Background
Methods
Design and setting
Participants
Data collection and variables
Facility factors | Individual factors | Pregnancy and referral factors | Delivery factors |
---|---|---|---|
District | Age | Parity | Sex of baby: male, female |
Type of facility where ANC was received: Health centre, polyclinic, community clinic, CHPS | Health Insurance coverage: Yes or No | Gestational age (Trimester) at first ANC visit: 1st, 2nd, rd | Gestational age at delivery: preterm (< 37 weeks) Term (37–40 weeks) Post term (> 40 weeks) |
Ownership of facility: Government or Private | Age | Number of ANC visits during pregnancy: 0, 1–3, 4+ | Any new-born complication at delivery: Yes or No |
Availability of sulfadoxine-pyrimethamine at pharmacy or dispensary: Yes or No | Highest educational attainment: none, primary, secondary, tertiary | History of previous pregnancy complication: Yes or No | Any maternal complication at developed at delivery: Yes or No |
Stock-out of sulfadoxine-pyrimethamine at pharmacy or dispensary within 6 months prior to study: Yes or No | Marital status: single, married, living together | Indication for referral is Malaria: Yes or No | Haemoglobin level at delivery: Normal (≥ 12 g/dl), mild anaemia (10.0–11.9 g/dl), moderate anaemia (9.9–7.0 g/dl) severe anaemia (< 7.0 g/dl) |
Employment status: Yes or No | Indication for referral is a pregnancy complication: Yes or No | Birth weight of baby: Low birth weight (< 2.5 kg) Normal weight (2.5–4.0 kg) Big baby (> 4.0 kg) | |
Dose of IPTp received during pregnancy: 0, 1–3, 4–5, > 5; Adequate (NMCP/WHO): (5 +)/(3 +), Inadequate (NMCP/WHO): (< 5)/(< 3) |
Statistical analysis
Strength and limitations
Results
Characteristics of participants
Variable | Category | Frequency N = 460 | % | |
---|---|---|---|---|
District | A | 94 | 20.5 | |
B | 62 | 13.5 | ||
C | 304 | 66.1 | ||
Ownership | Government | 398 | 86.5 | |
Private | 62 | 13.5 | ||
Covered by Health Insurance | Yes | 454 | 98.7 | |
Age category | < 20 | 58 | 12.6 | |
20–35 | 339 | 73.7 | ||
> 35 | 63 | 13.7 | ||
Parity category | 0 | 147 | 32.0 | |
1–2 | 182 | 39.6 | ||
3–4 | 103 | 22.4 | ||
> 4 | 28 | 6.1 | ||
Highest education attained | None | 71 | 15.4 | |
Primary/Basic | 293 | 63.7 | ||
Secondary/Vocational | 83 | 18.0 | ||
Tertiary | 10 | 2.2 | ||
Marital status | Single | 70 | 15.2 | |
Married | 251 | 54.6 | ||
Living together | 139 | 30.2 | ||
Employed | Yes | 348 | 75.7 | |
No | 112 | 24.3 | ||
Trimester at first ANC visit | 1st | 227 | 49.3 | |
2nd | 197 | 42.7 | ||
3rd | 33 | 7.2 | ||
No. of ANC visits so far | 0 | 18 | 3.9 | |
1–3 | 96 | 20.9 | ||
≥ 4 | 344 | 74.8 | ||
Trimester at referral | 1st | 22 | 4.8 | |
2nd | 22 | 4.8 | ||
3rd | 410 | 89.1 | ||
Previous pregnancy complication | Yes | 62 | 13.5 | |
No | 398 | 86.5 | ||
Complication in current pregnancy | Yes | 284 | 61.7 | |
Previous referral in current pregnancy | Yes | 12 | 2.6 | |
Type of referring facility/where ANC and IPTp were received | Health center | 375 | 81.5 | |
Polyclinic | 38 | 8.3 | ||
Clinic | 38 | 6.1 | ||
CHPS | 19 | 4.1 | ||
Is referral emergency | Yes | 243 | 52.8 | |
Reason for referral | Complication | 380 | 82.6 | |
Lack of required staff | 79 | 17.2 | ||
Lack of space/bed | 3 | 0.7 | ||
Lack of logistic/supplies/infrastructure | 36 | 7.8 | ||
Lack of required service | 28 | 6.1 | ||
Clinical Indication (complication) for this referral | Anemia | 50 | 10.87 | |
Vaginal bleeding/APH | 21 | 4.6 | ||
Fetal distress | 10 | 2.2 | ||
IUFD/No fetal heart | 13 | 2.8 | ||
Malaria in pregnancy | 6 | 1.3 | ||
Malpresentation | 19 | 4.1 | ||
PIH/Preeclampsia/Eclampsia | 82 | 17.8 | ||
Post date | 60 | 13.0 | ||
Postpartum hemorrhage | 6 | 1.3 | ||
Previous caesarean section | 40 | 8.7 | ||
Prolonged labor | 29 | 6.3 | ||
Other | 79 | 17.2 | ||
IPTp Doses received by delivery | 0 | 90 | 19.6 | |
1–3 | 279 | 60.7 | ||
4–5 | 83 | 18.0 | ||
> 5 | 6 | 1.3 | ||
< 5 (Inadequate, NMCP) | 420 | 91.3 | ||
≥ 5 (Adequate, NMCP) | 40 | 8.7 | ||
< 3 (Inadequate, WHO) | 237 | 51.5 | ||
≥ 3 (Adequate, WHO) | 223 | 48.5 | ||
Gestational maturity at delivery | Pre term | 63 | 13.7 | |
Term | 288 | 62.6 | ||
Post maturity | 109 | 23.7 | ||
Hemoglobin at delivery | Normal | 78 | 17.0 | |
Mild anemia | 194 | 42.2 | ||
Moderate anemia | 188 | 40.8 | ||
Maternal complication developed at delivery | Yes | 182 | 39.6 | |
Anemia | 12 | 2.6 | ||
Abruptio placenta | 7 | 1.5 | ||
PIH/eclampsia | 33 | 7.2 | ||
Prolonged/obstructed labor | 48 | 10.4 | ||
Malpresentation | 32 | 7.0 | ||
Postpartum hemorrhage | 8 | 1.7 | ||
New-born complication | Yes | 87 | 18.9 | |
Low Birth Weight | 38 | 8.3 | ||
Fetal distress | 25 | 5.4 | ||
Asphyxia | 18 | 3.9 | ||
Stillbirth | 6 | 1.3 | ||
Intrauterine death | 2 | 0.4 | ||
Sepsis | 12 | 2.8 | ||
Jaundice | 1 | 0.2 | ||
Birth weight category | Low birth weight | 39 | 8.5 | |
Normal | 397 | 86.3 | ||
Big baby | 10 | 2.2 | ||
Sex of baby | Male | 253 | 54.9 | |
Female | 207 | 45.1 |
Variable | Mean (95% CI) | Standard deviation | Median | Inter-quartile range |
---|---|---|---|---|
Age of woman (years) | 28.0 (27.4 –28.6) | 6.5 | 28.0 | 10.0 |
Gestational age at first ANC (months) | 3.7 (3.5–3.9) | 1.8 | 3.0 | 3.0 |
Gestational age at referral (weeks) | 35.5 (34.7–36.2) | 7.9 | 38.0 | 5.0 |
Gestational age at delivery (weeks) | 38.4 (38.0–38.8) | 3.8 | 39.0 | 2.0 |
Hemoglobin at delivery (g/dl) | 10.0 (9.9–10.2) | 1.6 | 10.1 | 2.5 |
Birth weight (kg) | 3.1 (3.05–3.14) | 0.5 | 3.1 | 0.6 |
Doses of IPTp received | 2.2 (2.1–2.4) | 1.5 | 2.0 | 2.0 |
Predictors of IPTp dose coverage
USING WHO CRITERIA | IPTp coverage | |||
---|---|---|---|---|
Variable | Category | Inadequate (< 3) | Adequate (+3) | p value |
District | A | 42.6 | 57.4 | < 0.01 |
B | 46.8 | 53.2 | ||
C | 55.3 | 44.7 | ||
Facility type | Health centre | 51.5 | 44.7 | < 0.01 |
Polyclinic | 42.9 | 57.1 | ||
Community clinic | 50.0 | 50.0 | ||
CHPS | 68.4 | 31.6 | ||
Ownership | Government | 52.3 | 47.7 | 0.05 |
Private | 46.8 | 53.2 | ||
Insurance | Yes | 51.8 | 48.2 | 0.03 |
No | 33.3 | 66.7 | ||
Age | < 20 | 51.7 | 48.3 | 0.58 |
20–35 | 51.0 | 49.0 | ||
> 35 | 54.0 | 46.0 | ||
Parity | 0 | 52.4 | 47.6 | < 0.01 |
1–2 | 55.5 | 44.5 | ||
3–4 | 46.6 | 53.4 | ||
> 4 | 39.3 | 60.7 | ||
Education | None | 49.3 | 50.7 | < 0.01 |
Primary/Basic | 52.6 | 47.4 | ||
Secondary | 45.8 | 54.2 | ||
Tertiary | 80.0 | 20.0 | ||
Marital status | Single | 44.3 | 55.7 | < 0.01 |
Married | 49.4 | 50.6 | ||
Living together | 59.0 | 41.0 | ||
Employed | Yes | 52.3 | 47.7 | 0.15 |
No | 49.1 | 50.9 | ||
Trimester at first ANC visit | 1st | 53.7 | 46.3 | 0.11 |
2nd | 50.0 | 50.0 | ||
3rd | 48.5 | 51.5 | ||
Number of ANC visits | 0 | 50.0 | 50.0 | 0.67 |
1–3 | 53.1 | 46.9 | ||
4 + | 51.2 | 48.8 | ||
Previous pregnancy complication | Yes | 53.4 | 46.6 | 0.44 |
No | 51.2 | 48.8 |
Predictors of adequate IPTp doses received during pregnancy | ||||
---|---|---|---|---|
Predictors | Category | Adjusted OR (95% CI) | p-value | |
District | A | 1.41 (1.14–1.74) | < 0.01 | |
B | 1.18 (0.84–1.65) | 0.34 | ||
C | ¥ | |||
Type of Health Facility | Health center | 1.90 (1.22–2.97) | 0.01 | |
Polyclinic | 1.74 (1.03–2.93) | 0.04 | ||
Clinic | 2.77 (1.60–4.79) | < 0.01 | ||
CHPS | ¥ | |||
Highest Education attained | None | ¥ | ||
Primary/basic | 1.00 (0.80–1.26) | 0.99 | ||
Secondary | 1.44 (1.09–1.92) | 0.01 | ||
Tertiary | 0.41 (0.21–0.81) | 0.01 | ||
Insurance coverage | Yes | 0.24 (0.09–0.66) | 0.01 | |
No | ¥ | |||
Marital status | Single | ¥ | ||
Married | 0.86 (0.66–1.13) | 0.28 | ||
Living together | 0.66 (0.50–0.86) | < 0.01 | ||
Number of ANC visits | 0 | 0.57 (0.35–0.93) | 0.02 | |
1–3 | 0.86 (0.71–1.06) | 0.15 | ||
4+ | ¥ |
Outcome | Category | Unadjusted OR (95% CI) | p-value | Adjusted ORa (95% CI) | p-value |
---|---|---|---|---|---|
New-born complication | Yes | 0.74 (0.61–0.90) | < 0.01 | 0.80 (0.65–0.98) | 0.03 |
Maternal complication developed at delivery | Yes | 0.71 (0.61–0.83) | < 0.01 | 0.88 (0.72–1.07) | 0.20 |
Anaemia at delivery | Normal | ¥ (reference) | ¥ | ||
Mild | 1.11 (0.89–1.34) | 0.36 | 1.14 (0.90–1.44) | 0.29 | |
Moderate | 0.91 (0.77–1.14) | 0.41 | 0.90 (0.71–1.14) | 0.38 | |
Hemoglobin level | 0.93 (0.83–0.99) | 0.03 | |||
Birth weight | LBW | 0.55 (0.41–0.72) | <0.01 | 0.51 (0.38–0.68) | <0.01 |
Normal | ¥ | ¥ | |||
Big baby | 0.98 (0.58–1.63) | 0.92 | 0.38 (0.20–0.72) | <0.01 | |
Term at gestation | Preterm | 0.72 (0.57–0.91) | 0.01 | 0.71 (0.55–0.90) | 0.01 |
Term | ¥ | ¥ | |||
Post term | 1.06 (0.88–1.27) | 0.56 | 0.95 (0.77–1.61) | 0.59 | |
Sex of baby | Female | 0.89 (0.77–1.04) | 0.14 | 1.13 (0.96–1.33) | 0.14 |
Male | ¥ | ¥ | |||
Referral is due to malaria | Yes | 0.71 (0.34–1.49) | 0.36 | 0.70 (0.56–0.87) | <0.01 |
No | ¥ | ¥ |