Women’s knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana: A crosssectional study

Abstract

Introduction Improving maternal health is a global public health challenge especially in sub-Saharan Africa. The optimum utilisation of antenatal care (ANC) by pregnant women is known to improve maternal health outcomes. Maternal morbidity and mortality rates in Ghana remain unacceptably high, particularly in rural settings where skilled delivery care often times is disproportionally low. This study assessed factors associated with optimum utilisation of antenatal care in rural Ghana. Methods A cross-sectional design was applied to collect data among eligible participants between October 2018 and January 2019. A total of 322 women who gave birth and attended the postnatal clinic were recruited for the study. Consecutive sampling was employed in recruiting participants. The associations between the dependent variables (ANC service utilisation and knowledge of ANC) and independent variables (socio-demographic characteristics) were examined using ordinary least squares logistic regression at 95% confidence interval in STATA version 14.0. Results Of the 322 participants, 69.0% reported utilising at least four or more times ANC services. Determinants of women attending ANC for four or more times was significantly associated with age [OR = 4.36 (95%CI: 2.16–8.80), p<0.001], educational level [OR = 10.18 (95%CI:3.86–26.87), p<0.001], and insured with National Health Insurance Scheme [OR = 3.42 (95%CI: 1.72–6.82), p<0.001]. Not married [OR = 0.65 (0.39–1.09), p = 0.011] or divorced [OR = 0.33 (95%CI: 0.13–0.83), p = 0.019] was negatively associated with utilisation of four or more ANC services. The majority (79.0%) of the participants had a good level of knowledge regarding antenatal care. Conclusion Although the majority of women in this study had good knowledge of ANC services, a significant number of them did not complete the recommended number of ANC visits for at least four times during a normal pregnancy. Awareness and further education to reproductiveage women on the significant role adequate ANC attendance plays in advancing health and well-being require further investments, particularly among rural women in Ghana. Introduction Globally, about 303, 000 women and adolescent girls die as a result of pregnancy and childbirth- related complications [1] of which an alarming 99% of these maternal deaths occur in low-resource settings. Though globally, the number of women and girls dying due to pregnancy- related complications and childbirth decreased by nearly half (50%) from 1990 to 2013, the number of deaths within the West African region remains unacceptably high with Maternal Mortality Ratio (MMR) of 679 deaths per 100,000 live births in 2015 [2–4]. According to the 2017 Ghana Maternal Health Survey (GMHS), the MMR in Ghana is 310 per 100,000 live births, which remains unacceptably high. Data from the 2017 GMHS shows that nearly half of the women (50%) in rural settings of the Northern and Volta regions of Ghana deliver at home compared with the national average of 21% [5]. Delivering at home without the presence of a skilled birth attendant predisposes pregnant women to some lifethreatening conditions. Facility-based delivery allows pregnant women to receive emergency care by skilled health professionals when complications arise which can help save the lives of both baby and mother [5]. Optimum antenatal care utilisation can pre-empt women the need for hospital delivery, thereby reducing possible pregnancy-related morbidities and mortalities. Antenatal care (ANC) is the health care and education provided to pregnant women and adolescent girls by skilled health care professionals to ensure the best health conditions for the mother and the baby during pregnancy [1, 5]. Antenatal care utilisation is an important constituent of maternal health care, which reduces maternal and perinatal morbidity and mortality both directly through identification and management of pregnancy-related complications, and indirectly through the identification of pregnant women and girls most likely to develop complications during labour and delivery, thus ensuring early referral to an appropriate health facility for further care [1]. Globally, while most women now attend at least one ANC visit (86%), only 62% attend four, with lower rates reported in sub-Saharan Africa and South Asia [6]. An analytical review of the recent WHO Global Health Observatory data repository shows that ANC coverage, between 2000 and 2017, was indirectly correlated with MMR worldwide [7, 8]. The evidence indicates that countries with poor ANC coverage are more likely to have high MMR [9–11]. For example, ANC utilisation in Australia is 94% with MMR of 6 per 100, 000, Finland has 99% ANC utilisation with MMR 3 per 100, 000 and France has 99% ANC utilisation with MMR 8 per 100000 live births. In comparison with sub-Saharan Africa, Nigeria PLOS ONE Women’s knowledge and its associated factors regarding optimum utilisation of antenatal care in rural Ghana.