Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
BMC Public Health. 2023 Mar 30;23(1):599. doi: 10.1186/s12889-023-15506-0.
Despite gains throughout the 20th century, maternal health remains a major public health concern. Despite global efforts to enhance access to maternal and child healthcare services, women in low- and middle-income countries still have a high risk of dying during pregnancy and after birth. This study aimed to determine the magnitude and determinants of late antenatal care initiation among reproductive age women in Gambia.
Secondary data analysis was conducted using the 2019-20 Gambian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had an antenatal care visit for the last child were included in this study. The total weighted sample size analyzed was 5310. Due to the hierarchical nature of demographic and health survey data, a multi-level logistic regression model was performed to identify the individual and community level factors associated with delayed first antenatal care initiation.
In this study, the prevalence of delayed initiation of initial antenatal care was 56% ranged from 56 to 59%. Women with age 25-34 [Adjusted Odds Ratio = 0.77; 95% CI 0.67-0.89], 35-49 [Adjusted Odds Ratio = 0.77; 95% CI 0.65-0.90] and women reside in urban area [Adjusted Odds Ratio = 0.59; 95% CI 0.47-0.75] respectively had lower odds of delayed first antenatal care initiation. While women with unplanned pregnancy [Adjusted Odds Ratio = 1.60; 95% CI 1.37-1.84], no health insurance [Adjusted Odds Ratio = 1.78; 95% CI 1.14-2.76] and previous history of cesarean delivery [Adjusted Odds Ratio = 1.50; 95% CI 1.10-2.07] had higher odds of delayed initiation of antenatal care.
Despite the established advantages of early antenatal care initiation, this study revealed that late antenatal care initiation is still common in Gambia. Unplanned pregnancy, residence, health insurance, history of caesarian delivery, and age were significantly associated with delayed first antenatal care presentation. Therefore, focusing extra attention on these high-risk individuals could reduce delayed first antenatal care visit and this further minimizes maternal and fetal health concerns by recognizing and acting early.
尽管在 20 世纪取得了进步，但产妇健康仍然是一个主要的公共卫生关注点。尽管全球努力提高获得孕产妇和儿童保健服务的机会，但中低收入国家的妇女在妊娠和分娩后仍面临很高的死亡风险。本研究旨在确定冈比亚育龄妇女中晚期产前护理开始的程度和决定因素。
使用 2019-20 年冈比亚人口与健康调查数据进行二次数据分析。所有在调查前五年内分娩且最后一次分娩时接受过产前护理的育龄妇女均纳入本研究。分析的总加权样本量为 5310 人。由于人口与健康调查数据的层次性质，采用多水平逻辑回归模型来确定与首次产前护理延迟开始相关的个体和社区层面的因素。
在这项研究中，延迟开始首次产前护理的流行率为 56%，范围为 56%至 59%。年龄在 25-34 岁的女性[调整后的优势比 = 0.77；95%置信区间 0.67-0.89]、35-49 岁的女性[调整后的优势比 = 0.77；95%置信区间 0.65-0.90]和居住在城市地区的女性[调整后的优势比 = 0.59；95%置信区间 0.47-0.75]分别具有较低的延迟首次产前护理开始的可能性。而意外怀孕的女性[调整后的优势比 = 1.60；95%置信区间 1.37-1.84]、没有医疗保险的女性[调整后的优势比 = 1.78；95%置信区间 1.14-2.76]和有剖宫产史的女性[调整后的优势比 = 1.50；95%置信区间 1.10-2.07]则更有可能延迟开始产前护理。
尽管早期产前护理开始有明显的优势，但本研究表明，冈比亚仍普遍存在晚期产前护理开始的情况。意外怀孕、居住地、医疗保险、剖宫产史和年龄与首次产前护理就诊的延迟显著相关。因此，通过及早识别和采取行动，对这些高风险个体给予额外关注，可以减少首次产前护理就诊的延迟，从而最大限度地减少母婴健康问题。
