Out-of-pocket costs and time spent attending antenatal care services: a case study of pregnant women in selected rural communities in Zinder, Niger

Césaire T Ouédraogo, Stephen A Vosti, K Ryan Wessells, Charles D Arnold, M Thierno Faye, Sonja Y Hess, Césaire T Ouédraogo, Stephen A Vosti, K Ryan Wessells, Charles D Arnold, M Thierno Faye, Sonja Y Hess

Abstract

Background: Despite an official policy of exemption from health care costs, pregnant women in Niger still face some out-of-pocket costs (OPC) in addition to time costs when they attend antenatal care (ANC) services. We aimed to: 1) assess the OPC for pregnant woman attending ANC, 2) estimate the time spent to attend ANC and the opportunity cost of that time, and 3) assess how OPC and time spent to attend ANC affected ANC attendance.

Methods: Data were obtained from a quasi-experimental descriptive study carried out in the region of Zinder, Niger, which compared pre- and post-intervention cohorts of pregnant women (n = 1736 women who reported attending ANC during their current pregnancy). An ANC attendance score was developed to describe the timing of ANC attendance in regard to the WHO recommendation of attending 4 ANC sessions. OPC and time spent were evaluated separately for associations with ANC attendance using Spearman correlations.

Results: The mean (±SD) age of pregnant women was 25.0 ± 6.4 yr, 19.0% were ≤ 19 yr and 99.7% were in their second or third trimester of gestation at the time of the interview. Among those who were > 13 weeks and > 27 weeks of gestation, 4.0 and 74.4% had attended ANC during their first and second trimesters, respectively. The median (1st quartile (Q1), 3rd quartile (Q3)) ANC score was 0 (- 1, 0), reflecting that the majority of women failed to follow the WHO recommendation. More than half of the women (72.5%) experienced OPC related to ANC. The majority of women (> 80%) reported spending ~ 3 h for an ANC visit, including travel and waiting time. Time spent to attend ANC was not associated with ANC attendance score. Women who experienced OPC, and those who received iron folic acid (IFA) or long-lasting insecticide-treated bednets during an ANC visit, were more likely to have a higher ANC attendance score compared to those who did not.

Conclusion: OPC and time spent were not identified as barriers to ANC visits, and IFA and long-lasting insecticide-treated bednets distribution could be used to motivate pregnant women to attend ANC.

Trial registration: The NiMaNu project was registered at www.clinicaltrials.gov as NCT01832688 . Registered 16 April 2013.

Keywords: Antenatal care; Niger; Opportunity cost of time; Out-of-pocket costs; Pregnancy.

Conflict of interest statement

All the authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow chart of participants included in the out-of-pocket costs and time cost analysis 1Visit 1 and 2 were one month apart, attrition was due to birth (n=584), relocation (n=107), consent withdrawal (n=59), stillbirth (n=49) and maternal death (n=4) ; By either visit 1 or 2
Fig. 2
Fig. 2
Smoothed distribution of antenatal care (ANC) visits by women’s gestational age from the first to the fifth ANC visit, assuming a normal distribution *Women were interviewed at any time of their pregnancy and had self-selected how many antenatal care (ANC) visits to attend and reported on sequential visits from earlier intervals, thus resulting in different available sample size per ANC visit

References

    1. United Nations Inter-agency Group for Child Mortality Estimation (UN IGME) Levels and trends in child mortality: Report 2018. New York: Estimates developed by the UN IGME; 2018.
    1. Countdown to 2015. A decade of tracking progress for maternal, newborn and child survival. The 2015 report. Available from: . (Accessed on 12 September 2018).
    1. Koffi AK, Maina A, Yaroh AG, Habi O, Bensaid K, Kalter HD. Social determinants of child mortality in Niger: results from the 2012 National Verbal and Social Autopsy Study. J Glob Health. 2016;6(1):010603. doi: 10.7189/jogh.06.010603.
    1. Institut National de la Statistique . Etude sur la gratuité des soins de santé au Niger. Niamey. 2015.
    1. Ousseni A. Une politique publique de santé au Niger: la mise en place d’exemptions de paiement des soins en faveur des femmes et des enfants. Niamey: LASDEL; 2011.
    1. World Health Organization . WHO antenatal care randomized trial: manual for the implementation of the new model. Geneva: World Health Organization; 2002.
    1. Institut National de la Statistique (INS) & ICF International . Enquête Démographique et de Santé et à Indicateurs Multiples du Niger 2006. Calverton, Maryland, USA. 2007.
    1. Institut National de la Statistique & ICF International . Enquête Démographique et de Santé et à Indicateurs Multiples du Niger 2012. Calverton, Maryland, USA. 2013.
    1. Diarra A. Mise en œuvre locale de l’exemption des paiements des soins au Niger: évaluation dans les districts sanitaires. Afr Contemp. 2012;243(3):77–93.
    1. Dalinjong PA, Wang AY, Homer CSE. Has the free maternal health policy eliminated out of pocket payments for maternal health services? Views of women, health providers and insurance managers in Northern Ghana. PLoS One. 2018;13(2):e0184830. doi: 10.1371/journal.pone.0184830.
    1. Rahman M, Rob U, Noor FR, Bellows B. Out-of-pocket expenses for maternity care in rural Bangladesh: a public-private comparison. Int Q Community Health Educ. 2012;33(2):143–157. doi: 10.2190/IQ.33.2.d.
    1. Leone T, James KS, Padmadas SS. The burden of maternal health care expenditure in India: multilevel analysis of national data. Matern Child Health J. 2013;17(9):1622–1630. doi: 10.1007/s10995-012-1174-9.
    1. Olivier de Sardan JP, Ridde V. L’exemption de paiment des soins au Burkina Faso, Mali et Niger: les contractions des politiques publiques. Afr Contemp. 2012;2012/3(n 243):11–32.
    1. Verhoef TI, Daley R, Vallejo-Torres L, Chitty LS, Morris S. Time and travel costs incurred by women attending antenatal tests: a costing study. Midwifery. 2016;40:148–152. doi: 10.1016/j.midw.2016.06.013.
    1. Hitimana R, Lindholm L, Krantz G, Nzayirambaho M, Pulkki-Brannstrom AM. Cost of antenatal care for the health sector and for households in Rwanda. BMC Health Serv Res. 2018;18(1):262. doi: 10.1186/s12913-018-3013-1.
    1. Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–260. doi: 10.1111/j.1365-2648.2007.04532.x.
    1. Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in Low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):65. doi: 10.1186/s12884-017-1246-3.
    1. Ali SA, Dero AA, Ali SA, Ali GB. Factors affecting the utilization of antenatal care among pregnant women: A literature review. J Preg Neonatal Med. 2(2):41–5.
    1. Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, Galea S. Women’s preferences for place of delivery in rural Tanzania: a population-based discrete choice experiment. Am J Public Health 2009;99(9):1666–1672.
    1. Kruk ME, Paczkowski MM, Tegegn A, Tessema F, Hadley C, Asefa M, et al. Women’s preferences for obstetric care in rural Ethiopia: a population-based discrete choice experiment in a region with low rates of facility delivery. J Epidemiol Community Health. 2010;64(11):984–988. doi: 10.1136/jech.2009.087973.
    1. Hess SY, Ouedraogo CT, Bamba IF, Wessells KR, Keith N, Faye T, et al. Using formative research to promote antenatal care attendance and iron folic acid supplementation in Zinder, Niger. Matern Child Nutr. 2018;14(2):e12525. doi: 10.1111/mcn.12525.
    1. Begum K, Ouedraogo CT, Wessells KR, Young RR, Faye MT, Wuehler SE, et al. Prevalence of and factors associated with antenatal care seeking and adherence to recommended iron-folic acid supplementation among pregnant women in Zinder, Niger. Matern Child Nutr. 2018;14(Suppl 1). 10.1111/mcn.12466.
    1. Wessells KR, Ouedraogo CT, Young RR, Faye MT, Brito A, Hess SY. Micronutrient status among pregnant women in Zinder, Niger and risk factors associated with deficiency. Nutrients. 2017;9(5). 10.3390/nu9050430.
    1. Ouedraogo CT, Wessells KR, Young RR, Bamba IF, Faye MT, Banda N, et al. The mixed effects of a package of multilevel interventions on the health and care of pregnant women in Zinder, Niger. BMJ Glob Health. 2019;4(6):e001200. doi: 10.1136/bmjgh-2018-001200.
    1. Ridde V, Diarra A. A process evaluation of user fees abolition for pregnant women and children under five years in two districts in Niger (West Africa) BMC Health Serv Res. 2009;9:89. doi: 10.1186/1472-6963-9-89.
    1. Institut National de la Statistique . Manuel des concepts et definitions. Niamey. 2013.
    1. United Nations . Designing household survey samples: pratical guidelines. New York. 2008.
    1. Hess SY, Ouedraogo CT. NiMaNu project. Open Science Framework. 2016.
    1. Pound Sterline Live . Historical rates for the USD/XOF currency conversion on 31 December 2015. 2015.
    1. World Vision . Moringa improves livelihoods and nutrition in Niger. 2015.
    1. Moussa S. Impact de l’élevage de la chèvre rousse de Maradi sur le statut socio-economique de la femme rurale. Master d’Economie et Politique d’Elevage. Université Cheick Anta Diop de Dakar. 2011.
    1. Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–468. doi: 10.1093/heapol/czl029.
    1. Coates J, Swindale A, Bilinsky P. Household Food Insecurity Access Scale (HFIAS) for Measurement of Household Food Access: Indicator Guide (v.3). Washington, DC. 2007.
    1. FAO and FHI 360 . Minimum Dietary Diversity for Women: a guide for the measurement. Rome. 2016.
    1. Moller AB, Petzold M, Chou D, Say L. Early antenatal care visit: a systematic analysis of regional and global levels and trends of coverage from 1990 to 2013. Lancet Glob Health. 2017;5(10):e977–ee83. doi: 10.1016/S2214-109X(17)30325-X.
    1. République du Niger . Ministère de la Santé Publique, Direction des Statistiques. Annuaire des Statistiques Sanitaires du Niger 2016. 2017.
    1. Lule GS, Tugumisirize J, Ndekha M. Quality of care and its effects on utilisation of maternity services at health centre level. East Afr Med J. 2000;77(5):250–255.
    1. République du Niger . Ministère de la Santé Publique, Direction des Statistiques. Annuaire des Statistiques Sanitaires du Niger 2013. 2014.
    1. République du Niger . Ministère de la Santé Publique, Direction des Statistiques. Annuaire des Statistiques Sanitaires du Niger 2015. 2015.
    1. Diarra A, Ousseini A. The coping strategies of front-line health workers in the context of user fee exemptions in Niger. BMC Health Serv Res. 2015;15(Suppl 3):S1. doi: 10.1186/1472-6963-15-S3-S1.
    1. Ye Y, Yoshida Y, Harun-Or-Rashid M, Sakamoto J. Factors affecting the utilization of antenatal care services among women in Kham District, Xiengkhouang province. Lao PDR. Nagoya J Med Sci. 2010;72(1–2):23–33.
    1. van Eijk AM, Bles HM, Odhiambo F, Ayisi JG, Blokland IE, Rosen DH, et al. Use of antenatal services and delivery care among women in rural western Kenya: a community based survey. Reprod Health. 2006;3:2. doi: 10.1186/1742-4755-3-2.
    1. Zafar AA, Ehiri JE, Anyanwu EC. Use of antenatal services in Kampung District, Cambodia. Sci World J. 2003;3:1081–1092. doi: 10.1100/tsw.2003.95.
    1. Mason L, Dellicour S, Ter Kuile F, Ouma P, Phillips-Howard P, Were F, et al. Barriers and facilitators to antenatal and delivery care in western Kenya: a qualitative study. BMC Pregnancy Childbirth. 2015;15:26. doi: 10.1186/s12884-015-0453-z.
    1. Ganga-Limando M, Gule WP. Potential barriers to focused antenatal care utilisation by HIV-positive pregnant women in Swaziland. South Afr Fam Pract. 2015;57(6):360–362. doi: 10.1080/20786190.2015.1085223.
    1. Kruk ME, Mbaruku G, Rockers PC, Galea S. User fee exemptions are not enough: out-of-pocket payments for ‘free’ delivery services in rural Tanzania. Trop Med Int Health. 2008;13(12):1442–1451. doi: 10.1111/j.1365-3156.2008.02173.x.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다