Attendance at antenatal clinics in inner-city Johannesburg, South Africa and its associations with birth outcomes: analysis of data from birth registers at three facilitiesReportar como inadecuado

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BMC Public Health

, Volume 17, Supplement 3, pp 29–40

First Online: 04 July 2017


BackgroundAntenatal care ANC clinics serve as key gateways to screening and treatment interventions that improve pregnancy outcomes, and are especially important for HIV-infected women. By disaggregating data on access to ANC, we aimed to identify variation in ANC attendance by level of care and across vulnerable groups in inner-city Johannesburg, and document the impact of non-attendance on birth outcomes.

MethodsThis record review of routine health service data involved manual extraction of 2 years of data from birth registers at a primary-, secondary- and tertiary-level facility within inner-city Johannesburg. Information was gathered on ANC attendance, HIV testing and status, pregnancy duration, delivery mode and birth outcomes. Women with an unknown attendance status were considered as not having attended clinic, but effects of this assumption were tested in sensitivity analyses. Multiple logistic regression was used to identify associations between ANC attendance and birth outcomes.

ResultsOf 31,179 women who delivered, 88.7% 27,651 had attended ANC 95% CI = 88.3–89.0. Attendance was only 77% at primary care 5813-7543, compared to 89% at secondary 3661-4113 and 93% at tertiary level 18,177-19,523. Adolescents had lower ANC attendance than adults 85%, 1951-2295 versus 89%, 22,039-24,771. Only 37% of women not attending ANC had an HIV test 1308-3528, compared with 93% of ANC attenders 25,756-27,651. Caesarean section rates were considerably higher in women who had attended ANC 40%, 10,866-27,344 than non-attenders 13%, 422-3360. Compared to those who had attended ANC, non-attenders were 1.6 fold more likely to have a preterm delivery 95% CI adjusted odds ratio aOR = 1.4–1.8 and 1.4 fold more likely to have a stillbirth aOR 95% CI = 1.1–1.9. Similar results were seen in analyses where missing data on ANC attendance was classified in different ways.

ConclusionInner-city Johannesburg has an almost 5% lower ANC attendance rate than national levels. Attendance is particularly concerning in the primary care clinic that serves a predominantly migrant population. Adolescents had especially low rates, perhaps owing to stigma when seeking care. Interventions to raise ANC attendance, especially among adolescents, may help improve birth outcomes and HIV testing rates, bringing the country closer to achieving maternal and child health targets and eliminating HIV in children.

KeywordsAntenatal attendance urban health Maternal health South Africa Birth outcomes PMTCT Adolescents Stillbirths AbbreviationsANCAntenatal care

ARTAntiretroviral treatment

CMJAHCharlotte Maxeke Johannesburg Academic Hospital

HCHCHillbrow Community Health Centre

LMICLow- and Middle-Income Countries

PMTCTPrevention of Mother-to-Child Transmission

SDGSustainable Development Goals

SRHSouth Rand Hospital

Electronic supplementary materialThe online version of this article doi:10.1186-s12889-017-4347-z contains supplementary material, which is available to authorized users.

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Autor: Siphamandla Gumede - Vivian Black - Nicolette Naidoo - Matthew F. Chersich


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