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

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.