Department of Food Science and Technology, College of Agriculture, Animal Sciences and Veterinary Medicine, University of Rwanda, P.O. Box 210, Musanze, Rwanda.
School of Agriculture and Environment, Massey University, Tennent Drive, Palmerston North, 4442, New Zealand.
BMC Pregnancy Childbirth. 2023 Jan 26;23(1):69. doi: 10.1186/s12884-023-05384-0.
Inadequate antenatal care (ANC) in low-income countries has been identified as a risk factor for poor pregnancy outcome. While many countries, including Rwanda, have near universal ANC coverage, a significant proportion of pregnant women do not achieve the recommended regimen of four ANC visits. The present study aimed to explore the factors associated with achieving the recommendation, with an emphasis on the distance from household to health facilities.
A geo-referenced cross-sectional study was conducted in Rutsiro district, Western province of Rwanda with 360 randomly selected women. Multiple logistic regression analysis including adjusted odd ratio (aOR) were performed to identify factors associated with achieving the recommended four ANC visits.
The majority (65.3%) of women had less than four ANC visits during pregnancy. We found a significant and negative association between distance from household to health facility and achieving the recommended four ANC visits. As the distance increased by 1 km, the odds of achieving the four ANC visits decreased by 19% (aOR = 0.81, P = 0.024). The odds of achieving the recommended four ANC visits were nearly two times higher among mothers with secondary education compared with mothers with primary education or less (aOR = 1.90, P = 0.038). In addition, mothers who responded that their household members always seek health care when necessary had 1.7 times higher odds of achieving four ANC visits compared with those who responded as unable to seek health care (aOR = 1.7, P = 0.041). Furthermore, mothers from poor households had 2.1 times lower odds of achieving four ANC visits than mothers from slightly better-off households (aOR = 2.1, P = 0.028).
Findings from the present study suggest that, in Rutsiro district, travel distance to health facility, coupled with socio-economic constraints, including low education and poverty can make it difficult for pregnant women to achieve the recommended ANC regimen. Innovative strategies are needed to decrease distance by bringing ANC services closer to pregnant women and to enhance ANC seeking behaviour. Interventions should also focus on supporting women to attain at least secondary education level as well as to improve the household socioeconomic status of pregnant women, with a particular focus on women from poor households.
在低收入国家，产前保健（ANC）不足已被确定为不良妊娠结局的一个风险因素。尽管包括卢旺达在内的许多国家已经实现了近乎普遍的 ANC 覆盖率，但仍有相当一部分孕妇未能达到推荐的四次 ANC 就诊次数。本研究旨在探讨与实现推荐方案相关的因素，重点关注家庭与卫生机构之间的距离。
在卢旺达西部省的鲁西罗区进行了一项基于地理位置的横断面研究，共纳入了 360 名随机选择的妇女。采用多变量逻辑回归分析（调整后的优势比[aOR]）来确定与实现推荐的四次 ANC 就诊次数相关的因素。
大多数（65.3%）孕妇在怀孕期间的 ANC 就诊次数少于四次。我们发现，家庭与卫生机构之间的距离与实现推荐的四次 ANC 就诊次数之间存在显著的负相关关系。距离每增加 1 公里，实现四次 ANC 就诊的几率就会降低 19%（aOR=0.81，P=0.024）。与小学或以下学历的母亲相比，具有中学教育程度的母亲实现推荐的四次 ANC 就诊的几率几乎高出两倍（aOR=1.90，P=0.038）。此外，回答家庭成员在必要时总是寻求医疗保健的母亲实现四次 ANC 就诊的几率比回答无法寻求医疗保健的母亲高 1.7 倍（aOR=1.7，P=0.041）。此外，来自贫困家庭的母亲实现四次 ANC 就诊的几率比来自稍微富裕家庭的母亲低 2.1 倍（aOR=2.1，P=0.028）。
本研究结果表明，在鲁西罗区，前往卫生机构的旅行距离，加上社会经济方面的限制，包括教育水平低和贫困，可能使孕妇难以实现推荐的 ANC 方案。需要采取创新策略来缩短孕妇与 ANC 服务之间的距离，并增强 ANC 就诊行为。干预措施还应侧重于支持妇女获得至少中学教育水平，并改善孕妇的家庭社会经济状况，特别关注贫困家庭的妇女。
