Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries
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Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries Yhenneko J. Taylor1,2 • Sarah B. Laditka2 • James N. Laditka2 Larissa R. Brunner Huber2 • Elizabeth F. Racine2
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Ó Springer Science+Business Media New York 2016
Abstract Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman’s involvement in decision-making at home. Any prenatal care was defined by C1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26–0.33) and lower odds of adequate care (OR 0.73, CI 0.68–0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11–0.18), and less likely to have adequate care (OR 0.31, CI 0.27–0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are
& Yhenneko J. Taylor [email protected] 1
Dickson Advanced Analytics, Carolinas HealthCare System, 720 E. Morehead St., Suite 202, Charlotte, NC 28202, USA
2
Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC 28223, USA
important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care. Keywords Prenatal care West Africa Literacy Wealth Demographic and Health Surveys
Significance What is already known on this subject? Wealth and education are associated with prenatal care for women in subSaharan Africa. What this study adds? Using data from ten countries, we used a composite measure of prenatal care that includes visit timing and frequency, and provider skill level. Women who were not literate were substantially less likely to have adequate prenatal care. Differences by wealth and literacy were larger for having any prenatal care than for having adequate care. Low rates of first trimester prenatal care and having fewer than four prenatal care visits contribute to inadequate care for all women.
Introduction Global disparities in maternal health remain stark despit
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