Antenatal care visits and pregnancy outcomes at a Kenyan rural district hospital: a retrospective cohort study
Background: The goal of antenatal care (ANC) is to improve maternal and neonatal outcomes. Fewer ANC visits in focused antenatal care (FANC) model can affect maternal and perinatal outcomes in low income settings where the number ANC visits are often low.
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 who received ANC and were admitted at Longisa District Hospital postnatal ward after delivery at or above 28 weeks gestation.
Study site: Postnatal ward, Longisa District Hospital, Bomet County, Kenya.
Results: Between 1st July and 31st August 2014, 200 (83%) of the screened postpartum (n=241) women were found to be eligible. Majority (n=122, 61.0%) of the women received less than 4 ANC visits. Most women were: married (83.5%), housewives (65.5%), and had: parity of 2 to 4 (50.5%); primary education (66.5%); live births (93.0%); spontaneous vertex delivery (82.5%); spontaneous onset of labour (n=192, 96.0%) and no complication at or post-partum (n=175, 87.5%). Majority of the neonates had 5 minute APGAR score >7 (88.0%); and were with their mothers after 24 hours postpartum (81.5%). High parity (≥5) was associated with reduced frequency of ANC visits (OR=0.29, 95% CI 0.1-0.87, p=0.027). Early perinatal and maternal outcomes were not significantly associated with the number of ANC visits.
Conclusion: In this rural Kenyan hospital, few women had 4 or more ANC visits. Parity of 5 or greater was significantly associated with fewer than 4 ANC visits. Early perinatal and maternal outcomes did not vary with the number of visits. Quality rather than number of ANC visits should be evaluated as a measure of ANC.