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Prenatal care utilization and foetal outcomes at Harare Maternity Hospital, Zimbabwe
J Galvan1, G B Woelk, K Mahomed
1Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, USA.
Objectives:
To examine the association between adverse infant outcomes and maternal under utilization of prenatal care, among women delivering at Harare Maternity Hospital.
Design:
Hospital based, cross sectional study.
Setting:
Harare Maternity Hospital, Harare, Zimbabwe.
Subjects:
A random sample of 3,864 pregnant women.
Main Outcome Measures:
Prenatal care utilization, maternal socio-demographic information, as well as birth weight and other neonatal outcome characteristics.
Results:
Of the total number of women who participated in this study 3,491 (90%) had at least one prenatal care visit. Women receiving no prenatal care, were more likely to be younger, unmarried and to have been transferred for delivery as compared with women receiving prenatal care. Women receiving no prenatal care were seven times more likely to deliver an infant weighing less than 1,500 grams, adjusted odd ratio (OR) = 7.22; 95% confidence interval (CI) 4.58 to 11.39 as compared with those who booked for care. Newborns of unbooked mothers were more likely to have a low apgar score at birth, adjusted OR = 1.71; to have been admitted to the neonatal intensive care unit, adjusted OR = 2.14, and to require intubation, adjusted OR = 3.35. A large proportion of women (31.4%) initiated prenatal care after 30 weeks gestation.
Conclusions:
There were significant differences between maternal characteristics and foetal outcomes in relation to booking status. Under utilization of prenatal care was associated with sub-optimal foetal outcomes. Improving the socio-economic status of women, their education and access to health care, and family planning methods are all strategies that should contribute to the reduction of adverse foetal outcomes.