Socioeconomic and geographic variations in antenatal care coverage in Angola: further analysis of the 2015 demographic and health survey
- Authors: Shibre, Gebretsadik , Zegeye, Betregiorgis , Idriss-Wheeler, Dina , Ahinkorah, Bright Opoku , Oladimeji, Olanrewaju , Yaya, Sanni
- Date: 2023
- Subjects: Prenatal care , Mothers -- Mortality , Health surveys
- Language: English
- Type: text , article
- Identifier: http://hdl.handle.net/11260/4489 , vital:44125 , https://doi.org/10.1186/s12889-020-09320-1
- Description: In African countries, including Angola, antenatal care (ANC) coverage is suboptimal and maternal mortality is still high due to pregnancy and childbirth-related complications. There is evidence of disparities in the uptake of ANC services, however, little is known about both the socio-economic and geographic-based disparity in the use of ANC services in Angola. The aim of this study was to assess the extent of socio-economic, urban-rural and subnational inequality in ANC coverage in Angola. We analyzed data from the 2015 Angola Demographic and Health Survey (ADHS) using the World Health Organization (WHO) Health Equity Assessment Toolkit (HEAT) software. The analysis consisted of disaggregated ANC coverage rates using four equity stratifiers (economic status, education, residence, and region) and four summary measures (Difference, Population Attributable Risk, Ratio and Population Attributable Fraction). To measure statistical significance, an uncertainty interval (UI) of 95% was constructed around point estimates. The study showed both absolute and relative inequalities in coverage of ANC services in Angola. More specifically, inequality favored women who were rich (D = 54.2, 95% UI; 49.59, 58.70, PAF = 43.5, 95% UI; 40.12, 46.92), educated (PAR = 19.9, 95% UI; 18.14, 21.64, R = 2.14, 95% UI; 1.96, 2.32), living in regions such as Luanda (D = 51.7, 95% UI; 43.56, 59.85, R = 2.64, 95% UI; 2.01, 3.26) and residing in urban dwellings (PAF = 20, 95% UI; 17.70, 22.38, PAR = 12.3, 95% UI; 10.88, 13.75). The uptake of ANC services were lower among poor, uneducated, and rural residents as well as women from the Cuanza Sul region. Government policy makers must consider vulnerable subpopulations when designing needed interventions to improve ANC coverage in Angola to achieve the 2030 Sustainable Development Goal of reducing global maternal mortality ratio to 70 deaths per 100,000 live births.
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- Date Issued: 2023
Barriers to utilisation of antenatal care services in Bloemfontein, sub-district of Mangaung Metro, Free State, South Africa
- Authors: Montshiwa, Kgalalelo Christine
- Date: 2022-11
- Subjects: Prenatal care
- Language: English
- Type: Master's theses , text
- Identifier: http://hdl.handle.net/10353/26995 , vital:66212
- Description: Background: Maternal and child mortality remain a global health problem, regardless of preventative measures put in place. Antenatal care is crucial to decrease maternal and child morbidity and mortality. However, in Bloemfontein, the sub-district of Mangaung Metro in the Free State, it has been identified that women utilise this kind of service sub-optimally. The study aimed to explore and describe barriers to the utilisation of antenatal care by pregnant women in the Bloemfontein sub-district of Mangaung Metro. Methodology: This study was qualitative and used an explorative, descriptive design. Qualitative data was collected by using focus group discussions and key informants’ interviews. Three focus group discussions with twenty-five pregnant and lactating mothers, aged between 18 and 49 years, were conducted. Participants took part in one focus group discussion at each healthcare facility. Four key informant interviews were conducted with four facility managers and one professional midwife who conducted ANC at the clinic at the time of the study in the three healthcare facilities. A thematic analysis process was used to analyse the collected qualitative data under each identified barrier. The STATA version 15 was used in the analysis of the demographic characteristics of the participants. Results: Most of the participants indicated that they are aware of the importance of attending ANC appointments however, they have voiced that the delayed waiting times and staff attitudes contribute to how they feel about visiting a clinic early. Some of the participants mentioned that they have cultural barriers as they still believe that a traditional pregnant woman should not reveal her pregnancy in the early days but must rather wait until her stomach has grown significantly for her to visit the clinic. Two participants indicated that they had unplanned pregnancies and wanted to do an abortion, but their religious beliefs prevented them to choose to terminate their pregnancies. Economically, not all participants complained about their financial situation though the majority were unemployed and single. Participants from the Bloemspruit facility complained of transport as they stay far from the clinic and they are sometimes forced to walk alone which makes it difficult to attend all their booked sessions with their midwives. The results of the study revealed that there are several factors contributing to late antenatal care attendance namely provider and personal factors contributing to late antenatal care attendance in the Bloemfontein sub-district of Mangaung Metro. Personal factors that were found to be contributing to late antenatal care booking were lack of transport, especially for Bloemspruit participants, unwanted pregnancy, lack of financial support, lack of partner support, cultural and religious beliefs, and lack of knowledge. Provider factors that were found to be contributing to late booking were lack of resources like tools of the trade, long waiting times, poor infrastructure, human resources, and midwives’ attitudes. Recommendations. To deploy qualified midwives to conduct antenatal care clinics, to extend the service over the weekends as participants mentioned that they struggle to get time off from work during the week. Health promotion and community awareness campaigns on the importance of antenatal care may increase the utilisation of antenatal care services. , Thesis (MPA) -- Faculty of Health Sciences, 2023
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- Date Issued: 2022-11
Development of a strategy to promote prenatal physical activity participation among women in Buffalo City Municipality, South Africa
- Authors: Okafor, Uchenna Benedine https://orcid.org/0000-0002-0435-2041
- Date: 2022-03
- Subjects: Prenatal care , Exercise for pregnant women
- Language: English
- Type: Doctoral theses , text
- Identifier: http://hdl.handle.net/10353/22919 , vital:53218
- Description: Research has proven that prenatal physical activity practice is associated with multiple health benefits; however, most women in South Africa rarely participate in prenatal physical activity. In contrast to more developed countries, there is dearth of research focusing specifically on prenatal physical activity and exercise among South African women. Nevertheless, in order to effectively, and strategically promote such prenatal activity, such information is important to plan for an intervention strategy. The main aim of this study was to assess the level, patterns, and associated factors of prenatal physical activity; beliefs, knowledge, attitudes, perceived benefits, and sources of information women received during pregnancy; and, furthermore, to develop an effective and relevant intervention strategy to facilitate the participation in this particular activity in Buffalo City Municipality, Eastern Cape, South Africa. Methods The study was a mixed-method, cross-sectional study design with both quantitative and qualitative data collection and analyses. The sequential explanatory design was adopted to merge and mix different datasets to be collected and analysed. The quantitative data involved a convenient sample of 1082 pregnant women in 12 randomly selected primary healthcare clinics offering antenatal health services in Buffalo City, Eastern Cape. The Pregnancy Physical Activity Questionnaire was interviewer-administered to women at each antenatal health clinic on pre-specified days, in a designated room allocated to the primary researcher by the health facility manager. The descriptive statistics were frequency distribution, percentages, mean and standard deviation. Furthermore, the bivariate and multivariate analyses were performed on two categories of participants, namely inactive or active, to determine the factors affecting prenatal physical activity behaviour. Furthermore, multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels, and the associations between prenatal physical activity levels and socio-demographic, lifestyle, and obstetrics characteristics were determined using a chi-squared analyses. The significance level was set at p = 0.05. In addition, a qualitative descriptive approach was applied, using semi-structured face-to-face interviews with 15 purposively selected pregnant women, as well as 17 midwives offering antenatal health-care services to pregnant women in the 12 selected healthcare clinics. Qualitative data were analysed using a thematic content analysis. To develop the physical activity strategy for the promotion of prenatal physical activity practice, three frameworks were applied, namely the Strength, Weakness, Opportunity and Threat (SWOT), the Political, Economic Growth, Socio-Cultural, Technological, Laws and Environmental (PESTLE), and, lastly, the Build, Overcome, Explore and Minimise (BOEM) analytical frameworks. To facilitate the validation of the strategy, the findings were additionally analysed, after which, appropriate intervention strategies promoting prenatal physical activity were developed by again using the SWOT and PESTLE analytical strategic frameworks. This process involved a purposive sampling of seven experts with knowledge of and a proven academic and scholarly background in prenatal physical activity and maternal health. Next, the developed physical activity strategy was presented to various stakeholders, which included six primary healthcare managers, two midwives, and pregnant women purposively selected in each of the 12 chosen antenatal health clinics for the validation process. The stakeholders discussed, deliberated on, and provided comments and opinions of the feasibility and implementation of the developed prenatal physical activity for promotion of physical activity practices in the Eastern Cape Province. Results The findings of this particular study demonstrated low levels of prenatal physical activity among pregnant women, and, further indicated that the most preferred form of activity was light-intensity and household activities. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate–vigorous physical activity was 151.6 min (95% CI: 147.2– 156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8–67.0), and 47.6% (95% CI: 46.3–48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16–0.76), semi-urban residence (AOR = 0.8; CI: 0.55–1.03), lower educational level (AOR = 0.5; CI: 0.20–0.71), unemployment (AOR = 0.5; CI: 0.29–0.77) and nulliparity (AOR = 0.6; CI: 0.28–1.31) were negatively associated with prenatal physical activity, while prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06–3.31) compared to other trimesters. In addition, the pregnant women were aware of the safety (88.2%) and benefits of physical activity for both mother and baby (79.6%), improved labour and delivery (93.1%), promote energy (89.0%), and should be discontinued when tired (76.6%). However, they also held the contradictory belief that pregnancy is “a time to rest” (56.5%). Furthermore, the most common sources of information about prenatal physical activity were the media, television, the radio and Internet-based websites (70.2%). Most women affirmed that prenatal physical activity reduced infant weight (61.4%), lessen moodiness (90.4), decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). The majority of women indicated that prenatal physical activity improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). The results from the quantitative data revealed that the major modifiable barriers to prenatal physical activity were tiredness (73.3%), lack of advice from healthcare professionals (nurses/midwives) (64.7%), low energy (64.5%), and non-accessibility to physical activity facilities (63.0%). The results were confirmed in the qualitative data, based on the Ecological Model, in which women also mentioned tiredness, work and household responsibilities, a lack of motivation, and the lack of physical activity advice and information on the relevant recommendations and guidelines. Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). In addition, the study highlighted that midwives rarely educate and counsel pregnant women about prenatal physical activity during scheduled antenatal visits, which was attributed largely to the shortage of midwives handling many responsibilities at clinics. Nevertheless, the midwives did express a willingness to provide effective physical activity education and counselling on prenatal physical activity, if supported by relevant training and workshops. Furthermore, they further recommended the use of the Mom Connect application, which is a technological device designed by the National Department of Health, to distribute relevant information about maternal and child health. The prenatal physical activity strategies developed to address the above-mentioned and other barriers associated with prenatal physical activity include the use of scientific and technological innovations to provide basic information on prenatal physical activity to pregnant women by means of Mom Connect, and, by collaborating with the various cellphone and network companies in South Africa. Another strategy was to integrate prenatal physical activity training into the curricula of the existing higher institutions of learning that provide teaching of maternal health in the Eastern Cape Province. Additional strategies included the documentation and subsequent clarification of misconceptions about the safety concerns often associated with prenatal physical activity by making the documents accessible to all women at the clinics in the form of a small pamphlet or booklet. Lastly, stakeholders suggested that the government offer periodic prenatal physical activity campaigns, which should be presented in local community town halls and clinics and by other stakeholders to address the current lack of awareness and effectively eliminate misrepresentations and falsehoods around the safety of prenatal physical activity within geographical setting of the Eastern Cape Province. Conclusion Despite the advantages of prenatal physical activity practices, most pregnant women in South Africa do not participate in moderate-intensity physical activity. Notably, while women perceive prenatal physical activity as beneficial to both mother and baby, such theoretical knowledge is not easily translatable into practice. The predominant sources of information on prenatal physical activity are the television, the radio, and other media, which may be potentially misleading or contradictory to evidence-based physical activity practice. Furthermore, tiredness, a lack of time, work and household responsibilities, and a lack of motivation were major modifiable barriers to prenatal physical activity by the women. In addition, pregnant women rarely receive information on prenatal physical activity. Consequently, to address the needs of the pregnant women as highlighted in this study, a prenatal physical activity intervention strategy was developed and validated by key stakeholders to promote prenatal physical activity and exercise practice among women, taken in account the local context. , Thesis (PhD) -- Faculty of Health Sciences, 2022
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- Date Issued: 2022-03