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. 2020 Feb 10;20(1):88.
doi: 10.1186/s12884-020-2775-8.

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Marie Paul Nisingizwe  1 , Germaine Tuyisenge  2 , Celestin Hategeka  1 , Mohammad Ehsanul Karim  1   3
Affiliations

Are perceived barriers to accessing health care associated with inadequate antenatal care visits among women of reproductive age in Rwanda?

Marie Paul Nisingizwe et al. BMC Pregnancy Childbirth. .

Abstract

Background: Maternal and child mortality remain a global health concern despite different interventions that have been implemented to address this issue. Adequate antenatal care (ANC) is crucial in reducing maternal and neonatal morbidity and mortality. However, in Rwanda, there is still suboptimal utilization of ANC services. This study aims to assess the relationship between perceived barriers to accessing health care and inadequate ANC visits among women of reproductive age in Rwanda.

Methods: This study is cross-sectional using secondary data from the 2014-15 Rwanda demographic and health survey (RDHS). The study included 5876 women aged 15-49 years, and the primary outcome of the investigation was inadequate ANC visits defined as delayed first ANC visit and non-completion of at least four recommended visits during the pregnancy period. The primary exposure was perceived barriers to accessing health care, operationalized using the following 4 variables: distance to the health facility, getting money for treatment, not wanting to go alone and getting permission to go for treatment. A survey-weighted multivariable logistic regression analysis and backward elimination method based on Akaike information criterion (AIC) was used to select the final model. We conducted a number of sensitivity analyses using stratified and weighting propensity score methods and investigated the relationship between the outcome and each barrier to care separately.

Results: Of 5, 876 women included in the analysis, 53% (3132) aged 20 to 34 years, and 44% (2640) were in the lowest wealth index. Overall, 64% (2375) of women who perceived to have barriers to health care had inadequate ANC visits. In multivariable analysis, women who perceived to have barriers to health care had higher odds of having inadequate ANC visits (OR: 1.14; 95% CI: 0.99, 1.31). However, the association was borderline statistically significant. The findings from sensitivity analyses were consistent with the main analysis results.

Conclusion: The study suggests a positive association between perceived barriers to health care access and inadequate ANC visits. The findings speak to a need for interventions that focus on improving access to health care in Rwanda to increase uptake of ANC services.

Keywords: Antenatal care; Barriers to care; Demographics and health survey; Maternal health; Rwanda.

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Conflict of interest statement

MPN is supported by the University of British Columbia 4 Year Doctoral Fellowship. GT declares no competing interests. CH is supported by a Vanier Canada Graduate Scholarship and a University of British Columbia 4 Year Doctoral Fellowship. MEK holds research grants from the Natural Sciences and Engineering Research Council of Canada and BC SUPPORT Unit and is supported by the Michael Smith Foundation for Health Research Scholar award. Over the past 2 years, MEK has received consulting fees from Biogen Inc. Funding.

Figures

Fig. 1
Fig. 1
Flow chart of the analytic sample selection using women and household’s data from 2015 Rwanda Demographic and Health Survey (RDHS)
See this image and copyright information in PMC

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