Underutilization of the recommended frequency of focused antenatal care services in Northwest Ethiopia: Using Andersen’s healthcare service utilization model approach

  • Clinical Epidemiology and Global Health, Volume 11, Year 2021

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Study Justification:
The study aimed to investigate the underutilization of the recommended frequency of Focused Antenatal Care (FANC) services in Northwest Ethiopia. This is an important area of research because the World Health Organization (WHO) introduced the FANC model in 2001, recommending a minimum of four visits for pregnant women. However, the underutilization of FANC visits can have negative impacts on maternal and child health outcomes. Therefore, understanding the factors associated with underutilization is crucial for improving healthcare services in low-resource settings like Ethiopia.
Highlights:
– The study found that more than half (55.6%) of the post-partum mothers in the study underutilized the recommended frequency of FANC visits.
– Factors associated with underutilization included not watching television, not listening to the radio, living far from a health facility, and lacking companionship when visiting the health facility.
– On the other hand, mothers between the ages of 20 and 34 and those who had follow-up at private clinics were less likely to underutilize FANC services.
– The study highlights the need for community mobilization through mass media, improving geographical access to health facilities, and enhancing client-provider relationships to improve FANC utilization.
Recommendations:
Based on the findings, the following recommendations are suggested:
1. Increase awareness through mass media campaigns: Implement targeted campaigns using television and radio to educate pregnant women about the importance of FANC visits and the benefits to maternal and child health.
2. Improve geographical access to health facilities: Establish satellite clinics or mobile health units in remote areas to ensure pregnant women have easier access to FANC services.
3. Enhance client-provider relationships: Train healthcare providers to provide compassionate and supportive care during FANC visits, ensuring that pregnant women feel comfortable and encouraged to attend all recommended visits.
Key Role Players:
1. Ministry of Health: Responsible for coordinating and implementing strategies to improve FANC utilization.
2. Local Health Authorities: Involved in the planning and implementation of community mobilization campaigns and improving geographical access to health facilities.
3. Media Organizations: Collaborate with healthcare authorities to develop and broadcast educational programs on television and radio.
4. Healthcare Providers: Receive training on providing quality care and building positive relationships with pregnant women during FANC visits.
Cost Items for Planning Recommendations:
1. Media Campaigns: Budget for producing and broadcasting television and radio advertisements, including scriptwriting, production, and airtime costs.
2. Infrastructure Development: Allocate funds for establishing satellite clinics or mobile health units in remote areas, including construction, equipment, and staffing costs.
3. Training Programs: Set aside a budget for training healthcare providers on compassionate and supportive care, including workshop fees, materials, and facilitator expenses.
Please note that the cost items provided are general categories and the actual costs would depend on the specific context and resources available in Northwest Ethiopia.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study used a cross-sectional design and employed multivariable binary logistic regression to identify factors associated with underutilization of FANC visits. The sample size of 358 post-partum mothers is relatively small, which may limit the generalizability of the findings. To improve the strength of the evidence, future studies could consider using a larger sample size and a longitudinal design to establish causality. Additionally, conducting similar studies in different regions of Ethiopia would enhance the external validity of the findings.

Background: World Health organizations (2001) introduced an antenatal care model called Focused Antenatal Care (FANC) and recommended to have a minimum of four visits. This model is still feasible for low resource setting countries like Ethiopia. Underutilization of the recommended frequency of FANC results to hurt maternal and child health outcomes. Methods: Institutional based cross-sectional study was conducted from August 1 to October 30, 2019, at Debre Markos Referral Hospital, and a total of 358 post-partum mothers were participated in this study. A multivariable binary logistic regression was employed to identify factors associated with underutilization of the recommended frequency of FANC visits. A p-value < 0.05 was a cut-off point to declare statistical significance. Results: The magnitude of the recommended frequency of FANC visits was 55.6%. The high odds of underutilization were observed among mothers who did not watch television [AOR = 3.5; 95% CI (1.25–5.99)], not listing radio [AOR = 4.29; 95% CI (1.67–10.97)], reside far from health facility [AOR = 11.3; 95% CI (4.15–30.90)], and lack companionship/s when visited health facility [AOR = 3.5; 95% CI (1.91–6.50)]. Whereas, mothers age between 20 and 34 years [ AOR = 0.21; 95% CI (0.07–0.67)] and had follow up at private clinic/s [AOR = 0.013; 95% CI (0.001–0.143)] were inversely associated with underutilization. Conclusion: More than half of the total study participants were underutilized the recommended frequency of FANC which was high. Community mobilization through mass media, improve geographical access to the health facility, and improve client-provider relationships could improve FANC utilization.

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The study recommends the following innovations to improve access to maternal health:

1. Community mobilization through mass media: This innovation involves using mass media platforms such as television and radio to increase awareness and knowledge about the importance of antenatal care and the recommended frequency of Focused Antenatal Care (FANC) visits. By disseminating information through these channels, communities can be mobilized and educated about the benefits of regular antenatal care visits and the potential risks of underutilization.

2. Improve geographical access to health facilities: To address the barrier of distance, efforts should be made to improve geographical access to health facilities. This can be achieved through the establishment of more health facilities in remote areas or the implementation of mobile health clinics that can reach underserved communities. By bringing healthcare services closer to pregnant women, access to antenatal care can be improved.

3. Improve client-provider relationships: This innovation focuses on enhancing the relationship between healthcare providers and pregnant women during antenatal care visits. Training healthcare providers on effective communication and interpersonal skills can help create a supportive and comfortable environment for pregnant women. Additionally, ensuring privacy and confidentiality, as well as promoting a patient-centered approach to care, can contribute to improved client-provider relationships.

Implementing these innovations can help increase the utilization of FANC visits, ultimately improving maternal and child health outcomes.
AI Innovations Description
The recommendation provided in the study to improve access to maternal health is as follows:

1. Community mobilization through mass media: Increasing awareness and knowledge about the importance of antenatal care and the recommended frequency of Focused Antenatal Care (FANC) visits can be achieved through community mobilization campaigns. Mass media platforms such as television and radio can be utilized to disseminate information about the benefits of regular antenatal care visits and the potential risks of underutilization.

2. Improve geographical access to health facilities: Many mothers in the study cited distance as a barrier to accessing antenatal care services. To address this issue, efforts should be made to improve geographical access to health facilities. This can be done by establishing more health facilities in remote areas or implementing mobile health clinics that can reach underserved communities.

3. Improve client-provider relationships: The study found that the lack of companionship during health facility visits was associated with underutilization of FANC. Improving client-provider relationships can help create a supportive and comfortable environment for pregnant women during their antenatal care visits. This can be achieved through training healthcare providers on effective communication and interpersonal skills, ensuring privacy and confidentiality, and promoting a patient-centered approach to care.

Implementing these recommendations can help increase the utilization of FANC visits, ultimately improving maternal and child health outcomes.
AI Innovations Methodology
To simulate the impact of the main recommendations on improving access to maternal health, the following methodology can be employed:

1. Community mobilization through mass media: Conduct a community-based intervention by implementing mass media campaigns to increase awareness and knowledge about the importance of antenatal care and the recommended frequency of FANC visits. This can be done by developing and airing educational television and radio programs, creating informative posters and flyers, and organizing community events to disseminate information. Measure the impact of the intervention by comparing the utilization rates of FANC visits before and after the campaign.

2. Improve geographical access to health facilities: Identify underserved areas with limited access to health facilities. Establish new health facilities in these areas or implement mobile health clinics that can reach remote communities. Measure the impact by comparing the utilization rates of FANC visits in these areas before and after the intervention. Additionally, collect data on the distance traveled by pregnant women to access antenatal care services before and after the intervention to assess the improvement in geographical access.

3. Improve client-provider relationships: Provide training to healthcare providers on effective communication and interpersonal skills. This can include workshops or seminars focusing on patient-centered care, privacy and confidentiality, and creating a supportive environment for pregnant women. Assess the impact of the training by conducting surveys or interviews with pregnant women to measure their satisfaction with the client-provider relationship and their comfort level during antenatal care visits.

To evaluate the overall impact of these interventions, collect data on the utilization rates of FANC visits before and after the implementation of each recommendation. Compare the data to determine if there has been an increase in utilization. Additionally, gather qualitative feedback from pregnant women and healthcare providers to assess their perceptions of the interventions and any barriers that may still exist.

By implementing this methodology, it will be possible to simulate the impact of the main recommendations on improving access to maternal health and determine their effectiveness in increasing the utilization of FANC visits.

Statistics:
Citations: 1
Authors: 5
Identifiers:
DOI: 10.1016/j.cegh.2021.100746
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care
Study Countries:
Ethiopia
Study Design:
Cross Sectional Study
Study Approach:
Quantitative
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