Prenatal care and uptake of HIV testing among pregnant women in Gambia: A cross-sectional study

  • BMC Public Health, Volume 20, No. 1, Year 2020

listen audio

Study Justification:
The study aims to address the evidence gap regarding the socioeconomic inequalities in the use of maternal healthcare, specifically prenatal care and HIV testing, among pregnant women in Gambia. Improving the coverage of antenatal care is crucial for reducing maternal and child mortality, especially in low-income settings. By analyzing nationally representative data, this study provides valuable insights into the factors influencing the utilization of maternal healthcare services, highlighting the need for strategic direction to promote their utilization.
Highlights:
– The study analyzed data from the Gambia Demographic and Health Survey conducted in 2013.
– A total of 5,351 women aged 15-49 years were included in the study.
– The study focused on three outcome variables: timing of first antenatal care, frequency of antenatal care, and HIV testing during antenatal care visits.
– Results showed that a large proportion of women in Gambia were not using antenatal care and HIV testing during pregnancy.
– Socioeconomic factors such as education, employment, and household wealth were found to be associated with the utilization of maternal healthcare services.
– Rural areas had higher odds of early and adequate antenatal care visits compared to urban areas.
– Women with secondary and higher education had higher odds of making early antenatal care visits.
– Women from wealthier households had significantly higher odds of having early and adequate antenatal care visits.
– Access to electronic media was positively associated with adequate antenatal care visits and HIV testing during antenatal care.
– Having an unintended child was negatively associated with early antenatal care visits but positively associated with taking HIV tests during antenatal care.
Recommendations:
– Develop targeted interventions to improve the utilization of antenatal care and HIV testing among pregnant women in Gambia.
– Focus on reducing socioeconomic inequalities by providing equal access to education, employment opportunities, and improving household wealth.
– Strengthen health promotion campaigns through electronic media to increase awareness and knowledge about the importance of antenatal care and HIV testing.
– Enhance the availability and accessibility of antenatal care services, particularly in urban areas.
– Implement strategies to reduce unintended pregnancies and promote family planning services.
Key Role Players:
– Gambia Bureau of Statistics (GBOS)
– Ministry of Health and Social Welfare
– Healthcare providers and facilities
– Non-governmental organizations (NGOs) working in maternal and child health
– Community leaders and influencers
– Media organizations for health promotion campaigns
Cost Items for Planning Recommendations:
– Development and implementation of targeted interventions: funding for program design, training, and monitoring and evaluation.
– Improvement of healthcare infrastructure and facilities: budget for construction, renovation, and equipment.
– Health promotion campaigns through electronic media: funding for content creation, dissemination, and monitoring.
– Training and capacity building for healthcare providers: budget for workshops, seminars, and skill development programs.
– Family planning services: funding for contraceptives, counseling, and education.
– Research and data collection: budget for surveys, data analysis, and reporting.
Please note that the above cost items are general categories and may vary based on the specific context and requirements of the recommendations.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides descriptive statistics and regression analysis to explore socioeconomic inequalities in the use of maternal healthcare. However, the abstract does not mention the specific methods used for data analysis, such as the regression model used or the statistical software. Additionally, it does not provide information on the sample size or the representativeness of the sample. To improve the evidence, the abstract could include more details on the statistical methods used, sample size, and the representativeness of the sample.

Background: Improving the coverage of antenatal care is regarded as an important strategy to reduce the risks of maternal and child mortality in low income settings like Gambia. Nonetheless, a large number of countries in Africa, including Gambia, are struggling to attain an optimum level of healthcare utilization among pregnant women. The role of socioeconomic inequalities in maternal healthcare uptake has received little attention in Gambia. To address this evidence gap, the present study analyses nationally representative data to explore the socioeconomic inequalities in the use of maternal healthcare. Methods: Data on women aged 15-49 years (n = 5351) were extracted from the latest round of Gambia Demographic and Health Survey in 2013 for this study. The outcome measures were early and adequate antenatal visit and HIV tests during the last pregnancy. Data were analyzed using descriptive and multivariate regression methods. Socioeconomic status was assessed through the women’s education, type of employment, and household wealth quintile. Results: From the total of 5351 participants included in the study, 38.7 and 78.8% of the women had early and adequate ANC visits respectively with a 65.4% HIV test coverage during ANC visits. The odds of early [OR = 1.30, 95% confidence interval (CI) =1.06, 1.59] and adequate [OR = 1.45, 95%CI = 1.15, 1.82] ANC visits were higher in the rural areas compared with urban. Women with secondary [OR = 1.24, 95%CI = 1.04, 1.48] and higher education [OR = 1.80, 95%CI = 1.20, 2.70] had higher odds of making early ANC visits. Women from richest wealth quintile households had significantly higher odds of having early [OR = 1.49, 95%CI = 1.14, 1.95] and adequate ANC visits [OR = 2.06, 95%CI = 1.48, 2.87], but not of having HIV tests. Having access to electronic media showed a positive association with adequate ANC visits [OR = 1.32, 95%CI = 1.08, 1.62] and with taking HIV test during ANC [OR = 1.48, 95%CI = 1.21, 1.80]. A fewer odds of having unintended child was associated with early ANC visit [OR = 0.70, 95%CI = 0.59, 0.84], but positively associated with taking HIV test [OR = 1.75, 95%CI = 1.42, 2.15]. Conclusion: A large proportion of women in Gambia were not using antenatal care and HIV tests during pregnancy. There are important sociodemographic differences in using maternal healthcare services such as HIV testing during pregnancy. This calls for strategic direction to promote the utilization of these services.

Data analyzed to achieve the objective of this was obtained from the Gambia Demographic and health survey (GDHS) conducted in 2013 [17, 18]. The survey was implemented by Gambia Bureau of Statistics (GBOS) and the Ministry of Health and Social Welfare [17, 18]. The main purpose of DHS surveys is to provide quality information for monitoring and evaluation of population health programmes and assist in evidence-based health policy making. For this survey, sample population were selected from 14 sampling stratum divided into 281 Enumeration Areas (EAs) or clusters (also known as primary sampling units) throughout the eight regions (known as Local Government Areas). DHS surveys used multistage sampling strategy for sample selection. In the first stage, the EAs were selected with probability proportional to size and with independent selection in each sampling stratum. After selection of the EAs, 25 households in each EA were selected using equal probability systematic selection. A total of 105 interviewers and supervisors were recruited for training and the training was conducted from November 26 to December 14 of 2012. Data collection for the survey took place from February 2 to April 28 of 2013. A total of 10,233 women were interviewed with a response rate of 90.7%. Further details of the surveys are available from the final report by GBOS [17]. The study had three outcomes variables, and these were: 1) timing of first antenatal care, 2) frequency of antenatal care, 3) HIV testing during ANC visit. Determination of these outcome variables was based on the participant’s self-report for the latest childbirth that occurred within the last 5 years of the survey. The ANC visits were categorized as ‘timely’ if within the first trimester and ‘late’ if beyond the first trimester [1]. The frequency of ANC visits was defined as adequate (at least four visits) and inadequate (less than four visits) as recommended by the World Health Organization recommendation at the time the data used for this study was collected during the survey [19]. During the ANC visits, HIV testing was categorized as Yes (had HIV tests done) and No (had no HIV tests done). The independent variables identified and included in the analysis was based upon the availability of key variables and plausible covariates in the dataset. These variables include: Predisposing factors: Age (15-19 years, 20-24 years, 25-29 years, 30-34 years, 35-39 years, 40-44 years, and 45-49 years); Residency (Urban, Rural); Religion (Islam, Other); Ethnicity Mandinka/Jahanka, Wollof Jola/Karoninka, Fula/Tukulur/Lorobo, Serahuleh Other); Parity (1–5, > 5); Household head (Male, Female); Child wanted (Wanted Then, Wanted No More); Enabling factors: Education (No Education, Primary, Secondary, Higher); Husband’s education (No Education, Incomplete Primary, Incomplete Secondary, Higher); Employment (Not Working, Professional/Technical/Managerial, Agricultural – Self Employed); Wealth quintile (Poorest, Poorer, Middle, Richer, Richest); Access to electronic media (No, Yes); Need factor: Heard of FP on internet (No, Yes); We used Stata version 14 to analyze the data. Data was cleaned, coded and analyzed based on the study inclusion criteria of at least 1 childbirth experience in the past 5 years. Since the survey that provided this data used cluster sampling techniques, all analyses were adjusted to the effect with the svy command [20]. This command uses data on the sampling weight, strata, and primary sampling units that are given with the dataset. The characteristics of the study population were described as percentages. Prevalence of timing and adequacy of antenatal care were presented as bar charts. This was followed by the use of binary logistic regression models to estimate the odds ratio (with 95%CIs) of using these services. Separate tables were used to present results of the three outcome variables, each divided into three subsamples: overall, urban and rural. Following the regression analysis, the model fitness was evaluated using the variance inflation factor (VIF) command. No multi-collinearity was detected as VIF values were below 10 for all the models. The preformed statistical test was two-tailed with the significant alpha value set at 5%.

N/A

Based on the information provided, it is difficult to identify specific innovations for improving access to maternal health. However, some potential recommendations based on the study’s findings and the context of Gambia could include:

1. Strengthening rural healthcare infrastructure: Since the study found higher odds of early and adequate antenatal care visits in rural areas compared to urban areas, efforts could be made to improve healthcare facilities and services in rural areas to ensure access to maternal healthcare.

2. Increasing education opportunities: The study found that women with secondary and higher education had higher odds of making early antenatal care visits. Therefore, initiatives to increase access to education, particularly for girls and women, could help improve maternal healthcare utilization.

3. Addressing socioeconomic inequalities: The study found that women from wealthier households had higher odds of early and adequate antenatal care visits. Efforts to reduce socioeconomic inequalities, such as through income generation programs and social protection measures, could help improve access to maternal healthcare for disadvantaged populations.

4. Promoting the use of electronic media: The study found a positive association between access to electronic media and adequate antenatal care visits and HIV testing during antenatal care. Therefore, promoting the use of electronic media, such as mobile phones and internet, to disseminate information about maternal health services and provide reminders for appointments could be beneficial.

5. Integrating family planning services: The study found that women who had unintended pregnancies were less likely to have early antenatal care visits but more likely to take HIV tests during antenatal care. Integrating family planning services with antenatal care could help address unintended pregnancies and improve overall maternal health outcomes.

It is important to note that these recommendations are based on the information provided and may need to be further tailored and contextualized to the specific needs and resources of Gambia.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health in Gambia is to focus on addressing socioeconomic inequalities in the use of maternal healthcare services. This can be achieved through the following strategies:

1. Enhance education and awareness: Promote education and awareness about the importance of antenatal care (ANC) and HIV testing during pregnancy. This can be done through community-based education programs, media campaigns, and targeted messaging to reach women in both urban and rural areas.

2. Improve access to healthcare facilities: Increase the availability and accessibility of healthcare facilities, particularly in rural areas. This can be achieved by expanding the number of healthcare facilities, improving infrastructure, and ensuring the availability of skilled healthcare providers.

3. Address financial barriers: Implement policies and programs to reduce financial barriers to accessing maternal healthcare services. This can include providing subsidies or financial assistance for ANC visits and HIV testing, especially for women from low-income households.

4. Strengthen healthcare systems: Enhance the capacity and quality of healthcare systems to provide comprehensive maternal healthcare services. This can be done through training healthcare providers, improving the availability of essential supplies and equipment, and implementing quality assurance measures.

5. Promote gender equality: Address gender inequalities that may hinder women’s access to maternal healthcare. This can involve empowering women through education, promoting women’s rights, and engaging men in supporting maternal health initiatives.

By implementing these recommendations, it is expected that the utilization of maternal healthcare services, including ANC visits and HIV testing, will improve, leading to better maternal and child health outcomes in Gambia.
AI Innovations Methodology
To improve access to maternal health, here are some potential recommendations:

1. Strengthening healthcare infrastructure: Investing in healthcare facilities, equipment, and trained healthcare professionals in both urban and rural areas can improve access to maternal health services.

2. Mobile health (mHealth) interventions: Utilizing mobile technology to provide information, reminders, and support to pregnant women can help improve access to maternal health services, especially in remote areas.

3. Community-based interventions: Implementing community-based programs that educate and empower women about maternal health, provide antenatal care services, and facilitate transportation to healthcare facilities can increase access to maternal health services.

4. Financial incentives: Providing financial incentives, such as cash transfers or vouchers, to pregnant women who seek antenatal care and deliver in healthcare facilities can help overcome financial barriers and improve access to maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the target population: Identify the specific population group (e.g., pregnant women in a particular region) for which access to maternal health services needs to be improved.

2. Collect baseline data: Gather data on the current utilization of maternal health services, including the percentage of women receiving antenatal care, the timing and frequency of visits, and the uptake of HIV testing during pregnancy.

3. Introduce the recommendations: Simulate the implementation of the recommended interventions, such as strengthening healthcare infrastructure, implementing mHealth interventions, community-based programs, and financial incentives.

4. Analyze the impact: Compare the baseline data with the simulated data after implementing the recommendations. Measure the changes in the utilization of maternal health services, including improvements in antenatal care coverage, timing and frequency of visits, and uptake of HIV testing.

5. Assess socioeconomic inequalities: Analyze the impact of the recommendations on reducing socioeconomic inequalities in accessing maternal health services. Evaluate whether the interventions have effectively reached disadvantaged populations and improved their access to care.

6. Evaluate cost-effectiveness: Assess the cost-effectiveness of the implemented interventions by comparing the costs incurred with the improvements in access to maternal health services. Consider factors such as the cost of implementing the interventions, the number of additional women reached, and the potential reduction in maternal and child mortality.

7. Refine and adjust: Based on the findings, refine and adjust the recommendations to optimize their impact on improving access to maternal health services. Consider scaling up successful interventions and addressing any challenges or barriers identified during the simulation.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of different recommendations on improving access to maternal health services and make informed decisions to prioritize and implement effective interventions.


Statistics:
Citations: 7
Identifiers:
DOI: 10.1186/s12889-020-08618-4
Research Areas:
Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Gambia
Study Design:
Case-Control Study, Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Male & Female
Partagez ceci :
Facebook
Twitter
LinkedIn
WhatsApp
Email