Endawkie Abel, Kebede Shimels Derso, Abera Kaleab Mesfin, Abeje Eyob Tilahun, Enyew Ermias Bekele, Daba Chala, Asmare Lakew, Bayou Fekade Demeke, Arefaynie Mastewal, Mohammed Anissa, Tareke Abiyu Abadi, Keleb Awoke, Kebede Natnael, Tsega Yawkal
Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Department of Health Informatics, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
Front Glob Womens Health. 2024 Nov 27;5:1457350. doi: 10.3389/fgwh.2024.1457350. eCollection 2024.
Antenatal care (ANC) is an important component of maternal and child healthcare. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, evidence on whether the WHO recommendations have been followed is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa.
This study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan-Meier (K-M) survival estimate. A Weibull gamma shared frailty model was used to determine the predictors of time to the first ANC visit. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported.
The median time to ANC booking among pregnant women in East Africa was 4 ± 2 months. Maternal education at the primary (AHR = 1.01, 95% CI: 1.02-1.25), secondary (AHR = 1.03, 95% CI: 1.02-1.05), and higher level (AHR = 1.40, 95% CI: 1.30-1.50); husband's education level at the primary (AHR = 1.08, 95% CI: 1.06-1.09), secondary (AHR = 1.12, 95% CI: 1.10-1.13), and higher (AHR = 1.08, 95% CI: 1.07-1.10) levels as compared to with no education; a middle-class wealth status (AHR = 1.66, 95% CI: 1.60-1.70), being rich (AHR: 1.60, 95% CI: 1.56-1.73), high community-level maternal literacy (AHR = 1.05, 95% CI: 1.04-1.06), high community-level poverty (AHR = 0.99, 95% CI: 0.98-0.99), previous Cesarean section (CS) (AHR = 1.35, 95% CI: 1.33-1.39), and unwanted pregnancy (AHR = 0.74, 95% CI: 0.72-0.77) were predictors of the time to ANC booking.
The median time to ANC booking among pregnant women in East Africa is longer than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, a better household, community-level wealth index, and previous CS increase the likelihood of an early ANC booking. However, unwanted pregnancy lowers the likelihood of an early ANC booking. Therefore, strengthening systematic efforts to improve women's and their husbands' educational status, encouraging women's education in the community, providing economic support for women with low wealth status and poor communities, encouraging wanted pregnancy, and providing accessible counseling services for women with unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.
产前保健是妇幼保健的重要组成部分。世界卫生组织（WHO）建议孕妇在妊娠12周及以前进行首次产前保健。然而，在东非，关于是否遵循WHO建议的证据有限。因此，本研究旨在确定东非孕妇进行首次产前保健的时间及其预测因素。
本研究在东非的86662名孕妇中开展。使用Kaplan-Meier（K-M）生存估计法估算首次产前保健的时间。采用Weibull伽马共享脆弱模型确定首次产前保健时间的预测因素。报告校正风险比（AHR）及95%置信区间（CI）。
东非孕妇首次产前保健的中位时间为4±2个月。与未接受教育相比，孕妇接受小学教育（AHR = 1.01，95%CI：1.02 - 1.25）、中学教育（AHR = 1.03，95%CI：1.02 - 1.05）和高等教育（AHR = 1.40，95%CI：1.30 - 1.50）；丈夫接受小学教育（AHR = 1.08，95%CI：1.06 - 1.09）、中学教育（AHR = 1.12，95%CI：1.10 - 1.13）和高等教育（AHR = 1.08，95%CI：1.07 - 1.10）；中等财富状况（AHR = 1.66，95%CI：1.60 - 1.70）、富裕（AHR：1.60，95%CI：1.56 - 1.73）、社区层面较高的孕产妇识字率（AHR = 1.05，95%CI：1.04 - 1.06）、社区层面较高的贫困率（AHR = 0.99，95%CI：0.98 - 0.99）、既往剖宫产史（AHR = 1.35，95%CI：1.33 - 1.39）以及意外妊娠（AHR = 0.74，95%CI：0.72 - 0.77）均为首次产前保健时间的预测因素。
东非孕妇首次产前保健的中位时间长于WHO的新建议。孕产妇及丈夫的教育程度、社区层面较高的孕产妇识字率、较好的家庭及社区层面财富指数以及既往剖宫产史会增加早期进行首次产前保健的可能性。然而，意外妊娠会降低早期进行首次产前保健的可能性。因此，加强系统性努力以提高妇女及其丈夫的教育水平，在社区鼓励妇女接受教育，为低财富状况妇女和贫困社区提供经济支持，鼓励有计划妊娠，并为意外妊娠妇女提供可及的咨询服务，将有助于鼓励东非孕妇早期进行首次产前保健。
