Abstract:
Inadequate access and under-utilisation of modern healthcare services have been identified as major reasons for increased maternal morbidity and mortality in developing countries. In Nigeria, maternal mortality rate at 2017 was estimated to be 821 per 100,000 live births. In 2017, only 11.07% of the women that registered for Antenatal Care (ANC) delivered at the Primary Health Centres (PHCs) in Lagos state. Health education, reminder calls and home visits have been recognised as important interventions in preventing maternal morbidity and mortality; but there is scarcity of data regarding the effectiveness of these intervention among women attending PHCs in Lagos rural communities. Hence, this study was designed to evaluate the outcome of health education, reminder calls and home visits onadherence to ANC andUtilisation of Delivery Services (UDS) in PHCs in Lagos state.
A quasi-experimental study was conducted in twelve randomly selected Comprehensive /Midwifery Service Scheme (MSS) PHCs in Lagos state. Intervention-Group (IG) PHCs were 3 from Ikorodu and 3 from Epe towns while 6 PHCs from Badagry town served as Control-Group (CG). A total of 280 pregnant women in their first trimester, 152 in the IG and 128 in the CG participated in the study lasting 28 weeks. Systematic random sampling was used for selection of respondents. Health education was given every fortnight using the module (importance of ANC and delivery services in PHCs), 58 reminder calls and 42 home visits were made to the participants in IG who did not attend regularly while CG received routine ANC. Adherence to ANC (regular ANC attendance, having received required tetanus toxoid, intermittent preventive treatment for malaria and antihelminthics) was assessed at 16th week (baseline) and 36th week, adopting Morisky Adherence Treatment Scale (MMAS-7), reliability (r) = 0.7603, with maximum score taken as 100%. Intention for UDS was assessed at baseline while actual UDS (delivery at the PHCs) was assessed after childbirth. Data were analysed using independent t-test, Chi-square test and multiple regression at α0.05.
Participants in IG and CG had mean age of 26.90±4.39 and 25.99±4.28 years, respectively. Adherence to ANC at 16th week was higher in CG compared to IG; IG = 39(26.4%), CG = 43(33.6%). At 36th week, high level of significant improvement in adherence was observed in IG compared to CG, IG =121(79.6%), CG =53(41.4%). Inter groups adherence to ANC at baseline, IG = 3.68±1.16; CG =3.98±1.26, while at post intervention, there was a significant difference in IG = 5.36±1.12; compared to CG = 4.13±1.39. At baseline, participants’ score for intention for UDS was IG = 85 (54.4%); CG = 50(39.1%) while at the end of pregnancy, actual UDS for IG = 122(82.4%), CG 73(59.0%), thereby indicating positive effect of the interventions. Age (OR = 0.48, CI = 0.14-1.70), occupation (OR = 3.68, CI = 0.38-35.46) and income (OR = 1.25, CI = 0.14 - 10.89), were not significantly associated with ANC adherence.
Health education, reminder calls and home visits improved pregnant women’s adherence to antenatal care and utilisation of delivery services.
