Quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia, a cross-sectional study

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Abstract

Background

Potentially, the risk of morbidity and mortality during pregnancy and child birth can be prevented through comprehensive, quality antenatal care services. The high maternal mortality rate in developing countries, including Ethiopia, is related to poor quality of antenatal care services and is still a major public health problem. The aim of this study is to assess the quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia.

Methods

An institution-based cross-sectional study was conducted using a quantitative method from December 10 to January 30, 2020. A total of 616 study participants were selected by a systematic random sampling technique. Data was collected using pre-tested structured interview administered questionnaires. The data was entered into Epi-info version 7.2.1 and analyzed by SPSS version 24. Bivariate and multivariable logistic regressions were performed to identify the presence and strength of the association between the outcome and predictor variables.

Results

Overall, 33% of pregnant women received good-quality antenatal care. Satisfaction with antenatal care service, antenatal care initiation time, maintaining confidentiality, and waiting time become significant predictors of the quality of antenatal care. As a result, a lack of confidential care (AOR = 0.37; 95% CI, (0.40, 0.88)), a long waiting time (AOR = 0.6, 95% CI, (0.48, 0.88)), and no satisfaction with ANC services (AOR = 0.26; 95% CI, (0.109, 0.36)) were identified as factors impeding the quality of antenatal care. While starting ANC later than four months of pregnancy was found to be a positive predictor of the quality of antenatal care (AOR = 1.9, 95% CI: (1.21, 3.12)).

Conclusion

Only one-third of pregnant mothers received good quality antenatal care. Lack of confidential care, long waiting time and no satisfaction with antenatal care services were factors hindering the quality of antenatal care. While initiation of antenatal care after four months of pregnancy was a positive predictor of the quality of antenatal care.

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Most cited references 31

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Defining and classifying clinical indicators for quality improvement.

J Mainz (2003)

This paper provides a brief review of definitions, characteristics, and categories of clinical indicators for quality improvement in health care. Clinical indicators assess particular health structures, processes, and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Furthermore, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses. Monitoring health care quality is impossible without the use of clinical indicators. They create the basis for quality improvement and prioritization in the health care system. To ensure that reliable and valid clinical indicators are used, they must be designed, defined, and implemented with scientific rigour.

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A global view of severe maternal morbidity: moving beyond maternal mortality

Stacie Geller, Abigail Koch, Caitlin Garland … (2018)

Background Maternal mortality continues to be of great public health importance, however for each woman who dies as the direct or indirect result of pregnancy, many more women experience life-threatening complications. The global burden of severe maternal morbidity (SMM) is not known, but the World Bank estimates that it is increasing over time. Consistent with rates of maternal mortality, SMM rates are higher in low- and middle-income countries (LMICs) than in high-income countries (HICs). Severe maternal morbidity in high-income countries Since the WHO recommended that HICs with low maternal mortality ratios begin to examine SMM to identify systems failures and intervention priorities, researchers in many HICs have turned their attention to SMM. Where surveillance has been conducted, the most common etiologies of SMM have been major obstetric hemorrhage and hypertensive disorders. Of the countries that have conducted SMM reviews, the most common preventable factors were provider-related, specifically failure to identify “high risk” status, delays in diagnosis, and delays in treatment. Severe maternal morbidity in low and middle income countries The highest burden of SMM is in Sub-Saharan Africa, where estimates of SMM are as high as 198 per 1000 live births. Hemorrhage and hypertensive disorders are the leading conditions contributing to SMM across all regions. Case reviews are rare, but have revealed patterns of substandard maternal health care and suboptimal use of evidence-based strategies to prevent and treat morbidity. Effects of SMM on delivery outcomes and infants Severe maternal morbidity not only puts the woman’s life at risk, her fetus/neonate may suffer consequences of morbidity and mortality as well. Adverse delivery outcomes occur at a higher frequency among women with SMM. Reducing preventable severe maternal morbidity not only reduces the potential for maternal mortality but also improves the health and well-being of the newborn. Conclusion Increasing global maternal morbidity is a failure to achieve broad public health goals of improved women’s and infants’ health. It is incumbent upon all countries to implement surveillance initiatives to understand the burden of severe morbidity and to implement review processes for assessing potential preventability.

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Determinants of frequency and contents of antenatal care visits in Bangladesh: Assessing the extent of compliance with the WHO recommendations

M Mazharul Islam, Mohammad Shahed Masud (2018)

Background In addition to the number of antenatal care (ANC) visits, the items of ANC services covered by ANC visits greatly influence the effectiveness of the ANC services. Recently the World Health Organization (WHO) recommended not only to achieve a minimum of eight ANC visits, but also to use a core set of items of ANC services for safe motherhood. This study examined the levels and determinants of frequency and contents of ANC visits in Bangladesh and thus assessed the level of compliance with the WHO recommended number and the content of ANC services during pregnancy in Bangladesh. Methods The data for the study come from the 2014 Bangladesh Demographic and Health Survey (BDHS), which covereda nationally representative sample of 17,863 ever-married women aged 15–49 years. Data derived from 4,627 mothers who gave birth in the three years preceding the survey constituted the study subjects. Descriptive, inferential and multivariate statistical techniques were used for data analysis. Results On average, mothers received less than three (2.7 visits) ANC visits and only 6% receive the recommended eight or more ANC visits. About 22% of the mothers received all the prescribed basic items of ANC services. About one-fifth (21%) of the mothers never received ANC visits and thus no items of ANC services. Measurement of blood pressure was the most common item received during ANC visit as reported by 69% mothers. Blood test was the least received item (43%). Significant positive association was found between frequency of ANC visits and receiving the increased number of items of ANC services. High socio-economic status, low parity, living in urban areas and certain administrative regions, planned pregnancies, having media exposure, visiting skilled providers for ANC services and visit to public or NGO health facilities are associated with frequent ANC visits and receiving higher number of items of ANC contents. Conclusion An unsatisfactory level of coverage of and content of ANC visits have been observed in Bangladesh. Further investigation is needed to identify the causes of under-utilization of ANC services in Bangladesh. A greater understanding of the identified risk factors and incorporating them into short and long term strategies would help improve the coverage and contents and thus quality of ANC services in Bangladesh.

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Author and article information

Contributors

Genet Atlabachew Hailu: Role: ConceptualizationRole: MethodologyRole: Writing – original draft

Zewdu Shewngizaw Weret: Role: MethodologyRole: Project administrationRole: Writing – original draftRole: Writing – review & editing

Zerihun Adraro Adasho:

ORCID: https://orcid.org/0000-0002-9446-5022

Role: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Belete Melesegn Eshete: Role: MethodologyRole: SupervisionRole: Writing – review & editing

Dylan A. Mordaunt: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 10 June 2022

Publication date Collection: 2022

Volume: 17

Issue: 6

Electronic Location Identifier: e0269710

Affiliations

[1 ] Department of Midwifery, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia

[2 ] Department of Psychiatry, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia

[3 ] Department of Neonatal Nursing, Menelik II Medical and Health Science College, Kotebe Metropolitan University, Addis Ababa, Ethiopia

Flinders University, AUSTRALIA

Author notes

Competing Interests: The authors declare that there is no any competing interest.

* E-mail: adrarozerihun12@ 123456gmail.com

Author information

Zerihun Adraro Adasho https://orcid.org/0000-0002-9446-5022

Article

Publisher ID: PONE-D-21-29855

DOI: 10.1371/journal.pone.0269710

PMC ID: 9187099

PubMed ID: 35687552

SO-VID: ac0d1766-d3f3-46a8-a735-3e73084fd3f6

License:

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.

History

Date received : 1 October 2021

Date accepted : 26 May 2022

Page count

Figures: 1, Tables: 3, Pages: 12

Funding

Funded by: Kotebe Metropolitan University Menelik II Medical and Health Science College

Award ID: አጠ5/32/10/4823

The research was funded by Kotebe Metropolitan University Menelik II Medical and Health Science College with grant award number of አጠ5/32/10/4823. The funder provided support in the form of salaries for all the authors, but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the author contributions section in the main manuscript.

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Data Availability All relevant data are within the paper and its Supporting Information files.

Quality of antenatal care and associated factors in public health centers in Addis Ababa, Ethiopia, a cross-sectional study

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Most cited references 31

Defining and classifying clinical indicators for quality improvement.

A global view of severe maternal morbidity: moving beyond maternal mortality

Determinants of frequency and contents of antenatal care visits in Bangladesh: Assessing the extent of compliance with the WHO recommendations

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