Background
Methods
Study design
Study setting
Selection of districts and facilities
Sample size and recruitment of women
Data collection processes and tools
Variables
Measuring adherence
Data analysis
Results
Adherence to first antenatal care guidelines
Participants’ baseline characteristics
Variable | Frequency (%) | % Incomplete adherence | % Complete adherence | Cluster adjusted |
---|---|---|---|---|
N = 926 |
N = 477 |
N = 449 |
p-value | |
Total sample | 51.5 | 48.5 | ||
Facility type | <0.01 | |||
Hospital | 519 (56.0) | 52.2 | 47.8 | |
Polyclinic | 333 (36.0) | 47.1 | 52.9 | |
Health center | 74 (8.0) | 65.8 | 34.2 | |
Age category | 0.01 | |||
<20 years | 52 (5.6) | 73.1 | 26.9 | |
20–35 years | 790 (85.5) | 50.5 | 49.5 | |
> =35 years | 82 (8.9) | 47.6 | 52.4 | |
Parity | 0.01 | |||
0 | 258 (27.9) | 76.7 | 22.7 | |
1–2 | 475 (51.3) | 40.8 | 59.2 | |
3–4 | 162 (17.5) | 43.2 | 56.8 | |
>4 | 31 (3.3) | 48.4 | 51.6 | |
Education | 0.87 | |||
None | 109 (11.8) | 47.7 | 52.3 | |
Primary | 179 (19.3) | 47.5 | 52.5 | |
Secondary | 423 (45.7) | 51.8 | 48.2 | |
Tertiary | 163 (17.7) | 57.1 | 42.9 | |
Other | 46 (5.0) | 47.8 | 52.2 | |
Trimester at first ANC | 0.05 | |||
First | 282 (30.5) | 57.8 | 42.2 | |
Second | 631 (68.1) | 48.0 | 52.0 | |
Number of times ANC attended | <0.01 | |||
1 | 44 (4.8) | 79.5 | 20.5 | |
2–3 | 137 (14.8) | 48.9 | 50.7 | |
> = 4 | 723 (78.1) | 50.1 | 49.9 | |
Marital status | 0 01 | |||
Single | 100 (10.8) | 64.0 | 20.5 | |
Married | 672 (72.6) | 48.5 | 51.5 | |
Formerly married | 12 (1.3) | 58.3 | 41.7 | |
Living together | 122 (13.2) | 54.9 | 45.1 | |
Employment | 0.01 | |||
No | 141 (15.2) | 66.0 | 34.0 | |
Yes | 777 (84.9) | 48.8 | 51.2 | |
Previous pregnancy history | 0.04 | |||
No complication | 853 (92.1) | 51.2 | 48.8 | |
Mean age (SD) | 28.15 (5.4) | 27.25 (5.6) | 29.11 (5.0) | <0.01 |
Risk of maternal and neonatal complications
Complication | Incidence (%) | Complete adherence | Incomplete adherence | Cluster adjusted |
---|---|---|---|---|
N = 926 |
N = 449 |
N = 477 |
p-value | |
Maternal | ||||
Malaria in pregnancy | 113 (12.2) | 56 (12.5) | 57 (11.9) | 0.81 |
Antepartum vaginal bleeding | 10 (1.1) | 3 (0.7) | 7 (1.5) | 0.24 |
PIH/pre-eclampsia/eclampsia | 49 (5.3) | 23 (5.1) | 26 (5.5) | 0.82 |
Anemia in pregnancy | 550 (59.4) | 269 (59.9) | 281 (58.9) | 0.12 |
Anemia developed after first antenatal visit | 144 (15.5) | 67 (14.9) | 77 (16.1) | 0.36 |
Any antenatal complication | 631 (68.1) | 308 (68.6) | 328 (68.7) | 0.88 |
Any antenatal complication (non-anemia) | 207 (22.4) | 99 (22.0) | 108 (22.6) | 0.83 |
Delivery by Caesarean section | 132 (14.3) | 65 (14.5) | 67 (14.0) | 0.84 |
Post-partum hemorrhage | 19 (2.1) | 6 (1.3) | 13 (2.7) | 0.14 |
Delivery/post-delivery complication | 41 (4.4) | 17 (3.8) | 24 (5.0) | 0.82 |
Any pregnancy related complication | 635 (68.6) | 310 (69.0) | 325 (68.1) | 0.87 |
Any pregnancy related complication (non-anemia) | 229 (24.4) | 108 (24.1) | 121 (25.4) | 0.56 |
Maternal mortality | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Neonatal | ||||
Preterm | 49 (5.3) | 23 (5.1) | 26 (5.5) | 0.31 |
Post-maturity | 88 (9.5) | 36 (8.0) | 52 (10.9) | 0.31 |
Low birth weight | 57 (6.1) | 19 (4.2) | 36 (7.5) | 0.21 |
Neonatal jaundice | 58 (6.3) | 29 (6.5) | 29 (6.1) | 0.21 |
Asphyxia/difficulty in breathing | 39 (4.2) | 15 (3.3) | 34 (7.1) | 0.21 |
Stillbirths | 4 (0.4) | 2 (0.4) | 2 (0.4) | 0.21 |
Any neonatal complication | 146 (15.8) | 60 (13.4) | 86 (18.0) | 0.05 |
Neonatal mortality (All cause) | 13 (1.4) | 6 (1.3) | 7 (1.5) | 0.87 |
Independent factor | Antenatal complication RR (95% CI) |
p-value
| Delivery/postpartum complication RR (95% CI) |
p-value
| Any maternal complication RR (95% CI) |
p-value
| Neonatal complication RR (95% CI) |
p-value
|
---|---|---|---|---|---|---|---|---|
Complete adherence |
1.02 (0.70–.50)
|
0.90
| 0.73 (0.48–1.11) | 0.14 | 0.64 (0.43–0.94) | 0.03 | 0.73 (0.55–0.96) |
0.03
|
Employment (Yes) |
0.72 (0.4–1.10)
|
0.13
| 2.17 (1.17–4.01) |
0.01
| 1.19 (0.63–2.95) |
0.58
| 0.89 (0.60–1.32) |
0.56
|
Age categories | ||||||||
<20 years | Ɨ | Ɨ | Ɨ | Ɨ | ||||
20–35years | 1.20 (0.76–1.91) |
0.44
| 0.60 (0.26–1.40) |
0.24
| 0.42 (0.28–0.64) |
<0.01
| 0.60 (0.31–1.34) |
0.12
|
>35 years | 0.74 (0.39–1.41) |
0.36
| 1.72 (0.64–4.63) |
0.29
| 1.04 (0.68–1.58) |
0.85
| 0.37 (0.12–1.13) |
0.08
|
Parity | ||||||||
0 | Ɨ | Ɨ | Ɨ | Ɨ | ||||
1–2 | 0.91 (0.71–1.71) |
0.48
| 1.56 (0.51–4.73) |
0.43
| 0.68 (0.48–0.95) |
0.03
| ||
3–4 | 1.49 (0.97–2.31) |
0.07
| 2.80 (1.47–5.35) |
<0.01
| 0.68 (0.43–1.07) |
0.10
| ||
>4 | 0.72 (0.31–1.71) |
0.46
| 1.11 (0.38–3.20) |
0.85
| 0.59 (0.25–6.41) |
0.24
| ||
Trimester of first ANC attendance | ||||||||
First | Ɨ | Ɨ | Ɨ | Ɨ | ||||
Second | 1.10 (0.72–1.68) |
0.65
| 0.87 (0.35–2.17) |
0.77
| 0.82 (0.41–1.69) |
0.57
| 0.86 (0.53–1.38) |
0.53
|
Number of times ANC attended (> = 4) | 0.73 (0.28–1.84) |
0.50
| 0.46 (0.11–1.98) |
0.30
| 0.63 (0.17–2.34) |
0.49
| 1.01 (0.19–1.77) |
0.33
|
Previous delivery complication (Yes) | 1.11 (0.64–1.94) |
0.71
| 1.13 (0.50–2.59) |
0.76
| 1.11 (0.31–3.91) |
0.88
| 1.24 (1.81–1.92) |
0.32
|
Any antenatal complication | NA | 0.87 (0.54–1.37) |
0.54
| NA | 1.55 (1.10–2.19) |
0.01
| ||
Antenatal complication (non-anemia) | NA | 1.92 (1.09–3.38) |
0.02
| NA | 2.67 (1.86–3.83) |
<0.01
|
Complication | Crude RR 95% Confidence interval |
p-value
|
aAdjusted RR 95% Confidence interval |
p-value
|
---|---|---|---|---|
Neonatal | 0.73 (0.55–0.96) | 0.03 | 0.72c (0.56–0.93) |
0.01
|
Any maternal | 1.01 (0.67–1.48) | 0.97 | 1.00b (0.67–1.48) |
0.99
|
Antenatal | 1.02 (0.70–1.50) | 0.90 | 1.02b (0.69–1.52) |
0.92
|
Antenatal (non-anemia) | 0.96 (0.75–1.23) | 0.73 | 0.90b (0.66–1.22) |
0.45
|
PIH/pre-eclampsia/eclampsia | 0.92 (0.62–1.37) | 0.69 | 0.95b (0.57–1.58) |
0.84
|
Antepartum vaginal bleeding | 0.45 (0.17–1.21) | 0.11 | 0.48b (0.16–1.43) |
0.19
|
Malaria in pregnancy | 1.05 (0.70–1.58) | 0.80 | 1.02b (0.68–1.53) |
0.92
|
Delivery | 0.64 (0.43–0.94) | 0.03 | 0.66b (0.44–0.99) |
0.04
|
Post-partum | 0.71 (0.28–1.77) | 0.46 | 0.72b (0.33–1.59) |
0.42
|