Objectives
Antenatal care (ANC) is a preventative measure that improves both mother and newborn health outcomes.The objective is to describe the compliance and determining factors for non-attendance are scarce and urgently needed to improve ANC in Morocco, if necessary.
Methods
During October 2014, mothers attending an urban paediatric hospital in Rabat or a rural clinic in Benslimane with children older than 6 months were approached.Oral informed consent was provided and a questionnaire on ANC filled. ANC was defined as done if the mother attended at least once the antenatal clinic. Logistic regression was used to determine independent risk factors for non-attendance to antenatal visits.
Results
A total of 235 women were recruited, 183 (78%) from the urban hospital. 51 (22%) women referred not to have done any antenatal visit, 53% of whom pointed distance as the reason for non-attendance. Among those who did at least one visit, 98% had at least one echography done, 78% had their blood group typed, and 73% had the haemoglobin assessed. On the other hand, 33% did not have the glycaemia checked, and no serology was tested in 58% of the women who attend an antenatal clinic. Household monthly revenue was higher among women who did at least one antenatal visit (median revenue 333 euros vs. 185 euros, Wilcoxon rank-sum test p < 0.001). In the multivariate analysis, being uneducated was strongly associated with not attending any antenatal visit (OR 37, 95%CI 13-107). Living in a rural area was also an independent risk factor for non-attendance (OR 4.3, 95%CI 1.5-12.5), as was the parity (OR 1.5, 95%CI 1.1-2.1 per unity increase of parity).
Conclusions
Adverse socio-economic factors are an important barrier to antenatal care in women from Rabat and outskirts, leaving mothers and children from poorer families in higher risk of perinatal morbidity. Programmes should be implemented to detect households in risk of exclusion and to promote and facilitate their access to medical care. The effect of high parity should be further explored to determine whether it might contribute to household poverty, or whether previous contact with the health system discourages mothers from attending antenatal clinics.
