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      Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey

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          Abstract

          Background

          In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola.

          Methods

          We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates.

          Results

          The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75).

          Conclusion

          The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.

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          Most cited references29

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          Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review

          Objectives To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa. Design Systematic review. Data sources Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science. Eligibility criteria Primary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018. Data extraction and synthesis A data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings. Results 74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband’s support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits. Conclusion A variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.
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            Wealth and antenatal care use: implications for maternal health care utilisation in Ghana

            The study investigates the effect of wealth on maternal health care utilization in Ghana via its effect on Antenatal care use. Antenatal care serves as the initial point of contact of expectant mothers to maternal health care providers before delivery. The study is pivoted on the introduction of the free maternal health care policy in April 2005 in Ghana with the aim of reducing the financial barrier to the use of maternal health care services, to help reduce the high rate of maternal deaths. Prior to the introduction of the policy, studies found wealth to have a positive and significant influence on the use of Antenatal care. It is thus expected that with the policy, wealth should not influence the use of maternal health care significantly. Using secondary data from the 2008 Ghana Demographic and Health survey, the results have revealed that wealth still has a significant influence on adequate use of Antenatal care. Education, age, number of living children, transportation and health insurance are other factors that were found to influence the use of Antenatal care in Ghana. There also exist considerable variations in the use of Antenatal care in the geographical regions and between the rural and urban dwellers. It is recommended that to improve the use of Antenatal care and hence maternal health care utilization, some means of support is provided especially to women within the lowest wealth quintiles, like the provision and availability of recommended medication at the health center; secondly, women should be encouraged to pursue education to at least the secondary level since this improves their use of maternal health services. Policy should also target mothers who have had the experience of child birth on the need to use adequate Antenatal care for each pregnancy, since these mothers tend to use less antenatal care for subsequent pregnancies. The regional disparities found may be due to inaccessibility and unavailability of health facilities and services in the rural areas and in some of the regions. The government and other service providers (NGOs, religious institutions and private providers) may endeavor to improve on the distribution of health facilities, human resources, good roads and necessary infrastructure among other things in order to facilitate easy access to health care providers especially for the rural dwellers.
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              Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis

              Background In the context of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. According to a 2016 national report, only 62% of pregnant women in Ethiopia made at least one antenatal care visit. The aim of this review was to systematically and quantitatively summarize the factors affecting utilization of antenatal care in Ethiopia. Methods We searched PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care database for studies that had been conducted in Ethiopia between 2002 and 2016. We summarized the studies on the use of antenatal care services quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates. Results A total of fifteen observational studies were included in this review. The pooled prevalence of utilization of antenatal care services in Ethiopia was 63.77% (95CI 53.84–75.54). The pooled odds ratio showed that a significant positive association was found between utilization of antenatal care and urban residence (OR = 1.92, 95%CI = 1.35–2.72), women’s education (OR = 1.90, 95%CI = 1.52–2.37), husband’s education (OR = 1.49, 95%CI = 1.32–1.69) and planned pregnancy (OR = 2.08, 95%CI = 1.45–2.98). Based on narrative synthesis exposure to mass media, family income and accessibility of the service were strongly associated with utilization of antenatal care. Conclusion The findings of this review found several modifiable factors such as empowering women through education and increasing their decision-making power, promoting family planning to prevent unplanned pregnancy, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of antenatal care. Further research is needed on accessibility and availability of the service at the individual and community level to assess the predictors of antenatal care service utilization.
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                Author and article information

                Contributors
                gebretsh@gmail.com
                betregiorgiszegeye27@gmail.com
                didri040@uottawa.ca
                brightahinkorah@gmail.com
                droladfb@gmail.com
                sanni.yaya@uOttawa.ca
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                15 August 2020
                15 August 2020
                2020
                : 20
                : 1243
                Affiliations
                [1 ]GRID grid.7123.7, ISNI 0000 0001 1250 5688, Department of Reproductive, Family and Population Health, School of Public Health, , Addis Ababa University, ; Addis Ababa, Ethiopia
                [2 ]Shewarobit Field Office, HaSET Maternal and Child Health Research Program, Addis Ababa, Ethiopia
                [3 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, Interdisciplinary School of Health Sciences, , University of Ottawa, ; Ottawa, Canada
                [4 ]GRID grid.117476.2, ISNI 0000 0004 1936 7611, The Australian Centre for Public and Population Health Research, Faculty of Health, , University of Technology Sydney, ; Ultimo, NSW Australia
                [5 ]GRID grid.412870.8, ISNI 0000 0001 0447 7939, Department of Public Health, , Walter Sisulu University, ; Mthatha, Eastern Cape South Africa
                [6 ]GRID grid.412114.3, ISNI 0000 0000 9360 9165, Faculty of Health Sciences, , Durban University of Technology, ; Durban, South Africa
                [7 ]GRID grid.7621.2, ISNI 0000 0004 0635 5486, Department of Family Medicine and Public Health, Faculty of Medicine, , University of Botswana, ; Gaborone, Botswana
                [8 ]GRID grid.28046.38, ISNI 0000 0001 2182 2255, School of International Development and Global Studies, Faculty of Social Sciences, , University of Ottawa, ; 120 University Private, Ottawa, ON K1N 6N5 Canada
                [9 ]GRID grid.4991.5, ISNI 0000 0004 1936 8948, The George Institute for Global Health, , The University of Oxford, ; Oxford, UK
                Author information
                http://orcid.org/0000-0002-4876-6043
                Article
                9320
                10.1186/s12889-020-09320-1
                7429730
                32799833
                cf69c18f-3a14-4ebd-90d6-9690192fd05a
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 May 2020
                : 30 July 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Public health
                antenatal care,inequality,health disparities,global health; angola,dhs
                Public health
                antenatal care, inequality, health disparities, global health; angola, dhs

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