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BACKGROUND

The most recent WHO guideline on antenatal care (ANC) utilization reaffirmed the necessary and compulsory care and services a pregnant woman should receive to maximize the importance and gains of ANC. While most studies focused on the time of initiation and number of ANC contacts, emphasis was rarely placed on the components of ANC offered to women. This study assessed how complete the components of ANC received by pregnant women are as a proxy for the quality of ANC services offered in Nigeria. We also assessed the clustering of the components and state-level differentials and inequalities in the components of ANC received in Nigeria.

METHODS

We used nationally representative cross-sectional data from the 2018 Nigeria Demographic Health Survey. We analysed the data of 11,867 women who had at least one ANC contact during the most recent pregnancy within five years preceding the survey. The assessed components were tetanus injection, blood pressure, urine test, blood test, iron supplement, malaria intermittent preventive treatment in pregnancy (IPTp), and told about danger signs. Others are intestinal parasite drugs (IPD)intermittent and HIV/PMTCT counsel. Descriptive statistics, bivariable and multivariable multilevel Bayesian Monte Carlo Poisson models were used.

RESULTS

In all, 94% had blood pressure measured, 91% received tetanus injection, had iron supplement-89%, blood test-87%, urine test-86%, IPTp-24%, danger signs-80%, HIV/PMTC-82% and IPD-22%. The overall prevalence of receiving all 9 components was 5% and highest in Ogun (24%) and lowest in Kebbi state (0.1%). The earlier the initiation of ANC, the higher the number of contacts, and the higher the quality of ANC received. Respondents with higher education have a 4% (adjusted incidence risk ratio (aIRR): 1.04, 95% credible interval (CrI): 1.01-1.09) higher risk of receiving more components of ANC relative to those with no education. The risk of receiving more ANC components was 5% (aIRRR: 1.05, 95% CI: 1.01-1.10) higher among pregnant women aged 40 to 49 years than those aged 15 to 19 years. Women who decide their healthcare utilization alone had a 2% higher risk of getting more components than those whose spouses are the only decision taker of healthcare use. Other significant factors were household wealth status, spouse education, ethnicity, place of ANC, and skill of ANC provider. Pregnant women who had their blood pressure measured were very likely to have blood and urine tests, tetanus injections, iron supplements, and HIV talks.

CONCLUSIONS

Only one in every 20 pregnant women received all the 9 ANC components with wide disparities and inequalities across the background characteristics and the States of residence in Nigeria. There is a need to ensure that all pregnant women receive adequate components. Stakeholders should increase supplies, train, and create awareness among ANC providers and pregnant women in particular.

背景

世界卫生组织最近发布的产前护理（ANC）利用指南重申了孕妇应接受的必要和强制性护理和服务，以最大限度地提高 ANC 的重要性和收益。虽然大多数研究都集中在 ANC 的起始时间和接触次数上，但很少强调向妇女提供的 ANC 服务的组成部分。本研究评估了孕妇接受的 ANC 服务组成部分的完整程度，作为尼日利亚提供的 ANC 服务质量的替代指标。我们还评估了 ANC 服务组成部分的聚类以及尼日利亚在 ANC 服务组成部分方面的州级差异和不平等。

方法

我们使用了来自 2018 年尼日利亚人口与健康调查的全国代表性横断面数据。我们分析了在调查前五年内最近一次怀孕期间至少有一次 ANC 接触的 11867 名妇女的数据。评估的组成部分包括破伤风注射、血压、尿液检查、血液检查、铁补充剂、妊娠间歇性预防治疗（IPTp）以及告知危险信号。其他包括肠道寄生虫药物（IPD）间歇性和艾滋病毒/PMTCT 咨询。使用描述性统计、双变量和多变量多层次贝叶斯蒙特卡罗泊松模型。

结果

共有 94%的人测量了血压，91%的人接受了破伤风注射，89%的人接受了铁补充剂，87%的人接受了血液检查，86%的人接受了尿液检查，24%的人接受了 IPTp，80%的人接受了危险信号，82%的人接受了艾滋病毒/PMTCT 咨询，22%的人接受了 IPD。总共 9 个组成部分全部接受的比例为 5%，其中奥贡州最高（24%），而在克贝州最低（0.1%）。ANC 开始得越早，接触次数越多，接受的 ANC 质量越高。接受过高等教育的受访者比没有接受过教育的受访者更有可能接受更多的 ANC 组成部分，风险比为 4%（调整发病率风险比（aIRR）：1.04，95%可信区间（CrI）：1.01-1.09）。与 15 至 19 岁的孕妇相比，40 至 49 岁的孕妇接受更多 ANC 组成部分的风险高 5%（aIRRR：1.05，95%CI：1.01-1.10）。与配偶是医疗保健唯一决策者的孕妇相比，独自决定医疗保健利用的孕妇获得更多 ANC 组成部分的风险高 2%。其他重要因素包括家庭财富状况、配偶教育程度、种族、ANC 地点和 ANC 提供者的技能。接受血压测量的孕妇很可能会接受血液和尿液检查、破伤风注射、铁补充剂和艾滋病毒检测。