ANTENATAL CARE AND PREGNANCY/NEONATAL LOSS IN ETHIOPIA: A COMMUNITY-BASED PANEL STUDY

Abstract

Introduction: Pregnancy or neonatal losses remained a substantial health burden worldwide. Significant losses occur across high-income countries (HICs) despite advances in medical technologies and low and middle-income countries (LMICs). Antenatal care (ANC; timeliness, adequacy, and contents) is believed to have paramount importance to reduce pregnancy and/or neonatal loss. Despite its importance for child survival and wellbeing of women, ANC timeliness, adequacy, or contents is rarely studied in Ethiopia.Therefore, this study aimed to identify ANC, pregnancy or neonatal loss, and their predictors in Ethiopia. Methods: A panel study design was conducted in Ethiopia among 2855 eligible pregnant and postpartum women nested within 217 enumeration areas from October 2019 to September 2020. A multistage cluster sampling with urban-rural stratification and regions as strata was used to draw a probability sample of households and women of reproductive age. Then all eligible participants in the enumeration area were enrolled in the panel. Experienced and trained female resident enumerators conducted baseline and 6-weeks interviews by using a pretested questionnaire prepared in an open data kit that was installed on a smartphone. Descriptive results were reported in proportion with a 95% confidence interval (CI). Multilevel and Cox proportional-hazard regression models were used to identify predictors of the outcome variables. Adjusted odds ratio (AOR), incidence rate ratio (IRR), and hazard ratio (AHR) with a 95% CI were used for reporting the results. A p-value less than 0.05 was considered as a cutoff point to declare statistical significance. Results: The timeliness and adequacy of ANC visits among Ethiopian women were 27% (95% CI: 25 to 29) and 43% (95% CI: 41 to 46), respectively. Rural residence (AOR=0.55, 95% CI: 0.36 to 0.84), dwelling in Addis Ababa (AOR=2.07, 95% CI: 1.02 to 4.21), and encouragement by a partner to go to a clinic for ANC visits (AOR=1.98, 95% CI: 1.14 to 3.44) were independently associated to the timeliness of ANC visits. Similarly, rural residence (AOR=0.20, 95% CI: 0.12 to 0.35), encouragement by a partner to go to a clinic for ANC visits (AOR=2.11, 95% CI: 1.31 to 3.40) and timeliness of ANC visit (AOR=4.59, 95% CI: 2.93 to 7.21) predicted xv adequacy of ANC visits. Further, women aged 20 to 24 years (IRR=1.10, 95% CI: 1.02 to 1.19), urban residence (IRR=1.09, 95% CI: 1.01 to 1.21), and encouragement by a partner to go to a clinic for ANC visits (IRR=1.14, 95% CI: 1.05 to 1.24) predicted ANC content received. The prevalence of pregnancy loss and the neonatal mortality rate was 5.7% (95% CI: 4.44 to 6.95) and 26.84 (95% CI: 19.43 to 36.96) per 1000 live births, respectively. The odds of pregnancy loss were high among women who experienced convulsion (AOR=2.11, 95% CI: 1.31 to 3.40), premature rupture of membrane (AOR=2.11, 95% CI: 1.31 to 3.40), and those who did not attend ANC visits (AOR=3.78, 95% CI: 1.12 to 12.80). However, it was low among women who received high ANC content (AOR =0.79, 95% CI: 0.65 to 0.98). The hazard of neonatal mortality was higher among neonates born to rural residents (AHR=2.18, 95% CI: 1.05 to 4.54), advanced maternal age (AHR=2.49, 95% CI: 1.19 to 5.21), and primipara mothers (AHR=3.16, 95% CI: 1.52 to 6.60). Conclusions: Timeliness, adequacy, and ANC contents received among Ethiopian women are low. This was manifested with substantial numbers of pregnancy losses. The study highlights targeting rural residents, female education, and partner involvement in decision-making about the ANC process to improve adequacy and timeliness of ANC visits. Further, teenage, higher level of education, and partner involvement in decision-making about the ANC process predicted ANC content received.Concerted effort to improve ANC attendance accompanied by ANC content received, female education, and prevention of delivery complications are needed to reduce pregnancy loss. Targeting rural residents and primipara mothers, female education, and avoiding pregnancy at advanced maternal age contribute to the survival of neonates. Therefore, timeliness, adequacy of both frequency and content of ANC visits, partner involvement in decision-making about ANC process, reduction of pregnancy loss should be taken into account during providing health care, policy designing, and program implementations