Family context and individual characteristics in antenatal care utilization among adolescent childbearing mothers in urban slums in Nigeria.
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ABSTRACT: Introduction
Adolescent pregnancy contributes significantly to the high maternal mortality in Nigeria. Research evidence from developing countries consistently underscores Antenatal Care (ANC) among childbearing adolescents as important to reducing high maternal mortality. However, more than half of pregnant adolescents in Nigeria do not attend ANC. A major gap in literature is on the influence of family context in pregnant adolescent patronage of ANC services.Methods
The study utilized a cross-sectional survey with data collected among adolescent mothers in urban slums in three Nigerian states namely, Kaduna, Lagos, and Oyo. The survey used a multi-stage sampling design. The survey covered a sample of 1,015, 1,009 and 1,088 childbearing adolescents from each of Kaduna, Lagos, and Oyo states respectively. Data were analyzed at the three levels: univariate, bivariate and multivariate.Results
Overall, about 70 percent of female adolescents in our sample compared with 75 percent in the Demographic and Health Survey (DHS) had any antenatal care (ANC) visit. About 62 percent in our sample compared with 70 percent in the DHS had at least 4 ANC visits, and, about 55 percent in our sample compared with 41 percent of the DHS that had 4 ANC visits in a health facility with skilled attendant (4ANC+). Those who have both parents alive and the mother with post-primary education have higher odds of attending 4ANC+ visits. The odds of attending 4ANC+ for those who have lost both parents is almost 60% less than those whose parents are alive, and, about 40% less than those whose mothers are alive. The influence of mother's education on 4ANC+ attendance is more significant with large disparity when both parents are dead.Conclusion
The study concludes that identifying the role of parents and community in expanding access to ANC services among adolescent mothers is important in improving maternal health in developing countries.
SUBMITTER: Akinyemi AI
PROVIDER: S-EPMC8629214 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundDepression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.MethodsFocus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria. Participants from this community-based study were from the database of respondents who participated in a previous randomized control trial (RCT) conducted between 2014 and 2016 in 28 primary health care facilities in the 11 Local government areas in Ibadan. Semi-structured interview guides, framed by themes of the Behavioral Model for Vulnerable Populations, was developed to obtain views of participants on the factors that promote or hinder help-seeking and engagement (see additional files 1 & 2). FGDs were conducted, and saturation of themes was achieved after discussions with six groups. Transcripts were analyzed using content analysis.ResultsA total of 42 participants, 17 mothers (who were adolescents at the time of the RCT), and 25 care providers participated in 6 FGDs. The availability of care for perinatal depression at the primary care level was an important enabling factor in healthcare utilization for the adolescents. Perceived health benefits of treatment received for perinatal depression were strong motivation for service use. Significant stigma and negative stereotypes expressed by care providers towards adolescent pregnancy and perinatal depression were obstacles to care. However, individual patient resilience was a major enabling factor, facilitating service engagement. Providers trained in the management of perinatal depression were perceived to deliver more tolerant and supportive care that adolescent mothers valued.ConclusionsParticipants identified unsupportive and stigmatizing clinic environments towards pregnant and parenting adolescents as significant barriers to accessing available care. Interventions to reduce stigma among healthcare providers may improve services for this vulnerable population.
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Project description:BackgroundAdequate antenatal care (ANC) utilization is recognized as one of the important drivers of safe childbirth and positive birth outcomes. The usage of ANC services fluctuates with various personal, socio-economic, and cultural characteristics and in resource-poor settings, adolescent mothers are at a particularly high risk of insufficient ANC utilization.ObjectivesThis paper investigates whether the usage of ANC services and institutional delivery as well as newborn birth weight differ systematically between adolescent and adult mothers in West and Central Africa. Moreover, we explore to what extent differences in birth weight are explained by ANC usage, adolescence, and select socio-economic characteristics of the mother.MethodsWe pooled cross-sectional data from all Demographic and Health Surveys (DHS) and Multi Indicator Cluster Surveys (MICS) conducted in countries in West and Central Africa region between 1986 and 2017 to estimate measures of ANC usage and qualified delivery assistance (along with a combined measure of "adequate maternal healthcare" aggregating these two factors) and newborn birth weight by maternal age group. We estimated various regression models to analyze a) the association between adolescence and adequate prenatal and maternal health care controlling for select socio-economic maternal characteristics as well as the local environment and b) between adolescence, adequate maternal health care, and newborn birth weight outcomes, also controlling for maternal characteristics and the local environment. All regressions were linear probability models for binary outcomes and simple linear models for continuous outcomes.ResultsAdequate maternal health care provision was lowest among adolescent mothers: 23.0% among adolescents vs an average of 29.2% across all other age groups. Moreover, we found maternal education and wealth to be positively and significantly associated with receiving adequate maternal health care. Adolescent mothers had the highest risk of low infantile birth weight with 14.5% (95% confidence interval (CI) = 13.6%-15.5%), which is roughly 1.5-2 times higher than in older mothers. We found that adolescence is still strongly associated with low birth weight even when adequate maternal health care and various socio-economic factors as well as the local environment are controlled for.ConclusionsOur findings suggest that ANC supply in resource-poor settings should be particularly tailored to adolescent mothers' needs and that further research is necessary to explore what individual maternal characteristics beyond socio-economic and physical (eg, BMI) factors drive the prevalence of low birth weight. Moreover, the currently used measures of maternal care quality are heavily dependent on pure quantitative measures (number of ANC visits). New indicators incorporating measures of factual quality and scope ought to be developed and incorporated into large routine household surveys such as DHS and MICS.
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Project description:BACKGROUND:Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. OBJECTIVE:Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. METHODS:We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. RESULTS:We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). CONCLUSIONS:The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. TRIAL REGISTRATION:ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818.
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