Antenatal Care Visits, Institutional Births, and Associated Risk Factors in Afghanistan: Insights from the Multiple Indicator Cluster Survey 2022-2023.

Jahar Bhowmik, Lakma Gunarathne, Sunil Bhar, Udayan Bhowmik, Raaj Kishore Biswas
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Abstract

Introduction: Insufficient use of antenatal care (ANC) services and institutional births services can elevate the maternal mortality risk in limited resource settings. Hence, the key objective of this study was to evaluate the potential association between the frequency of ANC visits and institutional birth services in Afghanistan, while also identifying other sociodemographic factors that may exert influence. Furthermore, we explored factors associated with the attendance of women at ANC visits during their pregnancy.

Methods: We employed data from the most recent Multiple Indicator Cluster Survey conducted in Afghanistan in 2022 to 2023 with a total of 8096 women aged 15 to 49. A complex survey weight-adjusted logistic regression model was used to examine factors related to institutional births, and a multinomial logistic regression model was fitted to assess the relationships between sociodemographic factors and ANC visits, adjusting for survey weights, cluster effects, and strata.

Results: Approximately 40% of the sample (n = 3247) had undergone 4 or more ANC visits, and 74.4% (n = 6,022) had opted for institutional birth. Women's higher education was found to be associated with ANC visits. The area of residence, wealth index, education levels of women, ownership of mobile phones, number of children, and number of ANC visits were associated with institutional births. Compared with women with no or one ANC visit, those with more than 3 visits had 31% higher odds (adjusted odds ratio, 1.31; 95% CI, 1.10-1.57) of accessing institutional births.

Discussion: Our findings indicate a significant association between ANC visits and use of institutional birth care. These findings carry implications for advancing safe motherhood and childbirth by enhancing women's social status.

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阿富汗的产前护理就诊率、住院分娩率及相关风险因素:2022-2023 年多指标类集调查的启示》。
导言:在资源有限的情况下,产前检查(ANC)服务和住院分娩服务使用不足会增加孕产妇死亡风险。因此,本研究的主要目的是评估阿富汗产前检查频率与住院分娩服务之间的潜在关联,同时确定可能产生影响的其他社会人口因素。此外,我们还探讨了妇女在怀孕期间接受产前检查的相关因素:我们采用了 2022 年至 2023 年在阿富汗进行的最新多指标类集调查的数据,共调查了 8096 名 15 至 49 岁的妇女。我们采用了一个复杂的调查权重调整逻辑回归模型来研究住院分娩的相关因素,并拟合了一个多叉逻辑回归模型来评估社会人口学因素与产前保健就诊之间的关系,同时对调查权重、集群效应和分层进行了调整:约 40% 的样本(n = 3247)接受过 4 次或更多次产前检查,74.4% 的样本(n = 6022)选择了住院分娩。研究发现,妇女接受高等教育与产前检查次数有关。居住地区、财富指数、妇女教育水平、手机拥有量、子女数量和产前检查次数与住院分娩有关。与未接受过产前检查或仅接受过一次产前检查的妇女相比,接受过 3 次以上产前检查的妇女接受住院分娩的几率要高出 31%(调整后的几率比为 1.31;95% CI 为 1.10-1.57):讨论:我们的研究结果表明,产前检查次数与使用住院分娩护理之间存在重大关联。这些发现对通过提高妇女的社会地位来促进安全孕产具有重要意义。
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