Factors associated with the use of antenatal care in Sindh province, Pakistan: A population-based study

Jin Won Noh, Young-MI Kim, Lena J. Lee, Nabeel Akram, Farhana Shahid, Young Dae Kwon, Jelle Stekelenburg

Research output: Contribution to journalArticle

Abstract

Background Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. Methods We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. Results Most women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95% confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95% CI = [1.57, 2.35]), higher women’s education (OR = 1.70; 95% CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95% CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95% CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95% CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95% CI = [1.06, 1.61]). Conclusions This study demonstrates that both socioeconomic factors and health information sources are associated with women’s use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.

Original languageEnglish (US)
Article numbere0213987
JournalPloS one
Volume14
Issue number4
DOIs
StatePublished - Apr 1 2019

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prenatal care
Prenatal Care
Pakistan
Health
odds ratio
confidence interval
Odds Ratio
Confidence Intervals
Population
health information
information sources
Logistics
households
Education
Logistic Models
midwives
Nurse Midwives
neonatal mortality
socioeconomic factors
Maternal Mortality

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

Cite this

Noh, J. W., Kim, Y-MI., Lee, L. J., Akram, N., Shahid, F., Kwon, Y. D., & Stekelenburg, J. (2019). Factors associated with the use of antenatal care in Sindh province, Pakistan: A population-based study. PloS one, 14(4), [e0213987]. https://doi.org/10.1371/journal.pone.0213987

Factors associated with the use of antenatal care in Sindh province, Pakistan : A population-based study. / Noh, Jin Won; Kim, Young-MI; Lee, Lena J.; Akram, Nabeel; Shahid, Farhana; Kwon, Young Dae; Stekelenburg, Jelle.

In: PloS one, Vol. 14, No. 4, e0213987, 01.04.2019.

Research output: Contribution to journalArticle

Noh, JW, Kim, Y-MI, Lee, LJ, Akram, N, Shahid, F, Kwon, YD & Stekelenburg, J 2019, 'Factors associated with the use of antenatal care in Sindh province, Pakistan: A population-based study', PloS one, vol. 14, no. 4, e0213987. https://doi.org/10.1371/journal.pone.0213987
Noh, Jin Won ; Kim, Young-MI ; Lee, Lena J. ; Akram, Nabeel ; Shahid, Farhana ; Kwon, Young Dae ; Stekelenburg, Jelle. / Factors associated with the use of antenatal care in Sindh province, Pakistan : A population-based study. In: PloS one. 2019 ; Vol. 14, No. 4.
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abstract = "Background Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. Methods We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. Results Most women (83.5{\%}) received one or more ANC, mostly by doctors (95{\%}), but only 57.3{\%} of them made the recommended four or more visits, and just 53.7{\%} received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95{\%} confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95{\%} CI = [1.57, 2.35]), higher women’s education (OR = 1.70; 95{\%} CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95{\%} CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95{\%} CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95{\%} CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95{\%} CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95{\%} CI = [1.06, 1.61]). Conclusions This study demonstrates that both socioeconomic factors and health information sources are associated with women’s use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.",
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AU - Shahid, Farhana

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N2 - Background Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. Methods We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. Results Most women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95% confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95% CI = [1.57, 2.35]), higher women’s education (OR = 1.70; 95% CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95% CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95% CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95% CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95% CI = [1.06, 1.61]). Conclusions This study demonstrates that both socioeconomic factors and health information sources are associated with women’s use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.

AB - Background Antenatal care (ANC) is critical to decrease maternal and neonatal mortality. However, little is known about the utilization of ANC services in Pakistan. This study assessed the utilization of ANC in Sindh province, Pakistan, and identified the factors that affect its use. Methods We analysed a subset of data from Maternal and Child Health (MCH) Program Indicator Surveys conducted in Sindh province, Pakistan in 2013 and 2014. Respondents included 10,200 women who had given birth in the past two years. The outcome measure was making at least four ANC visits. Logistic regression models were used to identify demographic, socioeconomic, characteristics of ANC, and informational factors associated with ANC use. Results Most women (83.5%) received one or more ANC, mostly by doctors (95%), but only 57.3% of them made the recommended four or more visits, and just 53.7% received their initial ANC care during the first trimester. Making four or more ANC visits was associated with: fewer household occupants (odds ratio [OR] = 0.98; 95% confidence interval [CI] = [0.97, 0.99]), large city residence (OR = 1.92; 95% CI = [1.57, 2.35]), higher women’s education (OR = 1.70; 95% CI = [1.33, 2.15]), greater household wealth (OR = 5.66; 95% CI = [4.22, 7.60]), and receiving MCH information from lady health worker (OR = 1.17; 95% CI = [1.00, 1.37]), mother-in-law (OR = 1.17; 95% CI = [1.01, 1.36]), other relatives/friends (OR = 1.19; 95% CI = [1.03, 1.38]), or nurse/midwife (OR = 1.31; 95% CI = [1.06, 1.61]). Conclusions This study demonstrates that both socioeconomic factors and health information sources are associated with women’s use of ANC. Therefore, programs should target socially disadvantaged and vulnerable groups, particularly rural, less educated, and poor women, to improve utilization of ANC. In addition, strategies to increase exposure to MCH information sources should be a priority in Sindh, Pakistan.

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