Socio-demographic determinants of full antenatal care services utilization among pregnant women delivering at a tertiary care hospital in Haryana

Introduction:


Introduction
In India, every year 28 million pregnancies take place of which 67,000 die due to maternal causes, one million women are left with chronic illnesses with one million neonatal deaths [1].Maternal mortality ratio in India declined to 167 per lakh live births and neonatal mortality rate to 29 per thousand live births during 2015 [2,3].
Antenatal period is a stressful period for both mother and foetus.The outcome of pregnancy is highly dependent on the antenatal care received by the pregnant woman.Hence, a good care of women during pregnancy is important to achieve a healthy mother and healthy baby at the end of pregnancy.
Antenatal care is an important determinant of maternal and perinatal mortality and is an essential component of maternal health care on which the health of mother and newborn depends [4].
Antenatal care in simple terms refers to the care that is given to an expectant mother from the confirmation of conception to the beginning of labour [5].ANC is a type of preventive care with the goal of providing regular check-ups that allows health care providers for early identification, treatment and prevention of potential health problems throughout the course of pregnancy.
Moreover, ANC visits may raise awareness about the need for care during delivery and give women and their families a familiarity with the health facilities so that in emergency they can seek help more efficiently.
Regular ANC visits provide health personnel an opportunity to manage the pregnancy.It is a period In India, full antenatal care utilization is only 21% and in Haryana it is only 19% (NFHS -4), which is far below the satisfactory level.So the current study was planned to study the socio-demograhic determinants responsible for full ANC utilization.From the labour room register.

Material & Methods
From this list, 8-10 delivered women were selected using simple random sampling technique using lottery method.
Consent: Each study participant was explained about the study and an informed written consent in vernacular language was taken from each of them before the conduct of the study.The confidentiality of the collected data was assured.

Inclusion criteria Exclusion criteria
Methodology: On the day of visit, 8-10 delivered women were selected using simple random sampling and the selected women were briefed about the nature and purpose of the study and interviewed one by one after taking their consent.
A pre-designed, pre-tested, semi-structured interview schedule, which consisted of questions regarding their socio-demographic profile, obstetric history and medical history was used for recoding their response.Results Out of total 500 participants, 3% (15) of the participants did not undergo ANC utilization even once.

Similar finding was reported by Pandey et al (2014)
[13] in their study, who reported that women with higher education were twice more likely to receive antenatal care than women with no education.
Unlike the results of present study, they also reported that age, income, type of family were strongly associated with the attendance at antenatal care service.
Jahan et al (2016) [14] in their study also stated that women with higher education status were more likely to take adequate ANC.They found that women with no education, primary and secondary education had received adequate ANC 0.03, 0.06 and 0.14 times less than women with higher Education.So women with primary education were 94 percent less likely to receive adequate ANC than highly educated women.Adhikari et al (2016) [15] in their study also found that ANC utilization was highest among those women with level of education 9th class and above (15-28%) which is also in concordance with the findings of present study.
Majority (49.9%) of present study subjects had undergone 4-7ANC check-ups followed by 38.1% who had 1-3 ANC visits.9.1% females underwent 8-12 ANC visits and only 2.9% females had more than 13 ANC visits.Almost similar results were shown by Kakati R et al (2016) [16] who found that 68.7% women had more than three antenatal visits, whereas, Uppadhaya S et al (2017) [17] in their study found that only 32.8% mothers received four or more antenatal check-ups.Majority (81.8%) of the present study subjects had received 2 doses of TT immunization followed by 10.4% females who had received booster.
So, 92.2% study subjects were protected against tetanus.2.6% females took only one TT injection, whereas, 5.2% females did not take any dose of TT.
Similar, results were quoted by Kakati R et al (2016) [16] who showed that 90% of study subjects were immunized with TT.Sharma N et al (2017) [18] [23] showed in their study that full ANC services were utilized by 93% women.

Conclusion & Recommendation
In present study it is found that there is statistically significant difference in terms of education utilization of full ANC, with increase in education level of females, ANC utilization was high.
Thus the meantime education level of women in the community is improved, efforts to encourage women to attend ANC could be targeted at less educated women and it should include formal or informal education sessions for younger women on topics like ANC and childbirth.Within the limited resources, safe motherhood strategies need to be targeted in order to increase access to antenatal and delivery care.

What the study adds to the existing knowledge
In our the and surveys have shown that the antenatal care services is far from satisfactory.It has also been found that, utilization of ANC services in Haryana is low as compared to southern states, where the utilization is high.The present study was planned to find out its socio-demographic determinant and it was found that with increase in education level of females, full ANC utilization was high.The influence of other socio-demographic determinants like age, caste, family type, socio-economic status and religion was not statistically significant.
during which a variety of services such as treatment of pregnancy induced hypertension (PIH), TT Immunization [5, 6], prophylaxis & micronutrient supplementation are provided [4, 7, 8].ANC attendance among pregnant adolescents is particularly important as complications during pregnancy and childbirth have been shown to be a major cause of death among girls aged 15-19 years in low-and middle-income countries [9].One of the major factors contributing to high rate of adverse birth outcome is slow improvement in prenatal & maternal health services [10].ANC remains one of the safe motherhood interventions which if properly implemented has the potential to significantly reduce maternal & perinatal mortality [11].The antenatal period provides opportunities for reaching pregnant women for interventions to improve maternal & neonatal health [5-9].For effective antenatal care-early registration, at least 4 antenatal check-ups, administration of 2 doses of TT injection and at least 100 tablets of iron & folic acid should be ensured.

A
Cross-Sectional hospital based observational study was carried out among pregnant women who delivered at Pt. B D Sharma PGIMS, Rohtak, Haryana in the department of Obstetrics & Gynaecology.The study was conducted over a period of one year from Apr 2017 to Apr 2018.Sample size:According to NFHS-4 data for Haryana, 45.1% mothers reported for at least 4 antenatal care visits.Hence, taking the prevalence as 45.1%, confidence interval 95 % and allowable error of 15%, sample size was calculated using the formula (Z1-a/2)2 X p X q N = ----------------------------D2 Where, Z=standard normal variate Z1-a/2 = value of two tailed alpha error; this is 1.96 at 5% P = expected prevalence in fraction Q = 1 -p D = allowable error (taken as 15%) Sample size came out to be 467.Assuming a nonresponse rate of 5%, it was planned to include 500 participants in the study and 500 subjects were interviewed.Sampling technique: As per the data available from the department of Obstetrics and Gynaecology, 30-40 deliveries per day are conducted in PGIMS, Rohtak.So, on each day of visit, a list of women who delivered on the previous day was prepared Vashisht B.M. et al: Socio-demographic determinants of full antenatal Public Health Review -International Journal of Public Health Research 2019;6(4) The details about the utilization of antenatal care services by the subjects was also enquired which included booked or unbooked ANC check-ups, period of gestation at first ANC, place and person who conducted ANC, number of ANC visits, examination & investigations etc. done if any.Information was also recorded regarding TT immunization, number of IFA tablets consumed.History of present labour was also enquired in detail which included date, time & mode of delivery.Confidentiality of the information was maintained.For socio-economic status of the subjects, revised B.G. Prasad Scale for the Year 2017 was used.Data analysis: Collected data were compiled, coded appropriately and entered in the MS EXCEL spread sheet and were cleaned for any possible Typographical error.Analysis was carried out using SPSS vs 20.0 (Statistical Package for Social Sciences) and appropriate statistical tests were applied wherever applicable.All mothers who were registered for antenatal check-up and having tracking ID and ANC card issued by health providers.Full antenatal care-considered as a proxy of quality antenatal care.It has three components which are as follows: , improving the quality of ANC offered and strengthening health systems to ensure the availability of medical supplies.

Table -
One or the other component of full ANC (minimum 4ANCs, 2 doses of TT and consumption of 100 IFA tablets) was missing.Only 39% females received full ante natal care.Vashisht B.M.