Factors Influencing the Utilisation of Antenatal Care Services among Women of Reproductive Age (15 – 49 Years) in Garowe, Puntland State of Somalia
Abstract
Despite governments' and international development partners' efforts, maternal deaths remain prevalent in Somalia, with approximately 621 deaths per 10,000 live births. Most complications resulting in these deaths are amenable to the use of quality obstetric care services, especially antenatal care (ANC) services. While the prevalence and correlates of prenatal care use are well documented, limited studies have focused on antenatal care uptake in Garowe, Puntland state of Somalia. This study aims to highlight factors associated with antenatal care services use among women aged 15–49 in Garowe, Nugaal Region, Somalia. We used a descriptive cross-sectional design. A cluster sampling technique was used to select 384 participants for the study. Logistic regression was computed to identify independent factors associated with four ANC visits. Respondents’ average age was 30.2 years, with a range of 16 to 48 years. More than half (56.8%, n=218) of the respondents did not complete four ANC visits. Multivariable analysis established that those who lack insurance, (adjusted odds ratio (aOR)= 6.07, 95%CI: 3.41 – 10.80, p<0.00), used public transport (aOR = 3.68, 95%CI: 1.31 – 10.32, p =0.013), walk to the health facility (aOR =4.0, 95%CI: 1.80 – 8.77, p =0.001), agreed that women discourage ANC attendance in the community (aOR = 3.72, 95%CI: 1.63 – 8.49, p =0.002) and had used TBAs (aOR =13.13, 95%CI: 6.81 – 25.29, p<0.001 were likely to not complete four ANC visits compared to their counterparts. While the WHO now recommends eight antenatal care visits, most pregnant women in the study setting did not complete the previously recommended four antenatal care visits, largely due to social and economic factors. There is a need to provide support to women in the community through financial support and ensure that ANC services are affordable and accessible to increase uptake
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References
Adedokun, S. T., & Yaya, S. (2020). Correlates of antenatal care utilization among women of reproductive age in sub-Saharan Africa: Evidence from multinomial analysis of demographic and health surveys (2010–2018) from 31 countries. Archives of Public Health.
Ahinkorah, B. O., Seidu, A.-A., Agbaglo, E., Adu, C., Budu, E., Jr, J. H., . . . Yaya, S. (2022). Factors impacting antenatal care utilization: A systematic review of 37 fragile and conflict-affected situations. Conflict and Health, 16(1), 33.
Alamneh, Y., Adane, F., Yirga, T., & Desta, M. (2020). Essential newborn care utilization and associated factors in Ethiopia: A systematic review and meta-analysis. In BMC Pregnancy and Childbirth.
Ali, S. A., Ali, S. A., Feroz, A., Saleem, S., Fatmai, Z., & Kadir , M. M. (2020). Factors affecting the utilization of antenatal care among married women of reproductive age in the rural Thatta, Pakistan: findings from a community-based case-control study. BMC pregnancy and childbirth, 20.
Ali, S. A., Ali, S. A., Feroz, A., Saleem, S., Fatmai, Z., & Kadir, M. M. (2020). Factors affecting the utilization of antenatal care among married women of reproductive age in the rural Thatta, Pakistan: Findings from a community-based case-control study. BMC Pregnancy and Childbirth.
Alibhai, K. M., Ziegler, B. R., Meddings, L., Batung, E., & Luginaah, I. (2022). Factors impacting antenatal care utilization: A systematic review of 37 fragile and conflict-affected situations. Conflict and Health, 16(1), 33. doi:. https://doi.org/10.1186/s13031-022-00459-9
Belay, A., Astatkie, T., Abebaw, S., Gebreamanule, B., & Enbeyle, W. (2022). Prevalence and factors affecting the utilization of antenatal care in rural areas of Southwestern Ethiopia. BMC pregnancy and childbirth, 22(1), 30.
Elmi, O. H., Hussein, N. A., Hassan, A. M., Ismail, A. M., Abdulrahman, A. A., & Muse, A. M. (2021). Antenatal Care: Utilization Rate and Barriers in Bosaso-Somalia, 2019. European Journal of Preventive Medicine.
Fenta, S. M., Ayenew, G. M., & Getahun, B. E. (2021). Magnitude of antenatal care service uptake and associated factors among pregnant women: Analysis of the 2016 Ethiopia Demographic and Health Survey. BMJ Open.
Finlayson, K., & Downe, S. (2013). Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS medicine, 10(1).
Joshi, C., Torvaldsen, S., Hodgson, R., & Hayen, A. (2014). Factors associated with the use and quality of antenatal care in Nepal: A population-based study using the demographic and health survey data. BMC Pregnancy and Childbirth, 14(1), 94. doi:https://doi.org/10.1186/1471-2393-14-94
Khamidovna, K. K., Alexandrovna, G. M., Alexandrovna, K. O., & Mikhailovich, G. A. (2016). Cross-sectional studies: Planning, sample size, data analysis. Ekologiya Cheloveka (Human Ecology). doi:https://doi.org/10.33396/1728-0869-2016-2-49-56
Mouhoumed, H. M., & Mehmet, N. (2021). Utilization pattern of antenatal care and determining factors among reproductive-age women in Borama, Somaliland. Journal of Preventive Medicine and Hygiene.
Mutai, K. T., & Otieno, G. O. (2021). Utilization of focused antenatal care among expectant women in Murang’a County, Kenya. Pan African Medical Journal.
Odusina, E. K., Ahinkorah, B. O., Ameyaw, E. K., Seidu, A.-A., Budu, E., Zegeye, B., & Yaya, S. (2021). Noncompliance with the WHO’s Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis. BioMed Research International.
Okedo-Alex, I. N., Akamike, I. C., Ezeanosike, O. B., & Uneke, C. J. (2019). Determinants of antenatal care utilisation in sub-Saharan Africa: A systematic review. BMJ Open, 9(10), 1–14.
Puntland Ministry of Health. (2020). Puntland Report 2020. Somali health and demographic survey, PLHDS.
Roro, M., Deressa, W., & Lindtjørn , B. (2018). WHO Global recommendations for routine antenatal care. Geneva World Heal Organ, 10, 1-10.
Seidu , A.-A., Ahinkorah, B. O., Agbaglo , E., Adu , C., Budu, E., Hagan Jr, J. E., Yaya , S. (2021). Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea Demographic and Health Survey data. BMC Pregnancy and Childbirth, 21, 1-11.
Sserwanja, Q., Mukunya, D., Musaba, M. W., Kawuki, J., & Kitutu, F. E. (2021). Factors associated with health facility utilization during childbirth among 15 to 49-year-old women in Uganda: Evidence from the Uganda Demographic Health Survey 2016. BMC Health Services Research.
Taye, B. T., Zerihun, M. S., Kitaw, T. M., Demisse, T. L., Worku, S. A., Fitie, G. W., Kebede, A. A. (2022). Women’s traditional birth attendant utilization at birth and its associated factors in Angolella Tara, Ethiopia. Plos One, 17(11). doi:e0277504.
Tsegay, Y., Gebrehiwot, T., Goicolea, I., Edin, K., Lemma, H., & Sebastian, M. (2013). Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: A cross-sectional study. International Journal for Equity in Health.
WHO. (2021). World Health Organization. Maternal mortality rates in the United States, 2020. National Center Health Statistics.
World Health Organization. (2019). Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division: executive summary. World Health Organization. Retrieved from https://www.who.int/publications/i/item/9789241516488
World Health Organization. (2023). Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization.
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