Research Article: Antenatal care service quality increases the odds of utilizing institutional delivery in Bahir Dar city administration, North Western Ethiopia: A prospective follow up study

Date Published: February 8, 2018

Publisher: Public Library of Science

Author(s): Tadese Ejigu Tafere, Mesganaw Fanthahun Afework, Alemayehu Worku Yalew, Bishwajit Ghose.


In Ethiopia, more than 62% of pregnant women attend antenatal care at least once, yet only about one in four women give birth at health facility. This gap has fueled the need to investigate on the quality of ANC services at public health facilities and its link with the use of institutional delivery.

To assess the linkage between ANC quality and the use of institutional delivery among pregnant women attending ANC at public health facilities of BDR City Administration

A facility based prospective follow up study was conducted. and nine hundred seventy pregnant women with gestational age ≤ 16 weeks who came for their first ANC visit were enrolled.Women were followed from their first ANC visit until delivery. Longitudinal data was collected during consultation with ANC providers using structured observation checklist. ANC service was considered as acceptable quality if women received ≥75th percentile of the essential ANC services. Generalized Estimating Equation (GEE) was carried out to control cluster effect among women who received ANC in the same facility.

Among 823 pregnant women who completed follow up, only about one third (27.6%) received acceptable quality of ANC services. In one health facility syphilis test was not done at all for the last two years. The odds of giving birth at health institution among pregnant women who received acceptable ANC quality service was about 3.38 times higher than among pregnant women who received unacceptable ANC quality service (AOR = 3.38, 95% CI: 1.67, 6.83).

In this study the quality of ANC service provision in public health facilities was compromised/low. Provision of quality ANC service had a great role in promoting institutional delivery. Therefore the local authorities at each level of health sector or the nongovernmental organizations working to improve maternal health need to provide training on focused antenatal care protocol for ANC providers.

Partial Text

Care during pregnancy is important for the health of the mother and the development of the unborn baby. Antenatal care is a crucial time to promote healthy behaviors and parenting skills. World Health Organization (WHO) envisions “every pregnant woman and newborn to receive quality care throughout the pregnancy, childbirth and postnatal period. However, approximately 303 000 women died as a result of pregnancy and childbirth-related complications in 2015; 99% in low-resource settings, with Sub-Saharan Africa (SSA) countries alone accounting for roughly 66% and most can be prevented. The lifetime risk of maternal mortality is estimated at 1 in 36 in SSA, contrasting 1 in 4900 in developed countries. These showed the presence of greater disparities in maternal health care worldwide [1–4].

In this study only about one in four of the observed pregnant women received acceptable quality of antenatal care service; this is consistent with a study done in rural Mexico that reported 28.4% received acceptable ANC quality [13]. Even if the proportion of women who received quality antenatal care in this study and the study done in Mexico was almost the same, there is 17 years gap in between two studies which indicates that the quality of ANC service in the study area is far behind. This might be due to the reason that the health facilities in the study area might not be well equipped with the necessary inputs and competent professionals for quality ANC service provision. The facility audit also supported the low quality of ANC service in the study area as almost half of ANC providers were not trained on FANC protocol; one health facility did not do syphilis screening test (VDRL/RPR) for the last two years due to lack of the test kit and no health facility had the focused antenatal care guide line.




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