Health System Predictors of Antenatal Care Compliance Among Rural Congolese Women

Health System Predictors of Antenatal Care Compliance Among Rural Congolese Women by Ngashi Ngongo MD, University of Kinshasa, 1990 MPH, University of Kinshasa, 1995 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2016 Abstract Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen’s behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < . 01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < . 05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < . 05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes.Fewer rural Congolese women complete 4 antenatal care (ANC) visits than do urban women, despite high maternal and child mortality rates. This quantitative cross-sectional survey applied Andersen’s behavioral model of service utilization to examine whether the ANC facility type, provider type, provider gender, time to ANC facility, cost, and number of services can predict ANC compliance among rural women. The study was a secondary analysis of the 2015 Maternal and Child Health (MCH) survey, which comprised 1,280 eligible women selected through stratified random sampling. The analysis included bivariate and multivariate logistic regressions. The findings showed that women seen in private facilities, AOR = 2.220, 95% CI [1.384, 3.561], p < . 01; women seen by female providers, AOR = 1.407, 95% CI [1.055, 1.877], p < . 05; and women receiving 7 to 9 ANC services, AOR = 1.680, 95% CI [1.142, 2.472], p < . 05, were more likely to complete 4 ANC visits. The cost of services and time to the ANC facility had no association with ANC compliance. Further analysis showed that private facilities provided more services (median of 6 vs. 5, p = .000) and had more women attended to by doctors (11% vs. 2%, p = .000) and female providers (72.9% vs. 58.4%, p < .001). These findings suggest that service quality and provider gender play a role in ANC compliance in rural areas. Therefore, Congolese health authorities should establish quality improvement programs and incentives to attract female providers to rural areas. This study contributes to positive social change by identifying ANC access barriers of rural populations and informing future efforts to close the urban-rural gap in MCH outcomes. Health System Predictors of Antenatal Care Compliance Among Rural Congolese Women by Ngashi Ngongo MD, University of Kinshasa, 1990 MPH, University of Kinshasa, 1995 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Public Health Walden University February 2016 Dedication All the glory and honor to the Almighty God for fulfilling my lifelong dream. I thank Him for His love, mercies, and provisions. I thank my dear wife and childhood friend, Mimika, and precious children, Joseph, Sarah, Allen, and Rebekah, for your true love, trust, support, and understanding, without which I would not have completed this thesis. I am grateful to my brothers and sisters in Christ, friends, and relatives for your spiritual support, prayers, and encouragement. To you all, I dedicate this thesis with a special feeling of gratitude. Acknowledgments I would like to express my sincere gratitude to my committee members, Dr. Patrick Tschida (chair), Dr. Earla White (member), and Dr. Daniel Okenu (University Research Reviewer) for their immense knowledge, patience, and motivation, as well as for the hard and stimulating questions that helped me refine my research to the point it has reached. I could not have wished to have a better committee. My sincere thanks also go to Dr. Mukengeshayi Kupa (Permanent Secretary) and Dr. Alain Mboko Iyetti (Director, Research and Planning) from the Congolese Ministry of Public Health for entrusting me with the data used in this study. My gratitude goes to my fellow doctoral students for the stimulating discussions and exchanges over the last 3 years, and the fun we enjoyed during group work and residencies. Finally, I thank Carey Little Brown for proofing, editing, and transforming this dissertation into a readable document.