Health Policy and Planning Advance Access published online on April 28, 2009
Health Policy and Planning, doi:10.1093/heapol/czp017
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Providing information on pregnancy complications during antenatal visits: unmet educational needs in sub-Saharan Africa
1 Research professional, Groupe de recherche interdisciplinaire en santé (GRIS), Faculté de médecine, département de Médecine sociale et préventive, Université de Montréal, Canada.
2 Professor, Regional Institute for Demographic Training and Research (IFORD), P.O. BOX 1556 Yaounde, Cameroon. E-mail: gbeninguisse{at}yahoo.fr
3 Associate Professor, Department of Community Health Sciences, Université de Sherbrooke, Quebec, Canada, and Canada Research Chair on Population Impacts of Healthcare.
* Corresponding author. GRIS, Faculté de médecine, département de Médecine sociale et préventive, Université de Montréal, C.P. 6128, succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada. Tel: +1 514 343-6111, ext. 15482. Fax: +1 514 343-2207. E-mail: B.Nikiema{at}UMontreal.ca
Introduction Lack of information on the warning signs of complications during pregnancy, parturition and postpartum hampers women's ability to partake fully in safe motherhood initiatives. We assessed the extent to which women in 19 countries of sub-Saharan Africa recall receiving information about pregnancy complications during antenatal care for the most recent pregnancy, and examined the impact of advice receipt on the likelihood of institutional delivery.
Methods A cross-sectional, cross-country analysis was performed on data from the most recent Demographic and Health Surveys (DHS) of 19 countries of sub-Saharan Africa. Multilevel logistic regressions were used to predict the probability of receiving information and delivering in a health centre, by clinical risk factors (age, parity, previous pregnancy termination), social factors (area of residence, education), and the frequency of service utilization (number of visits).
Results The percentage of women recalling information about potential complications of pregnancy during antenatal care varied widely, ranging from 6% in Rwanda to 72% in Malawi, and in 15 of the 19 countries, less than 50% of women reported receiving information. Institutional delivery ranged from 29% (Ethiopia) to 92% (Congo Brazzaville). Teenagers (OR = 0.84), uneducated (OR = 0.65) and rural women (OR = 0.70) were less likely to have been advised, compared with women aged 20–34 years, women with secondary education and urban women, respectively. Likelihood of recalling information increased with the number of antenatal visits. Advice reception interacts with the number of antenatal visits to increase the likelihood of institutional delivery.
Conclusion There is a high level of unmet need for information on pregnancy complications in sub-Saharan Africa, particularly among those who face significant barriers to accessing care if complications occur. Educational interventions are critical to safe motherhood initiatives; health providers must fully use the educational opportunity in antenatal care.
Key Words: Pregnancy complications, advice provision, antenatal care, institutional delivery, sub-Saharan Africa
Accepted for publication 6 January 2009.