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      Prevalence and factors associated with underutilization of antenatal care services in Nigeria: A comparative study of rural and urban residences based on the 2013 Nigeria demographic and health survey

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          Abstract

          Introduction

          Antenatal care (ANC) is a major public health intervention aimed at ensuring safe pregnancy outcomes. In Nigeria, the recommended minimum of four times ANC attendance is underutilized. This study investigates the prevalence and factors associated with underutilization of ANC services with a focus on the differences between rural and urban residences in Nigeria.

          Methods

          We analyzed the 2013 Nigeria Demographic and Health Survey dataset with adjustment for the sampling weight and the cluster design of the survey. The prevalence of underutilization of ANC was assessed using frequency tabulation while associated factors were examined using Chi-Square test and multivariable logistic regression analysis.

          Results

          The prevalence of underutilization of ANC was 46.5% in Nigeria, 61.1% in rural residence and 22.4% in urban residence. The North-West region had the highest prevalence of ANC underuse in Nigeria at 69.3%, 76.6% and 44.8% for the overall, rural and urban residences respectively. Factors associated with greater odds of ANC underuse in rural residence were maternal non-working status, birth interval < 24 months, single birth type, not listening to radio at all, lack of companionship to health facility and not getting money for health services. In urban residence, mothers professing Islam, those who did not read newspaper at all, and those who lacked health insurance, had greater odds of ANC underuse. In both rural and urban residence, maternal and husband’s education level, region of residence, wealth index, maternal age, frequency of watching television, distance to- and permission to visit health facility were significantly associated with ANC underuse.

          Conclusions

          Rural-urban differences exist in the use of ANC services, and to varying degrees, factors associated with underuse of ANC in Nigeria. Interventions aimed at addressing factors identified in this study may help to improve the utilization of ANC services both in rural and urban Nigeria. Such interventions need to focus more on reducing socioeconomic, geographic and regional disparities in access to ANC in Nigeria.

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          Most cited references 33

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          Revisiting the behavioral model and access to medical care: does it matter?

           John Andersen (1995)
          The Behavioral Model of Health Services Use was initially developed over 25 years ago. In the interim it has been subject to considerable application, reprobation, and alteration. I review its development and assess its continued relevance.
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            The role of conceptual frameworks in epidemiological analysis: a hierarchical approach.

            This paper discusses appropriate strategies for multivariate data analysis in epidemiological studies. In studies where determinants of disease are sought, it is suggested that the complex hierarchical inter-relationships between these determinants are best managed through the use of conceptual frameworks. Failure to take these aspects into consideration is common in the epidemiological literature and leads to underestimation of the effects of distal determinants. An example of this analytical approach, which is not based purely on statistical associations, is given for assessing determinants of mortality due to diarrhoea in children. Conceptual frameworks provide guidance for the use of multivariate techniques and aid the interpretation of their results in the light of social and biological knowledge.
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              Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature.

              This paper is a report of a systematic review to identify and analyse the main factors affecting the utilization of antenatal care in developing countries. Antenatal care is a key strategy for reducing maternal mortality, but millions of women in developing countries do not receive it. A range of electronic databases was searched for studies conducted in developing countries and published between 1990 and 2006. English-language publications were searched using relevant keywords, and reference lists were hand-searched. A systematic review was carried out and both quantitative and qualitative studies were included. Twenty-eight papers were included in the review. Studies most commonly identified the following factors affecting antenatal care uptake: maternal education, husband's education, marital status, availability, cost, household income, women's employment, media exposure and having a history of obstetric complications. Cultural beliefs and ideas about pregnancy also had an influence on antenatal care use. Parity had a statistically significant negative effect on adequate attendance. Whilst women of higher parity tend to use antenatal care less, there is interaction with women's age and religion. Only one study examined the effect of the quality of antenatal services on utilization. None identified an association between the utilization of such services and satisfaction with them. More qualitative research is required to explore the effect of women's satisfaction, autonomy and gender role in the decision-making process. Adequate utilization of antenatal care cannot be achieved merely by establishing health centres; women's overall (social, political and economic) status needs to be considered.
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                Author and article information

                Affiliations
                [1 ] Statistical and Genomic Epidemiology Laboratory, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
                [2 ] School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston, United Kingdom
                [3 ] Nepal Development Society, Butwal, Nepal
                [4 ] Drug Research and Production Unit, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
                [5 ] School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Australia
                [6 ] Health and Social Relief Initiative, Ilorin, Kwara State, Nigeria
                [7 ] Department of Obstetrics and Gynaecology, Chivar Specialist Hospital and Urology Centre LTD, Abuja, Nigeria
                [8 ] Department of Epidemiology and Biostatistics, School of Public Health, Curtin University, Bentley Campus, Perth, Australia
                Seoul National University College of Medicine, REPUBLIC OF KOREA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Contributors
                ORCID: http://orcid.org/0000-0002-4533-0340, Role: Conceptualization, Role: Data curation, Role: Formal analysis, Role: Funding acquisition, Role: Methodology, Role: Project administration, Role: Resources, Role: Software, Role: Validation, Role: Writing – original draft, Role: Writing – review & editing
                Role: Conceptualization, Role: Methodology, Role: Writing – original draft, Role: Writing – review & editing
                Role: Conceptualization, Role: Methodology, Role: Writing – original draft, Role: Writing – review & editing
                Role: Writing – original draft, Role: Writing – review & editing
                Role: Writing – original draft, Role: Writing – review & editing
                Role: Software, Role: Writing – original draft, Role: Writing – review & editing
                Role: Writing – original draft, Role: Writing – review & editing
                Role: Data curation, Role: Methodology, Role: Supervision, Role: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 May 2018
                2018
                : 13
                : 5
                PONE-D-17-37926
                10.1371/journal.pone.0197324
                5962076
                29782511
                © 2018 Adewuyi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Counts
                Figures: 3, Tables: 2, Pages: 21
                Product
                Funding
                The Queensland University of Technology supported this paper financially by providing article publication charge sponsorship. The fund for publication has no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Antenatal Care
                People and Places
                Geographical Locations
                Africa
                Nigeria
                Social Sciences
                Sociology
                Education
                Educational Attainment
                Social Sciences
                Economics
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Social Sciences
                Anthropology
                Cultural Anthropology
                Religion
                Social Sciences
                Sociology
                Religion
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Custom metadata
                The data analyzed in this study belong to the Demographic and Health Survey (DHS) program. The data are available and freely accessible in the public repositories of DHS program at https://www.dhsprogram.com/data/available-datasets.cfm. Access to- and permission to use the data are granted to everyone upon request. Authors did not have any special privileges that others would not have in gaining access to the data.

                Uncategorized

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