Population and Health Research Entity, North-West University, Mafikeng 2735, South Africa.
Int J Environ Res Public Health. 2024 Jan 27;21(2):143. doi: 10.3390/ijerph21020143.
Early initiation of antenatal care (ANC) is critical in identifying and mitigating adverse pregnancy-related complications. However, globally, a high percentage of women initiate ANC only at a late stage of their pregnancy. In view of this, the main objective of the study is to establish the prevalence and factors associated with late ANC initiation among women in Malawi. The study was based on the 2015-16 Malawi Demographic and Health Survey (MDHS). The study population consisted of 13,251 women of reproductive age who had given birth during the five years preceding the survey. The data was analyzed using the chi-square test and multivariate logistic regression. The prevalence of late ANC initiation in Malawi was 75.6%. The logistic regression modelling revealed increased odds of late ANC initiation attendance among women residing in the Northern Region (AOR: 1.172; 95% CI: 1.021-1.345) and the Central Region (AOR: 1.178; 95% CI: 1.074-1.291), women residing in urban areas (AOR: 1.273; 95% CI: 1.108-1.463), women with no education (AOR: 1.814; 95% CI: 1.13-1.47) or with primary education (AOR: 1.697; 95% CI: 1.13-1.47), women with less than four ANC visits (AOR: 4.155; 95% CI: 4.002-4.814), unmarried women (AOR: 1.478; 95% CI: 1.111-1.985) and those whose last birth was not by caesarean section (AOR: 1.377; 95% CI: 1.179-1.607). Reduced odds of late ANC initiation among women were observed among women in the 20-24 age group (AOR: 0.634; 95% CI: 0.456-0.881), those in the 25-29 age group (AOR: 0.645; 95% CI: 0.476-0.874) and those aged 30-34 years (AOR: 0.634; 95% CI: 0.456-0.881). The study found that ANC initiation in Malawi is often delayed, with most first visits occurring after the first trimester. Late ANC initiation is associated with region, place of residence, marital status, and the women's age. These are significant factors to be considered when designing new or reviewing ANC policies and strategies aimed at increasing ANC utilization and encouraging early initiation of ANC. Earlier ANC initiation among Malawian women can contribute positively towards improving maternal and child health in Malawi. Therefore, government policies and interventions should target women with no or little education, those living in poor families and other modifiable risk factors, such as young unmarried women.
早期开始产前护理（ANC）对于识别和减轻与妊娠相关的不良并发症至关重要。然而，全球范围内，很大比例的妇女在妊娠晚期才开始接受 ANC。有鉴于此，本研究的主要目的是确定马拉维妇女中晚期 ANC 开始的流行率和相关因素。该研究基于 2015-16 年马拉维人口与健康调查（MDHS）。研究人群包括在调查前五年内分娩的 13251 名育龄妇女。使用卡方检验和多变量逻辑回归分析数据。马拉维晚期 ANC 开始的流行率为 75.6%。逻辑回归模型显示，居住在北部地区（AOR：1.172；95%CI：1.021-1.345）和中部地区（AOR：1.178；95%CI：1.074-1.291）、居住在城市地区（AOR：1.273；95%CI：1.108-1.463）、没有受过教育（AOR：1.814；95%CI：1.13-1.47）或接受过小学教育（AOR：1.697；95%CI：1.13-1.47）、接受 ANC 少于四次（AOR：4.155；95%CI：4.002-4.814）、未婚妇女（AOR：1.478；95%CI：1.111-1.985）和最后一次分娩不是剖腹产的妇女（AOR：1.377；95%CI：1.179-1.607）的晚期 ANC 开始的可能性增加。在 20-24 岁年龄组（AOR：0.634；95%CI：0.456-0.881）、25-29 岁年龄组（AOR：0.645；95%CI：0.476-0.874）和 30-34 岁年龄组（AOR：0.634；95%CI：0.456-0.881）的妇女中，晚期 ANC 开始的可能性降低。研究发现，马拉维的 ANC 启动往往延迟，大多数首次就诊发生在妊娠第一 trimester 之后。晚期 ANC 开始与地区、居住地点、婚姻状况和妇女年龄有关。这些都是在设计新的 ANC 政策和策略或审查旨在增加 ANC 利用率和鼓励早期 ANC 开始的 ANC 政策和策略时需要考虑的重要因素。马拉维妇女更早开始 ANC，可以对改善马拉维母婴健康产生积极影响。因此，政府政策和干预措施应针对没有或很少接受教育、生活在贫困家庭和其他可改变的风险因素（如年轻未婚妇女）的妇女。
