Application of the Andersen-Newman model of health care utilization to understand antenatal care use in Kersa District, Eastern Ethiopia

Abstract

Background: In Ethiopia, the uptake of antenatal care services has been low. Moreover, there is less frequent and late attendance of antenatal care among women who attend. Using the Anderson-Newman model of health care utilization, this study identified factors that either facilitate or impede antenatal care utilization in Kersa district, Eastern Ethiopia.

Method: A community-based cross-sectional study was conducted. A total of 1294 eligible women participated in the study. Data were collected using face to face interviews with a pre-tested structured questionnaire administered with a digital survey tool. Data were collected in a house to house survey of eligible women in the community. Bivariate and multivariate logistic regression analyses were used to examine the predisposing, enabling and need factors associated with antenatal care utilization.

Result: Out of the 1294 respondents, 53.6% (95% CI: 50.8%, 56.3%) attended antenatal care at least once during their last pregnancy. Only 15.3% attended four or more antenatal care visits and just 32.6% attended prior to the 12th week of gestation. Educational status, previous use of antenatal care and best friend's use of maternal care were significant predisposing factors associated with at least one antenatal care visit. Type of kebele, wealth index and husband's attitude towards antenatal care were significant enabling factors associated with at least one antenatal care consultation. Health Extension Workers providing home visits, perceived importance of ANC and awareness of pregnancy complications were significant need factor associated with at least one antenatal care consultation. Husband's attitude towards ANC, head of the household, awareness of pregnancy complications, and history of abortion were predictors of attending four or more antenatal care visits.

Conclusion: More than half of the women attended at least one antenatal care visit. A sizable proportion of women had infrequent and delayed antenatal care. Intervention efforts to improve antenatal care utilization should involve the following: improving women's educational achievement, peer education programs to mobilize and support women, programs to change husbands' attitudes, ameliorate the quality of antenatal care, increasing the Health Extension Worker's home visits program, and increasing the awareness of pregnancy complications.

Fig 1. Sources of information about ANC among reproductive women in Kersa district, Eastern Ethiopia, 2017.

Fig 2. Commonly mentioned self-reported reasons for non-attendance of ANC among reproductive-aged women in Kersa district, Eastern Ethiopia, 2017.

Fig 3. Timing of first ANC by place of residence and previous use of ANC among reproductive-aged women in Kersa district, Eastern Ethiopia, 2017.

Fig 4. Modifiable predisposing, enabling and need factors associated with ANC utilization for government intervention based on ANBM, 2017.