Department of Statistics, Bangladesh Institute of Governance and Management, Dhaka, 1207, Bangladesh.
School of Clinical Medicine, University of New South Wales, Sydney, Australia.
Sci Rep. 2024 Aug 12;14(1):18646. doi: 10.1038/s41598-024-67206-3.
Maternal health is a global public health concern. The paucity of antenatal care (ANC) during pregnancy is directly associated with maternal mortality. This study assessed the individual and community-level determinants of quality ANC in six South-Asian countries. Data were obtained from a Demographic health survey of six South-Asian countries. This study included a sample of 180,567 (weighted) women aged 15-49 who had given birth in the preceding three years prior to the survey. The quality of ANC was determined by assessing whether a woman had received blood pressure monitoring, urine and blood sample screening, and iron supplements at any ANC visits. Frequency, percentage distribution, and inferential analysis (multilevel mixed-effects model) were conducted. The proportion of quality antenatal care utilization in South Asia was 66.9%. The multilevel analysis showed that women aged 35-49 years (AOR = 1.16; 95% CI = 1.09-1.24), higher education (AOR = 2.84; 95% CI = 2.69-2.99), middle wealth status (AOR = 1.55; 95% CI = 1.49-1.62), richest wealth status (AOR = 3.21; 95% CI = 3.04-3.39), unwanted pregnancy (AOR = 0.92; 95% CI = 0.89-0.95) and 2-4 birth order (AOR = 0.86; 95% CI = 0.83-0.89) were among the individual-level factors that were significantly associated with quality ANC utilization. In addition, rural residence (AOR = 0.77; 95% CI = 0.74-0.8), and big problem - distance to health facility (AOR = 0.63; 95% CI: 0.53-0.76) were the among community level factors there were also significantly associated with use of quality ANC. Meanwhile, women who lived in India (AOR: 22.57; 95% CI: 20.32-25.08) and Maldives (AOR: 33.33; 95% CI: 31.06-35.76) had higher odds of quality ANC than those lived in Afghanistan. Educational status, wealth status, pregnancy wantedness, sex of household head, birth order, place of residence, and distance to health facility were associated with quality ANC. Improving educational status, improving wealth status, reducing the distance to health facilities, and providing rural area-friendly interventions are important to increase the quality of ANC in South Asia.
孕产妇健康是全球公共卫生关注的问题。怀孕期间产前护理（ANC）的不足与孕产妇死亡率直接相关。本研究评估了六个南亚国家孕产妇 ANC 质量的个体和社区层面决定因素。数据来自六个南亚国家的人口健康调查。本研究包括了在调查前三年内生育的 180567 名（加权）15-49 岁的妇女。ANC 的质量通过评估妇女在任何 ANC 就诊时是否接受了血压监测、尿液和血液样本筛查以及铁补充剂来确定。进行了频率、百分比分布和推断分析（多层次混合效应模型）。南亚地区利用优质产前护理的比例为 66.9%。多水平分析显示，35-49 岁的妇女（AOR=1.16；95%CI=1.09-1.24）、较高的教育程度（AOR=2.84；95%CI=2.69-2.99）、中等财富状况（AOR=1.55；95%CI=1.49-1.62）、最富裕的财富状况（AOR=3.21；95%CI=3.04-3.39）、意外怀孕（AOR=0.92；95%CI=0.89-0.95）和 2-4 个出生顺序（AOR=0.86；95%CI=0.83-0.89）是与优质 ANC 利用显著相关的个体层面因素。此外，农村居住（AOR=0.77；95%CI=0.74-0.8）和“大问题-距离卫生设施”（AOR=0.63；95%CI：0.53-0.76）是社区层面的因素，也与优质 ANC 的使用显著相关。同时，居住在印度（AOR：22.57；95%CI：20.32-25.08）和马尔代夫（AOR：33.33；95%CI：31.06-35.76）的妇女比居住在阿富汗的妇女更有可能获得优质 ANC。教育程度、财富状况、妊娠意愿、家庭户主性别、出生顺序、居住地和距离卫生设施与优质 ANC 相关。提高教育程度、改善财富状况、减少卫生设施距离以及提供适合农村地区的干预措施，对于提高南亚地区 ANC 的质量非常重要。
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