Determinants and obstetric outcomes of high prenatal care utilization in a developing country

J. Awoleke, B. Olofinbiyi
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Abstract

Background: High prenatal care utilization could put a strain on the resources within the health system, especially in a developing economy. However, the factors responsible have not been explored in the Nigerian context. Methods: Using a prospective design, records of observed visits of antenatal attendees were employed to calculate the Kotelchuck Index, and identify determinants of high prenatal care utilization. Results: Most of the women, 514 (43.5%), had adequate prenatal visits, while 53 (4.5%) had excessive utilization. Excessive prenatal care utilization was predicted by being employed (81.1% versus 18.9%, p=0.024). Also, when compared with adequate users, women who utilized prenatal services excessively were significantly more likely to be aged between 20 years and 39 years (98.1% versus 97.5%, p=0.041), with pre-eclampsia (11.3% versus 2.1%, p<0.0001), and previous cesarean birth (18.9% versus 11.9%, p=0.047). Regarding their deliveries, excessive utilizers were significantly more likely to have cesarean births (30.2% versus 28.2%, p=0.008), and deliver before term (64.2% versus 13%, p<0.0001), compared with adequate utilizers. Mothers with pre-eclampsia (odds ratio: 4.84; 95% CI 1.92–12.23, p=0.001), and delivery before term (odds ratio: 0.09; 95% CI 0.05–0.17, p<0.0001) were found to be independently associated with excessive prenatal care utilization. Conclusions: Availability of emergency obstetric service and improved facilities for neonatal intensive care are advocated to promote safe motherhood.
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发展中国家产前护理高使用率的决定因素和产科结果
背景:高产前护理利用率可能会对卫生系统内的资源造成压力,特别是在发展中经济体。然而,没有在尼日利亚的情况下探讨造成这种情况的因素。方法:采用前瞻性设计,利用观察到的产前参与者的访问记录来计算Kotelchuck指数,并确定高产前护理利用率的决定因素。结果:514例(43.5%)孕妇产前检查充分,53例(4.5%)孕妇产前检查过度。产前护理过度利用与就业相关(81.1%比18.9%,p=0.024)。此外,与充分使用者相比,过度使用产前服务的妇女年龄在20岁至39岁之间(98.1%对97.5%,p=0.041),先兆子痫(11.3%对2.1%,p<0.0001)和既往剖宫产(18.9%对11.9%,p=0.047)的可能性明显更高。在分娩方面,与充分用药者相比,过度用药者更容易发生剖宫产(30.2%比28.2%,p=0.008)和足月前分娩(64.2%比13%,p<0.0001)。先兆子痫母亲(优势比:4.84;95% CI 1.92-12.23, p=0.001)和足月前分娩(优势比:0.09;95% CI 0.05-0.17, p<0.0001)与过度的产前护理利用独立相关。结论:提倡提供产科急诊服务和改善新生儿重症监护设施,以促进安全孕产。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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