The long journey towards optimal uptake of antenatal care in high HIV prevalence settings: an example from three population-based surveys in South Africa
South Africa, 2010 - 2013
Duduzile F. Nsibande, Ameena Goga, Ria Laubscher, Carl Lombard, Mireille Cheyip, Debra Jackson, Anna Larsen, Mary Mogashoa, Thu-Ha Dinh, Nobubelo K. Ngandu
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January 11, 2019
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January 11, 2019
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LongjourneytowardsuptakeofantenatalcareinhighHIVprevalencesettings
Title
The long journey towards optimal uptake of antenatal care in high HIV prevalence settings: an example from three population-based surveys in South Africa
Country
| Name | Country code |
|---|---|
| South Africa | ZAR |
Abstract
The long journey towards optimal uptake of antenatal care in high HIV prevalence settings: an example from three population-based surveys in South Africa
Short title: Uptake of antenatal care in high antenatal HIV prevalence settings
Abstract
In 2016, the World Health Organization recommended a shift from four antenatal care (ANC) visits to eight ANC contacts and emphasised on first ANC booking by 12-weeks' gestation to prevent poor pregnancy outcomes. This paper describes uptake of routine ANC and its associated factors in South Africa prior to 2016 recommendations, to bring to light potential challenges to achieving the current recommendations.
Data from three facility-based, cross-sectional, national surveys, conducted to measure six-week mother-to-child transmission of HIV (MTCT) in South Africa, were used. Mother-infant pairs attending selected public primary healthcare facilities for their infants' six-week immunization in 2010, 2011-12 and 2012-13 were recruited. Quantitative questionnaires were used to gather socio-demographic and antenatal-peripartum information from infant health booklets and maternal recall. A multivariable logistic regression model was used to identify (i) factors associated with ANC visits and (ii)how ANC visits relate to the extent of ANC care.
Of the 9470, 9646 and 8763 women who attended at least one ANC visit, only 47.5%[95% confidence interval 45.4-49.6], 55.6%[53.2-58.0] and 56.7%[54.3-59.1] were compliant with =4 ANC visits and 36.0%[34.5-37.5], 43.5%[42.0-45.1] and 50.8%[49.3-52.2] booked ANC early (before 20 weeks gestation) in 2010, 2011-12 and 2012-13, respectively. Multi-parity and lower socio-economic status were significantly associated with non-compliance, while later survey year, higher education, being married, older than 19 years, HIV-positive, planned pregnancy and knowledge about modes of HIV vertical transmission were strongly related to ANC visits compliance. The extent of ANC care improved significantly with survey, =4 ANC visits and self-reported pre-natal HIV-positive status, but was not associated with timing of ANC booking.
Despite improved increases in ANC visit compliance and early ANC booking between 2010 and 2013, these practices remain suboptimal. More ANC visits improve receipt of extended care but strengthened efforts are still needed to increase the uptake of at least four-to-eight ANC contacts.
Short title: Uptake of antenatal care in high antenatal HIV prevalence settings
Abstract
In 2016, the World Health Organization recommended a shift from four antenatal care (ANC) visits to eight ANC contacts and emphasised on first ANC booking by 12-weeks' gestation to prevent poor pregnancy outcomes. This paper describes uptake of routine ANC and its associated factors in South Africa prior to 2016 recommendations, to bring to light potential challenges to achieving the current recommendations.
Data from three facility-based, cross-sectional, national surveys, conducted to measure six-week mother-to-child transmission of HIV (MTCT) in South Africa, were used. Mother-infant pairs attending selected public primary healthcare facilities for their infants' six-week immunization in 2010, 2011-12 and 2012-13 were recruited. Quantitative questionnaires were used to gather socio-demographic and antenatal-peripartum information from infant health booklets and maternal recall. A multivariable logistic regression model was used to identify (i) factors associated with ANC visits and (ii)how ANC visits relate to the extent of ANC care.
Of the 9470, 9646 and 8763 women who attended at least one ANC visit, only 47.5%[95% confidence interval 45.4-49.6], 55.6%[53.2-58.0] and 56.7%[54.3-59.1] were compliant with =4 ANC visits and 36.0%[34.5-37.5], 43.5%[42.0-45.1] and 50.8%[49.3-52.2] booked ANC early (before 20 weeks gestation) in 2010, 2011-12 and 2012-13, respectively. Multi-parity and lower socio-economic status were significantly associated with non-compliance, while later survey year, higher education, being married, older than 19 years, HIV-positive, planned pregnancy and knowledge about modes of HIV vertical transmission were strongly related to ANC visits compliance. The extent of ANC care improved significantly with survey, =4 ANC visits and self-reported pre-natal HIV-positive status, but was not associated with timing of ANC booking.
Despite improved increases in ANC visit compliance and early ANC booking between 2010 and 2013, these practices remain suboptimal. More ANC visits improve receipt of extended care but strengthened efforts are still needed to increase the uptake of at least four-to-eight ANC contacts.
Producers and sponsors
Primary investigators
| Name | Affiliation |
|---|---|
| Duduzile F. Nsibande | Health Systems Research Unit (HSRU), South African Medical Research Council, Cape Town, South Africa |
| Ameena Goga | Health Systems Research Unit (HSRU), South African Medical Research Council, Cape Town, South Africa |
| Ria Laubscher | Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa |
| Carl Lombard | Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa |
| Mireille Cheyip | United States Centers for Disease Control and Prevention (CDC), Pretoria, South Africa |
| Debra Jackson | School of Public Health, University of the Western Cape, Cape Town, South Africa |
| Anna Larsen | United States Centers for Disease Control and Prevention (CDC), Pretoria, South Africa |
| Mary Mogashoa | United States Centers for Disease Control and Prevention (CDC), Pretoria, South Africa |
| Thu-Ha Dinh | United States Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA |
| Nobubelo K. Ngandu | Health Systems Research Unit (HSRU), South African Medical Research Council, Cape Town, South Africa |
Data Collection
Dates of Data Collection
| Start | End |
|---|---|
| 2010-06-01 | 2013-05-31 |