Influence Of The Number Of ANC Visits On Pregnancy Outcomes Of Mothers Delivering At A Rural Hospital, Longisa District Hospital.
Abstract
Background: Antenatal care (ANC) is the care that a woman receives during pregnancy. ANC
improves maternal and fetal outcomes. Focused antenatal care (FANC) emphasizes on quality
rather than quantity of ANC visits and is the recommended approach. It is unknown if visits
fewer than the recommended minimum of four in FANC can have the same effect on maternal
and perinatal outcomes. This may be important in Africa given the never ending shortage of
human resource and infrastructure for health.
Objective: To determine the number of ANC visits and their influence on maternal and perinatal
outcomes at a rural Kenyan hospital.
Study design: Retrospective cohort.
Study population: Women admitted in Longisa District Hospital postnatal ward after delivery at
or above 28 weeks gestation and had ANC.
Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya.
Study procedure: Eligible women were enrolled and data was collected on parity, age, marital
status, economic status, number of ANC visits, gestation age at delivery, onset of labour, mode
of delivery, maternal complications and mortality, 5 minute APGAR score, birth weight and fetal
death. Data analysis was carried out using the Statistical Package for Social Sciences version
17.0 (SPSS Inc, Chicago, IL, USA). Chi-square and Student’s t-test were used to test for
association.
Results: Of the screened postpartum women, two hundred (98.0%) were eligible. Most,
122(61.0%) of the eligible women had <4 ANC visits. Majority, 167(83.5%) of the participants
were married; 101(50.5%) were para 2 to 4; 131(65.5%) were housewives; 133(66.5%) had
primary level of formal education; 186(93.0%) had live births; 165(82.5%) had spontaneous
vertex delivery; 192(96.0%) had spontaneous onset of labour, and 175(87.5%) had no
complication at or post partum. Of the neonates delivered, 176(88.0%) had 5 minute APGAR
score >7; 185(92.5%) weighed between 2500 and 3999 grams, and 163(81.5%) were with their
mothers after 24hours postpartum. Of the maternal demographic characteristics, only parity
showed a significant association with the number of ANC visits. High parity, ≥5 was associated
with a lower frequency of ANC visits (OR=0.29, 95% CI 0.1 -0.87, p=0.027). Mothers with preexisting medical conditions were 3.9 times as likely as those with no pre-existing medical
condition to make ≥4 visits (OR=3.9, 95% CI 0.85-24). None of the past obstetric parameters
analyzed (miscarriage, still birth, live birth, mode of delivery) showed significant association
with the number of ANC visits. Perinatal outcomes (state of neonate at birth, 5 minute APGAR
score, birth weight, state of neonate after 24 hours postpartum) were not significantly associated
with the number of ANC visits. Likewise, maternal outcomes (mode of delivery, onset of labour,
morbidity and mortality) analyzed did not show any association with the number of ANC visits.
Conclusion: In this rural Kenyan hospital, a smaller proportion of women had ≥4 ANC visits.
Parity ≥5 was significantly associated with likelihood of <4 ANC visit. Early perinatal and
maternal outcomes were comparable between mothers with <4 ANC visits and those with ≥4
visits.
Publisher
University of Nairobi