶教育、医疗保健决策、媒体获取、族裔、宗教和其他社区因素。
尼日利亚对 ANC 接触次数的最低标准的遵循情况较差。因此，尼日利亚要实现可持续发展目标关于儿童和孕产妇健康的目标，还有很长的路要走。我们建议，孕产妇和儿童健康规划人员应审查现有政策，并制定新政策，以采取、实施和应对遵守世卫组织建议的至少 8 次 ANC 接触的挑战。妇女教育、社会经济地位和家庭的充分动员应被视为优先事项。需要紧急干预，以缩小各地区和各州孕妇特征方面存在的明显不平等和巨大差距。
