Influence Of The Number Of ANC Visits On Pregnancy Outcomes Of Mothers Delivering At A Rural Hospital, Longisa District Hospital.

Abstract

Background: Antenatal care (ANC) is the care that a woman receives during pregnancy. ANC improves maternal and fetal outcomes. Focused antenatal care (FANC) emphasizes on quality rather than quantity of ANC visits and is the recommended approach. It is unknown if visits fewer than the recommended minimum of four in FANC can have the same effect on maternal and perinatal outcomes. This may be important in Africa given the never ending shortage of human resource and infrastructure for health. Objective: To determine the number of ANC visits and their influence on maternal and perinatal outcomes at a rural Kenyan hospital. Study design: Retrospective cohort. Study population: Women admitted in Longisa District Hospital postnatal ward after delivery at or above 28 weeks gestation and had ANC. Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya. Study procedure: Eligible women were enrolled and data was collected on parity, age, marital status, economic status, number of ANC visits, gestation age at delivery, onset of labour, mode of delivery, maternal complications and mortality, 5 minute APGAR score, birth weight and fetal death. Data analysis was carried out using the Statistical Package for Social Sciences version 17.0 (SPSS Inc, Chicago, IL, USA). Chi-square and Student’s t-test were used to test for association. Results: Of the screened postpartum women, two hundred (98.0%) were eligible. Most, 122(61.0%) of the eligible women had <4 ANC visits. Majority, 167(83.5%) of the participants were married; 101(50.5%) were para 2 to 4; 131(65.5%) were housewives; 133(66.5%) had primary level of formal education; 186(93.0%) had live births; 165(82.5%) had spontaneous vertex delivery; 192(96.0%) had spontaneous onset of labour, and 175(87.5%) had no complication at or post partum. Of the neonates delivered, 176(88.0%) had 5 minute APGAR score >7; 185(92.5%) weighed between 2500 and 3999 grams, and 163(81.5%) were with their mothers after 24hours postpartum. Of the maternal demographic characteristics, only parity showed a significant association with the number of ANC visits. High parity, ≥5 was associated with a lower frequency of ANC visits (OR=0.29, 95% CI 0.1 -0.87, p=0.027). Mothers with preexisting medical conditions were 3.9 times as likely as those with no pre-existing medical condition to make ≥4 visits (OR=3.9, 95% CI 0.85-24). None of the past obstetric parameters analyzed (miscarriage, still birth, live birth, mode of delivery) showed significant association with the number of ANC visits. Perinatal outcomes (state of neonate at birth, 5 minute APGAR score, birth weight, state of neonate after 24 hours postpartum) were not significantly associated with the number of ANC visits. Likewise, maternal outcomes (mode of delivery, onset of labour, morbidity and mortality) analyzed did not show any association with the number of ANC visits. Conclusion: In this rural Kenyan hospital, a smaller proportion of women had ≥4 ANC visits. Parity ≥5 was significantly associated with likelihood of <4 ANC visit. Early perinatal and maternal outcomes were comparable between mothers with <4 ANC visits and those with ≥4 visits.