Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa
- PDF / 885,233 Bytes
- 10 Pages / 595.276 x 790.866 pts Page_size
- 104 Downloads / 219 Views
Demand-Side Causes and Covariates of Late Antenatal Care Access in Cape Town, South Africa Anja Smith1 · Ronelle Burger1 · Vivian Black2,3
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Objectives The objective of this study was to investigate the causes and covariates of late antenatal care access in South Africa. Methods A cross-sectional study was conducted, interviewing 221 women at four public-sector labour wards in Cape Town, South Africa in 2014. A definition of late attendance as attending ≥ 5 months was used. Data were analysed using univariate, bivariate and multivariate methods. Results Of the women who attended antenatal care at a public-sector clinic (n = 213, 96.4%), more than half (51.2%) attended ≥ 3 months and 20 weeks’ gestation as shown by the province’s health information system, with a late ANC care attendance rate of 45.5% for 2013/2014, the year preceding this study (Western Cape Government: Health 2015a). Within this poorly performing district, two sub-districts were selected for this cross-sectional study. Within these sub-districts, the study focused on the two main labour wards to which women are referred for delivery by their local clinics: one district hospital and one MOU based in a community health centre. Women with uncomplicated pregnancies are referred to MOUs for vaginal delivery while women with complicated pregnancies are referred to district hospitals for either vaginal deliveries or Caesarean sections.
Study Approach For the purpose of questionnaire design late ANC access was defined as a first visit to the clinic at or after 20-week’ (5-month’) gestation in accordance with the definition used by the Department of Health for attending ANC in terms of ART optimisation (Day and Gray 2016). A group of all-female enumerators interviewed women at facilities shortly after delivery. This was preferred over interviews at ANC facilities because not all pregnant women attend ANC sessions regularly. Also, respondents are likely to be less honest about negative aspects of care when interviewed at the site of care delivery. The interviews took place at the bedside of women in the post-labour ward during the work week (Monday–Friday). A structured questionnaire was used. The interviews were conducted by five enumerators in English, isiXhosa and Afrikaans, the three main languages in the Western Cape. The questionnaire was available in all three languages and women were interviewed in their language of choice. Interviews were conducted between 20 October and 20 November 2014 following pilot testing at one facility. An amended version of a questionnaire which had been fieldtested in a different context in a previous study (Solarin and Black 2013) was used.1
1
All collected data were captured in Epidata 3.1 and analysed using Stata 13.1.
Maternal and Child Health Journal Fig. 1 Antenatal care-seeking cascade for all respondents
4 (1.8%) a ended private doctor
N=221
213 (96.4%) a ended public clinic 4 (1.8%) accessed no care
n=213 182 (85.4%) bo
Data Loading...
