Effect of time and times of antenatal contact and other possible factors associated with birth outcomes in Jimma Zone, Southwest Ethiopia: Prospective follow up study

DOI: https://doi.org/10.21203/rs.3.rs-1555443/v1

Abstract

Background: Pregnancy is usually a pleased time for most women and their families. However, it can be a period of concern and anxiety for some women those who are experienced adverse birth outcomes. Antenatal care (ANC) and timing of booking for ANC are believed to be basic components of ANC services. Different studies reported different results on effects of time and times of ANC contact on birth outcomes.

Objective:  This study is aimed to examine the effect of time and times of ANC contacts on birth outcomes, Southwest Ethiopia.

Methods: A community-based prospective follow up study in pregnancy up to 42 days postpartum conducted among 987 pregnant women in Jimma Zone from July 2020 to June 2021. Data were entered into the Epi-data and analyzed using SPSS software version 20. The binary logistic regression model was used to select candidate variables for multivariable analysis. Multivariable analysis was fitted to see association between the dependent and independent factors. A statistically significant was declared at a p-value less than 0.05 and AOR with 95% CI

Results: Nine hundred and twenty-eight (94.0%) of the women were in the age group of less than 35 years with a mean and SD of 26.63, + 3.89 respectively. One hundred sixty-three (16.5%) of them made four or more ANC and early booking. The overall unfavorable birth outcome is 7.2 % (CI, 5.7%, 8.8%). Time and times of ANC contact has no effect on birth outcomes. Husband educational status (AOR: 4.835 95% CI 1.552, 15.062), family size (AOR: 7.854 95% CI 2.661,23.186) parity

 (AOR: .158 95% CI: .054, .456), mode of delivery (AOR: 2.672 95% CI: 1.089, 6.553), the service given during ANC contacts (AOR: 2.734 ,95% CI: 1.467, 5.095) and social support (AOR: 1.940 95% CI: 1.081, 3.482) were found to be associated with birth outcomes.

Conclusion and recommendations: The overall unfavorable birth outcome is significant. The time and times of ANC contacts has no statistically significant effect on birth outcomes. Educational status of the husband, family size, parity, mode of delivery, services given during ANC contact and social support were the possible factors that were statistically increases the odds of unfavorable birth outcomes. Hence, enactment of the recommended ANC services rather than focusing on time entry and times of contact is animated for birth outcomes.  Furthermore, we also recommend a more representative community-based study.

Introduction

Pregnancy is usually a pleased time for most women and their families. However, it can be a period of concern and anxiety for some women, those who are experienced adverse birth outcomes(1). Adverse birth outcome is a situation that no pregnant women would want to experience, and there are numerous indices of these adverse birth outcomes which includes: stillbirth, preterm birth, low birth weight, small for gestational age (SGA), macrosomia, neonatal death, and congenital anomaly (2, 3)

Stillbirth accounts for 2.6 million deaths annually, 98% of these stillbirth occur in low- and lower middle-income countries (LMICs)(4). For example, in southern Asia and sub- Saharan Africa, estimated stillbirth rates range from 21.3 to as high as 56.9 per 1000 births(5) and these regions have shown the slowest declines in stillbirth rates over the past 15 years(6). More recently, a stillbirth target of 12 per 1000 births in every country by 2030 is defined by Every Newborn Action Plan, a World Health Assembly resolution that articulates specific milestones for the United Nations’ Sustainable Development Goals (SDGs)(7, 8)

Preterm birth was considered as delivery occurring before 37 weeks of gestation and globally, it is the leading cause of neonatal deaths, disability and ill health later in life which is contributing to 35% of the world’s neonatal mortality(9). Preterm birth reduction is complex and involves national level commitment to improving maternal health and well-being. It can be prevented by interventions already available, the real challenge is in the successful implementation of these strategies(10)

Birth weight reflects gestational conditions and development in the fetal period. Low birth weight (LBW), defined by the World Health Organization (WHO) as birth weight less than 2,500 grams (11). It is the leading cause of neonatal death as well as the primary reason for childhood mortality and morbidity(12) and affects almost 20% of infants worldwide, mostly in LMICs (13). Also, it is an important predictor of public health and a measure of progress toward SDGs in developing countries(14)

Reducing adverse birth outcomes are essential to reduce under five mortality globally(10) and evidence showed implementation of several low cost interventions like high quality antepartum, intrapartum, and postpartum care, and timely access to emergency obstetric care could have potential for reductions in preterm birth, stillbirth and improve birth outcomes in LMICs(9, 15)

ANC and timing of booking for ANC are believed to be the basic components of ANC services; that used for early detection, managing, and prevention of pregnancy complications that ensure newborn has a good start(16).

Different studies reported different results on effects of ANC on birthweight, some studies have shown that ANC improves birthweight(17, 18) while others have shown a lack of evidence for the effectiveness of content, frequency and timing of visits in standard ANC program on maternal and child health(19)

The evidence from 18 LMICs Demographic Health Surveys (DHS) reported that having four or greater ANC consultation and time of consultation decreased odds of LBW(13)

A retrospective cohort study conducted in South Africa to see the association between time of initiation of ANC and stillbirths reported that gestational age at first ANC contact has no effect on stillbirths in isolation(20)

A systematic review and meta-analysis on adverse fetal outcomes and its associated factors in Ethiopia reported that the overall pooled prevalence of adverse fetal outcomes in Ethiopia was 26.88% and residency, lack of ANC follow up, pregnancy-induced hypertension, advanced maternal age and having current complication of pregnancy were the factors associated with adverse birth outcomes(2)

A study conducted in different part of Ethiopia reported different prevalence of adverse birth outcomes. For instance, study conducted in North Wollo; Northeast Ethiopia reported 31. 8% (21), at Gondar University Hospital, Northwest Ethiopia reported 23%(22), at Hawassa town governmental health institutions, south Ethiopia reported 18.3%(23) and ANC follow-up, previous history of adverse pregnancy outcome and complication during pregnancy, presence of cat in the house, having chronic disease/s, maternal age and knowledge of preconception care were predictors of adverse birth outcomes(2123)

WHO adopt a new ANC model that increased the numbers of ANC contacts from four to eight contacts with the aim of improving pregnancy outcomes(24). The Federal Democratic Republic of Ethiopia Ministry of Health also accepted and put this recommendation into practice and the time of ANC booking is acceptable until 16 weeks of gestation. In current health care, data has become the foundation of making critical decisions. However, there is no rarity of evidence on the effect of time and times of ANC contacts on birth outcomes. Hence, this study is aimed to examine the effect of time and times of ANC contacts on birth outcomes Southwest Ethiopia.

Methods And Materials

A community-based prospective follow up study in pregnancy up to 42 days postpartum was conducted in Jimma Zone from July 2020 to June 2021. Jimma Zone is one of the 21 Zones of Oromia Regional State, which is located at 350 kms from the capital Addis Ababa in southwest of Ethiopia.  

According to the Jimma Zonal annual report of the Zonal Health Desk, the Zone has a total population of   3.5 million, of which 50.1% are men and 49.9% are women. Most of the women 23.1% - are in reproductive age (15-49 years). The zone consists of 20 rural districts and two town administration, 42 urban and 513 rural kebeles. The provision of medical services in the zone is carried out through one tertiary hospital, three general hospitals, five primary hospital, 122 Health centers, and 556 health posts. The zone has  also 3327 all type health professionals except  those working at hospitals level  and 1136  health extension workers (1,2) 

Study population and sampling techniques  

All currently pregnant women in the randomly selected woredas of the zone after stratifying the zone based on population of the districts were source population and sampled pregnant women with gestational age ≤ 26 weeks and at least have one birth history were enrolled in the study. The minimum required sample size for this study was computed by using Epi-Info V.7.2.4.0 stat Calc by considering two sample comparisons of proportions based on the assumptions: Alpha: 0.05 (95 % CI), Power: 0.8, Ratio of unexposed to exposed group = 23.44, Probability of event in non-exposed group =25.78% and probability of event in exposed group =1.1%, a design effect of 2 was considered. Finally, 10% was added for non-responses and loss to follow up and the final sample size became 1065

A multistage-clustered sampling technique was used to identify a cohort of pregnant women enrolled in the follow up study and followed for ANC, facility delivery and PNC from which birth outcome is calculated (Figure 1)

Measurements 

The dependent variable for this study was status of Birth outcome. It was categorized into favorable, when it was free of Preterm, still birth, LBW and neonatal death with in the first 42 days otherwise categorized as unfavorable. The independent variables were: socio demographics, wealth index, birth order, previous experience birth history, experience of maternal health care utilization, time of ANC booking, times of ANC contact, service and advice given during maternal health care utilization, Place of care, social support, time and times of ANC contact.

The data collection tools were adapted from different literatures. The indicators for the wealth index were adapted from Ethiopian DHS (27). Indicators to measure maternal care practices were adapted from the WHO packages(28). Data on determinants of maternal health service utilization were collected by using structured questionnaire adapted from different literatures(29,30). All the questionnaires were prepared in English, and then translated to local languages ‘Afan Oromo’ before data collection.

Data collection process

A cohort study with adjusted follow up study of pregnant women was conducted from July 2020 to June 2021. The data were collected in three phases (Phase I, Phase II and Phase III) by using pre-tested interviewer administered structured questionnaires by trained midwives, nurses, and public health officers.

In order to prevent measurement bias, the study hypothesis was kept blind, the data collection was made following standard procedures; training was provided for data collectors on the study instrument and data collection procedure that includes the relevance of the study, objective of the study, confidentiality of the information, informed consent, and interviewing techniques. 

The data collectors were work under close supervision to ensure adherence to correct data collection procedures. There was debriefing sessions with the principal investigators, supervisors, and data collectors to solve the faced challenges as early as possible and to take corrective measures accordingly. Moreover, the data were carefully entered and cleaned before the beginning of the analysis. 

Data Management and analysis

Data were checked for completeness and consistency, the collected data were coded and entered into the Epidata V.4.6.0.2 to minimize logical errors and maintain skipping patterns and exported into SPSS version 20.0 statistical packages for cleaning, editing and analysis. Descriptive analysis was done by computing proportions and summary statistics to indicate summary of the variables. In addition, socioeconomic index, time and times of ANC contact, service and advice given during maternal health care utilization and social support were computed by composite indicator and they were computed based on the operational definitions. 

Bivariate analysis was used to see associations between the dependent and independent variables. All variables having P-value, 0.25 were considered as candidates for the final model. In multivariable logistic regression, a statistically significant association was declared a p-value less than 0.05 to determine factors associated with the birth outcomes and adjusted odds ratio with 95% CI.

Ethical approval was obtained from Institute Review Board (IRB) of Health Institute, Jimma University.   Similarly, administrative clearance was obtained from zone and selected woreda health offices. Information sheet addressing the objectives of the study, the benefits and harms were explained to the study participants. Informed consent was obtained from each respondent before actual data collection and participation in the study was totally on voluntary basis. The participant’s right to withdraw at any time during the interview was protected. To protect any complication, data collectors were trained to maintain confidentiality and provide necessary health information based on the need of the participants and arrange referral to health facilities for mothers who had problems.

Results

 A total of 987 sampled pregnant women included in the study. The detail process of enrollment in and attrition from the study (Figure 2)

Socio-demographic and economic characteristics

The pregnant women were followed for ANC contact and birth outcomes.  Of the total 987 women included in the analysis, almost all 928 (94.0%) of them were in the age group of less than 35 years with a mean and SD of 26.63, + 3.89 respectively. Larger portion, 788 (79.8%) of them were from urban residence. More than one third, 353 (35.8%) of the mothers didn’t attend formal education. Two third, 674 (68.3%) of them were housewife by occupation.  Similarly, more than two third, 673(69.2%) of their husbands were farmer by occupation. Concerning their current marital status almost all 919 (94.5%) of them were in monogamy type of marriage. One third 321 (32.5%) of them were from small family size and 680 (68.9%) of them were from poor household economic status categories (Tab 1)

Maternal health care utilization

As regards to maternal health care 102(10.3%) and 169 (17.1 %) of them had complications during the index pregnancy, and delivery respectively. Majority 778 (78.8%) of the women were multiparous, 363 (36.8%) of them had two or less than 24 months interpregnancy interval, 82 (8.3%) had previous experience of bad obstetrics history (BOH), 724 (73.4%) of them had their ANC first at health centers, 754 (76.4%) of them were made late booking for ANC and 391         (39.6%) of them had ANC or more and only    36      (3.6%) had complications during current pregnancy. As to the place of delivery 144(14.6%) of them gave their birth at home.  Two hundred eighteen (22.1%) of them had complications during current delivery, 231(23.4%) of them had incomplete services during the current ANC and less than one third reported as not having social support 291 (29.55% (Tab 2).

Time and times of ANC contact and Birth outcomes 

Regarding the time and times of ANC contact as shown in Fig. 3 the time and times of ANC contact was computed from the time of booking and the times of the women had the contact. Categorized as less than four ANC contact and late booking, and four or more ANC contact and early booking. Only, 163 (16.5%) of them made four or more ANC contact and early booking. The overall unfavorable birth outcome is 7.2 %.  Time and times of ANC contact is statistically associated with birth outcomes in bivariate analysis (p<0.25) but, not statistically significant in   multivariable logistic regression model (p<0.05 (tab 3)

Other possible factors associated with birth outcomes

On bivariate analysis from socio-demographic and economic variables: educational status of both partners, occupational status of both partners, family size, household wealth was significantly associated with birth outcomes. From obstetrics and maternal health care use factors: Parity, history of past obstetric experience, where they made the first ANC contact, time of booking for ANC, times of ANC contact, complications during current pregnancy and delivery, mode delivery, services and advice given to them during the current ANC contacts, and social support were statistically   associated with birth outcomes (p<0.25) (Table 3)

Similarly, multivariable logistic regression analysis was fitted to see determinants of the likelihood of birth outcomes and educational status of husband, family size, parity mode of delivery, services given during ANC contact   and social support were continued to be statistically significantly associated with birth outcomes. 

Educational status of husband was found to be the predictor for birth outcomes. Women whose partner had college and above education were almost five times (AOR: 4.835 95% CI 1.552, 15.062) more likely to have favorable birth outcomes compared with women whose partners with no formal education.  Being in small family size category was almost eight times (AOR: 7.854 95% CI 2.661,23.186) more likely to have favorable birth outcomes compared with women in a large family size 

Similarly, multiparous women were decrease the likelihood of unfavorable birth outcomes by 84.2% (AOR: .158 95% CI: .054, .456) compared with grand multiparity. Women those who gave birth by SVD were almost three times (AOR: 2.672 95% CI: 1.089, 6.553) more likely to have favorable birth outcomes compared with women who gave birth through CS. Women those who had recommended ANC service packages during the ANC contacts were two times (AOR: 2.734 ,95% CI: 1.467, 5.095) more likely to have favorable birth outcomes compared with women who had incomplete recommended ANC service packages.        

Those who had social support were two times (AOR: 1.940 95% CI: 1.081, 3.482) more likely to have favorable birth outcomes compared with women who had no social support (p<0.05) (Tab 3). 

Discussion

Birth outcomes was expected to remain the big challenge for low- and middle-income countries. This study was aimed to examine the effect of time and times of antenatal contacts on birth outcomes and the overall unfavorable birth outcomes is 7.2% (CI, 5.7%, 8.8%). This finding was by far lower than the findings reported in different part of the country. A systematic review and meta-analysis in Ethiopia reported that the pooled prevalence of adverse fetal outcomes was 26.88%(2), the study in Gondar University Hospital, reported 23% (22), the study in North Wollo zone; reported 31. 8% (21) ,study at Hawassa town governmental health institutions, reported 18.3%(23) and the study in Bale zone hospitals reported 21%(31)

This discrepancy may be attributed to variation in the study settings, study period and current ministry of health direction. For instance, most of the studies cited above were conducted at health facility level where most of the time the mothers use health facilities when they experienced complications that could be the reason for the increment for the proportions unfavorable birth outcomes and Amhara region, the region which hosts the largest share of child-brides that contribute for the birth outcomes (32, 33) and working definition of the studies, some of these studies were used stillbirth, preterm birth, low birth weight, small for gestational age, neonatal death, and congenital anomalies whereas only preterm, stillbirth, low birth weight and neonatal death within the first 42 days used in this study.

ANC provide chances for monitoring the feto-maternal wellbeing and allow timely intervention for feto-maternal protection(34) and time of booking and times of contact for ANC are among the basic components of ANC services; that help mothers to receive full packages of ANC services, early detection, management, and prevention of pregnancy associated complications(16)

However, this study revealed the time and times of antenatal contacts has no effect on birth outcomes. This implies that what matter is not only the time and times of ANC contact but, the quality of the service that used for identification and management of obstetric complications that could contribute for the birth outcomes as early detection and prevention of complications is at the heart of ANC’s (31, 35)

We cannot conclude that birth outcome would be prevented only by an adequate ANC, as birth outcome is associated with collective interventions and complex and multifactorial etiology like societal factors, some cultures promote some food types and some promotes nutritional taboos that may deprive them of essential nutrients, adding to nutritional deficiencies that leads to less maternal weight gain during pregnancy (Less 10 kg) that reflects poor fetal growth, parity, maternal age, a gestational ages and in cultures rest for pregnant women is not to be acknowledged were risk factors for birth outcomes(3638)

Also, systematic review about the interventions to reduce preterm birth, stillbirth, LBW and improve outcomes in MLICs reported as there was no significant difference effect on birth outcomes among the ANC users and non-users (10) and the evidence from 18 LMICs DHS reported as what matters is the quality of ANC services given during ANC visits than the frequency of ANC for preventing LBW (13)

Even though, timing of the first ANC check-up has an independent effect on the content of the care to be provided for pregnant women but ,the skill and motivation of care providers is critical to provide the WHO recommended standards of care(39)

However, this is contrast to the prospective follow-up study among pre-eclamptic patients conducted in Egypt that reported women who attended an inadequate number of visits had a 53-fold risk of a poor fetal outcome and a significantly higher risk of neonatal mortality in comparison to women who attended an adequate number of antenatal visits(40)

This study also observed other possible factors associated with on birth outcomes and educational status of the husband, family size, parity, mode of delivery, services given during ANC contact and social support were found to be the other possible predictors of birth outcomes.

This is agrees with a systematic review and meta-analysis that reported residency, lack of antenatal care follow up, previous history of adverse pregnancy outcome advanced maternal age, having current complication of pregnancy, presence of cat in the house, having chronic disease/s and knowledge of preconception care were significant predictor of adverse birth outcomes (2, 2123)

Educated husbands have opportunity to have better income, and access to health facilities. Education helps them to know about pregnancy and problems of a pregnant woman and used to acquire their emotional support toward their pregnant wives and promote pregnant women's quality of life that contributed to birth outcomes.

Family size of the women is among the predictors of birth outcomes. Women who had less family are more likely to be care of themselves, educated and stay aware of the latest pregnancy related information, access to health facilities and regular visits that help for early detection, management, and prevention of pregnancy associated complications

Also, in this study service given during the ANC contact is among the predictors of birth outcomes. Quality of the service leads for early identification and management of obstetric complications that could contribute for the birth outcomes and continuation of maternal health care (35). To maintain the quality of ANC services that improves pregnancy outcomes WHO adopt a new ANC model that recommends to increase the numbers of contact from four visits to eight contacts (24)

Generally, the finding of this study should be interpreted with the following limitations. Due to insufficient count of cases, it was not possible to examine specific adverse birth outcomes separately with time and times of ANC contacts. In addition, this study does not include adverse birth outcomes small for gestational age and congenital anomalies.

Conclusion And Recommendations

The overall unfavorable birth outcome is significant. The time and times of antenatal contacts has statistical significancy effect on birth outcomes. Educational status of the husband, family size, parity, mode of delivery, services given during ANC contact and social support were other factors that were statistically significant and increases the odds of the occurrence of unfavorable birth outcomes.

Hence, maintaining implementation of the recommended ANC services rather than only focusing on early ANC entry and frequency of ANC contact, as one of the strategies that used for the reduction of adverse birth outcomes through early identification and management of the risk factors. Furthermore, we also recommend a more representative community-based study.

Declarations

Ethics approval and consent to participate: Manuscript has adhered to the ethical standards and the ethical approval was obtained from IRB of Health Institute, Jimma University.   Informed consent was obtained from each respondent before data collection and participation in the study was totally on voluntary basis. The participant’s right to withdraw at any time during the interview was protected.

Availability of data and materials: The data are available from the corresponding author on reasonable request

Competing interests: The authors declare that they have no competing interests.

Funding: The source of fund for this study is Jimma University, Institute of health.

Authors' contributions: SB, GT, MA, Protocol development. SB, methodology, formal analysis, manuscript preparation, and all authors read, commented the method, analysis and approved the final manuscript.

Acknowledgement

We would like to express our very great appreciation to the team for their commitment and valuable contribution from the planning to the finalization of this work. Secondly, our appreciation extends to Jimma University for funding the study, KOFIH -JU -JZHO collaborative MCH for their transportation assistance, friends, and family for their backing during this work. 

List Of Abbreviations

Antenatal care [ANC ], Demographic Health Survey [EDHS], Institutional Review Board [IRB], Maternal Child health Care [MCH], Low and Middle-Income Countries [LMICs], Principal Components Analysis [PCA], Postnatal care [PNC], Skill birth attendance [SBA], Sustainable Development Goals [SDGs], Small for Gestational Age [SGA] Spontaneous vaginal delivery [SVD], World Health Organization [WHO], Weeks [Wks]

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Tables

Table 1Distribution of the study participants by their Socio-demographic and Economic characteristics July 2020 to June 2021, Jimma zone, Ethiopia

Variable 

Category

Frequency

%

Age

Less than 35

928

94.0

Equal or greater 35

59

6.0

Residence

Semi urban

199

20.2

Rural 

788

79.8

Educational status of the pregnant women 

No formal education

353

35.8

Primary (1 to 4)

201

20.4

Primary second cycle (5 to 8)

226

22.9

Secondary and above

207

21.0

Educational status of the Husband 

No formal education

267

27.4

Primary (1 to 4)

177

18.2

Primary second cycle (5 to 8)

250

25.7

Secondary

144

14.8

College and above

135

13.9

Occupation of the pregnant women

Housewife

674

68.3

Gov't employee

129

13.1

Other**

184

18.6

Occupation of the Husband

Farmer

673

69.2

Gov't employee

166

17.1

Other***

134

13.8

Type of Marriage

Monogamy

919

94.5

Polygyny

54

5.5

Family size

Small

321

32.5

Medium

509

51.6

Large

157

15.9

Wealth Index

Poor

680

68.9

Rich

307

31.1

Other*=Gurage, Yemi, Kefa, Other**= Has no regular occupation, student, self-employee, merchant Other ****=Deriver, no regular occupation, Sheki, self-employee, Other ****=Divorced , Widowed, Single

 

Table 2: Distribution of the study participants by their current maternal health care utilization and given services July 2020 to June 2021, Jimma zone, Ethiopia

Variable 

Category

Frequency

%

Complications during last pregnancy

No

885

89.7

Yes

102

10.3

Had maternal complications during past delivery

No

818

82.9

Yes

169

17.1

Parity

Multiparity 

778

78.8

Grand multiparity 

209

21.2

Birth to pregnancy interval

2 years or less

363

36.8

More than 2 years

624

63.2

Previous experience of BOH

Not had

905

91.7

Had

82

8.3

Where received ANC first 

Health Post

101

10.2

Health Center

724

73.4

Hospital

162

16.4

Time of booking for ANC

Early booking

233

23.6

Late Booking

754

76.4

Had 4 and more ANC visists 

No

596

60.4

Yes

391

39.6

Times had ANC

One times

64

6.5

Two times

263

26.6

Three

269

27.3

Four or more times

391

39.6

Complications during current pregnancy

Had 

36

3.6

Not had

951

96.4

Place of delivery

Home

144

14.6

Health facility

843

85.4

Mode of delivery(N=843)

SVD

800

94.9

Caesarean section

43

5.1

Complications during current delivery 

No

769

77.9

Yes

218

22.1

Services given during the current ANC

Complete

231

23.4

Incomplete

756

76.6

Advice given during the current pregnancy

Complete

886

89.8

Incomplete

101

10.2

social support

Not

291

29.5

Had

696

70.5

 

Table 3: Binary and multivariable logistic regression of factors associated with birth outcomes July 2020 to June 2021, Jimma zone, Ethiopia.

Variable 

Category

Odds Ratio   95% CI

Crude

Adjusted

Educational status of the pregnant women 

No formal education

1

 

 

 

 

 

Primary 

2.510

1.229

5.127

 

 

 

Primary second cycle 

2.568

1.291

5.110

 

 

 

Secondary and above

2.891

1.375

6.078

 

 

 

Educational status of the Husband 

No formal education

1

 

 

 

 

 

Primary 

2.724

1.273

5.830

3.73

1.47

9.413

Primary second cycle 

2.460

1.286

4.703

2.82

1.315

6.063

Secondary

2.481

1.116

5.514

1.978

.806

4.851

College and above

3.794

1.448

9.938

4.83

1.55

15.062

Occupation of the women

Housewife

1

 

 

 

 

 

Gov't employee

3.806

1.173

12.351

 

 

 

Other**

1.299

.681

2.478

 

 

 

Occupation of the Husband

Farmer

1

 

 

 

 

 

Gov't employee

3.533

1.261

9.899

 

 

 

Other***

.887

.461

1.707

 

 

 

Family size

Small

2.809

1.386

5.691

7.85

2.66

23.186

Medium

1.756

.979

3.152

4.00

1.58

10.172

Large

1

 

 

 

 

 

Wealth Index

Poor

1

 

 

 

 

 

Rich

1.915

1.050

3.492

 

 

 

Parity

Multiparity 

.591

.297

1.174

.158

.054

.456

Grand multiparity 

1

 

 

 

 

 

BOH

No

1

 

 

 

 

 

Yes 

2.139

.658

6.956

 

 

 

Where received ANC first 

Health Post

1

 

 

 

 

 

Health Center

2.981

1.609

5.523

 

 

 

Hospital 

2.353

1.063

5.207

 

 

 

Time of booking for ANC(Current)

Early booking

1.563

.825

2.962

 

 

 

Late booking

1

 

 

 

 

 

Had 4 and more ANC visits 

No

1

 

 

 

 

 

Yes

1.872

1.089

3.217

 

 

 

Complications during current pregnancy

Not had

2.163

.814

5.746

 

 

 

Had

1

 

 

 

 

 

Current mode delivery                                   

SVD

3.288

1.451

7.449

2.67

1.09

6.553

CS

1

 

 

 

 

 

Complications during current delivery

Not had

1.900

1.134

3.186

 

 

 

Had

1

 

 

 

 

 

Services given during the current ANC

Incomplete

1

 

 

 

 

 

Complete

2.603

1.585

4.275

2.73

1.47

5.095

Advice

Incomplete

4.181

1.009

17.317

 

 

 

Complete

1

 

 

 

 

 

Social support

Not

1

 

 

 

 

 

Had

1.724

1.051

2.826

1.940

1.081

3.482

Time and times of ANC contact

< four and Late

1

 

 

 

 

 

Four plus and early

1.604

.753

3.415