Adherence To Timing Of Focused Antenatal Care And Fetal Outcomes In The Accra Metropolitan Area

Abstract

Background Antenatal care is an integral part of safe motherhood. The World Health Organization recommended a departure from the traditional routine non-evidence based to the four visit evidence–based focused antenatal care for low risk clients. The Ghana Demographic and Health Survey, 2014 reported that about 85 percent of pregnant women had four or more visits. However, whether these visits were consistent with the recommended gestational ages of visits or not is not known. This information is needed to enhance successful implementation of the new eight visit positive pregnancy experience antenatal care model introduced since November, 2016. General objective This study sought to determine the adherence to timing of focused antenatal clinic attendance and the fetal outcomes in the Accra Metropolitan area. Methodology A hospital based, quantitative cross-sectional study was carried out from 1st June to 30th June, 2017. An interviewer administered structured questionnaire and abstraction form was used to obtain data from 446 postpartum mothers who received focused antenatal care in the Accra Metropolitan Area. The data were entered into an Excel spreadsheet (Microsoft, 2010) and exported into Stata version 16 for analysis. In addition to descriptive statistics, bivariate regression analysis was used to test for association between the sociodemographic factors, obstetrics and gynaecological history and adherence to timing of focused antenatal care. The association between timing of focused antenatal care and fetal outcomes was also determined bivariate regression analysis. Multiple logistic regressions were used in the analysis of determinants of adherence to the timing of focused antenatal care and the fetal outcomes. A confidence interval of 95% and p<0.05 was deemed to be statistically significant. Results Out of a total of 446 postpartum women who had focused antenatal care, 378(84.8%) had four or more visits. Among those who had 4 or more visits, 101 (26.7%) adhered to the recommended timing of focused antenatal care. Women who had correct timing of focused antenatal care were more likely to have had education up to Junior High School [AOR=3.31, 95% (1.03-10.61)] or Senior High School [AOR=4.47, 95% (1.14-17.51)]. They were also more likely to have had a history of abortion [(AOR=3.36, 95% (1.69-7.96)]. For every week increase in gestational age at booking at the antenatal clinic, respondents were 34% less likely to complete all four antenatal visits at the recommended times. [(AOR=0.66, 95% (0.60-0.73)]. Post-partum women whose ages were 25 years or more were 54% less likely to have babies with Apgar scores of 7 or more. [AOR=0.46, 95% (0.22-0.97)]. Conclusions About 85% of women receiving focused antenatal care in the Accra Metropolitan area have four or more visits. Only 27% these women adhered to the recommended timing of focused antenatal care. Early initiation of antenatal care, high School education as well as women with a history of abortion were predictors for adherence to the timing of focused antenatal care. Women more than 25 years old were less likely to have good fetal Apgar scores at 1 minute. There is the need to educate women on the recommended timing of antenatal care especially as the WHO introduces the new 8 visit schedule for a positive pregnancy experience.