Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh

BackgroundThe objectives of this study are to document the trend on utilisation of four or more (4+) antenatal care (ANC) over the last 22 years period and to explore the determinants and inequity of 4+ ANC utilisation as reported by the last two Bangladesh Demographic and Health surveys (BDHS) (2011 and 2014).MethodsThe data related to ANC have been extracted from the BDHS data set which is available online as an open source. STATA 13 software was used for organising and analysing the data. The outcome variable considered for this study was utilisation of 4+ ANC. Trends of 4+ ANC were measured in percentage and predictors for 4+ ANC were measured through bivariate and multivariable analysis. The concentration index was estimated for assessing inequity in 4+ ANC utilisation.ResultsUtilisation of 4+ ANC has increased by about 26% between the year 1994 and 2014. Higher level of education, residing in urban region and richest wealth quintile were found to be significant predictors. The utilisation of 4+ ANC has decreased with increasing parity and maternal age. The inequity indices showed consistent inequities in 4+ ANC utilisation, and such inequities were increased between 2011 and 2014.ConclusionsIn Bangladesh, the utilisation of any ANC rose steadily between 1994 and 2014, but progress in terms of 4+ ANC utilisation was much slower as the expectation was to achieve the national set target (50%: 4+ ANC utilisation) by 2016. Socio-economic inequities were observed in groups that failed to attend a 4+ ANC visit. Policymakers should pay special attention to increase the 4+ ANC coverage where this study can facilitate to identify the target groups whom need to be intervened on priority basis.

[1]  Z. Bhutta,et al.  Reducing stillbirths: behavioural and nutritional interventions before and during pregnancy , 2009, BMC pregnancy and childbirth.

[2]  Aminur Rahman,et al.  Trends and Inequities in Use of Maternal Health Care Services in Bangladesh, 1991-2011 , 2015, PloS one.

[3]  A. Baqui,et al.  Factors Associated with Four or More Antenatal Care Visits and Its Decline among Pregnant Women in Tanzania between 1999 and 2010 , 2014, PloS one.

[4]  V. Cokkinides.  Health Insurance Coverage-Enrollment and Adequacy of Prenatal Care Utilization , 2001, Journal of health care for the poor and underserved.

[5]  B. Weiss,et al.  The Relationship Between Literacy and Health , 1991, Journal of health care for the poor and underserved.

[6]  K. O. Pettersson,et al.  Magnitude and trends of inequalities in antenatal care and delivery under skilled care among different socio-demographic groups in Ghana from 1988 – 2008 , 2014, BMC Pregnancy and Childbirth.

[7]  M. Umezaki,et al.  Improved perinatal health through qualified antenatal care in urban Phnom Penh, Cambodia , 2007, Environmental health and preventive medicine.

[8]  E. van Doorslaer,et al.  On the interpretation of a concentration index of inequality. , 2004, Health economics.

[9]  L. Pritchett,et al.  Estimating Wealth Effects Without Expenditure Data—Or Tears: An Application To Educational Enrollments In States Of India* , 2001, Demography.

[10]  S. Pallikadavath,et al.  Antenatal care: provision and inequality in rural north India. , 2004, Social science & medicine.

[11]  N. Madise,et al.  Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. , 2000, Social science & medicine.

[12]  Martin McKee,et al.  Good Health at Low Cost 25 years on: lessons for the future of health systems strengthening , 2013, The Lancet.

[13]  M. Tanner,et al.  The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania , 2009, BMC pregnancy and childbirth.

[14]  D. Kaye,et al.  Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda , 2013, BMC Pregnancy and Childbirth.

[15]  H Abdel-Aleem,et al.  Therapeutic amnioinfusion for intrapartum fetal distress using a pediatric feeding tube , 2005, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[16]  A. Pradhan.  Situation of antenatal care and delivery practices. , 2005, Kathmandu University medical journal.

[17]  Magnus Lindelow,et al.  Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and Their Implementation , 2007 .

[18]  R. Pattinson.  Are Deaths Due to Prematurity Avoidable in Developing Countries? , 2004, Tropical doctor.

[19]  Md. Mizanur Rahman,et al.  Factors associated with use of antenatal care services in a rural area of Bangladesh , 2013 .

[20]  S. Horiuchi,et al.  Factors influencing the use of antenatal care in rural West Sumatra, Indonesia , 2012, BMC Pregnancy and Childbirth.

[21]  English Only.  THE PEOPLE'S REPUBLIC OF BANGLADESH , 2006 .

[22]  D. Wypij,et al.  Does antenatal care make a difference to safe delivery? A study in urban Uttar Pradesh, India. , 1999, Health policy and planning.

[23]  A. Wagstaff,et al.  On the measurement of horizontal inequity in the delivery of health care. , 1991, Journal of health economics.

[24]  D. Hruschka,et al.  Association of antenatal care with facility delivery and perinatal survival – a population-based study in Bangladesh , 2012, BMC Pregnancy and Childbirth.

[25]  Wardlaw Tm,et al.  Antenatal care in developing countries: promises achievements and missed opportunities. An analysis of trends levels and differentials 1990-2001. , 2003 .

[26]  M. Koblinsky,et al.  Quality of Obstetric Care in Public-sector Facilities and Constraints to Implementing Emergency Obstetric Care Services: Evidence from High- and Low-performing Districts of Bangladesh , 2009, Journal of health, population, and nutrition.

[27]  C. Ronsmans,et al.  International Journal for Equity in Health a Decade of Inequality in Maternity Care: Antenatal Care, Professional Attendance at Delivery, and Caesarean Section in Bangladesh (1991–2004) , 2022 .

[28]  M. Mugford,et al.  WHO systematic review of randomised controlled trials of routine antenatal care , 2001, The Lancet.

[29]  A. Wagstaff,et al.  Namibia - Socio-economic differences in health, nutrition, and population , 2007 .

[30]  H. Tuladhar,et al.  Impact of Antenatal Care on Maternal and Perinatal utcome: A Study at Nepal Medical College Teaching Hospital , 2012 .

[31]  P. Simkhada,et al.  Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. , 2008, Journal of advanced nursing.

[32]  A. Jahn,et al.  Use pattern of maternal health services and determinants of skilled care during delivery in Southern Tanzania: implications for achievement of MDG-5 targets , 2007, BMC pregnancy and childbirth.

[33]  A. Hayen,et al.  Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data , 2014, BMC Pregnancy and Childbirth.

[34]  A. Adegnika,et al.  Adolescence As Risk Factor for Adverse Pregnancy Outcome in Central Africa – A Cross-Sectional Study , 2010, PloS one.

[35]  A. Nandi,et al.  Social inequalities in the utilization of maternal care in Bangladesh: Have they widened or narrowed in recent years? , 2014, International Journal for Equity in Health.

[36]  N. Kakwani,et al.  Socioeconomic inequalities in health: Measurement, computation, and statistical inference , 1997 .

[37]  B. Dhaka.  Bangladesh Demographic and Health Survey 2014 , 2015 .

[38]  Daniel R Hogan,et al.  Who Library Cataloguing-in-publication Data , 2022 .