title: Social inequality and antenatal care: impact of economic welfare on pregnancy monitoring in Senegal.
abstract: OBJECTIVE
  To explore the links between antenatal care (ANC) non-attendance and economic welfare. METHOD AND SUBJECT: This was a cross-sectional, descriptive and analytical study of women aged 15 to 49 years living in Senegal in 2005. Data were from the Demography and Health Survey using a two-stage random sampling procedure. Participants were classed by quintile using an economic well-being score based on housing characteristics and ownership of sustainable goods. The quality of ANC was determined from the number of visits, the qualification of the person delivering care, and content (counseling, weight, height and blood pressure measurements). Logistic regression was used for data analysis.
  
  
  RESULTS
  A total of 6927 women were surveyed. Mean age was 28.15 years (±2.6); 20.3% were primiparous; 61.2% resided in rural areas; 70.0% had received no education. Each of the first four economic quintiles included about 20% (19.2% to 21.5%) of the participants while 16.9% were in the fifth (richest) quintile. A total of 457 women (6.6%) did not undergo any ANC visit. ANC non-attendance increased with parity, decreased with education level and was higher in rural areas than in urban areas, OR=7.2 (95% CI [5.1-10.1]). It decreased with increasing economic well-being: OR=0.6 [0.47-0.75] 2nd quintile vs. 1st, OR=0.02 [0.01-0.05] 5th quintile vs. 1st, p<0.05 overall.
  
  
  CONCLUSIONS
  Economic welfare plays a major role in determining use of ANC. The only way to solve health problems is to reduce inequalities. The solution to this problem is beyond the scope of health but concerns an overall economic program involving the entire community, including policy-makers.
authors.affiliation: Institut de santé et développement, université Cheikh Anta Diop, BP 16390, Dakar-Fann, Senegal. solaye2@yahoo.com
authors.forename: A
authors.initials: A
authors.lastname: Faye
authors.forename: M
authors.initials: M
authors.lastname: Diouf
authors.forename: K
authors.initials: K
authors.lastname: Niang
authors.forename: M M
authors.initials: MM
authors.lastname: Leye
authors.forename: S
authors.initials: S
authors.lastname: Ndiaye
authors.forename: M
authors.initials: M
authors.lastname: Ayad
authors.forename: A
authors.initials: A
authors.lastname: Tal-Dia
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D004560:Electricity; D005260:Female; D006282:Health Personnel / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006794:Household Articles; D006798:Housing; D006801:Humans; D008875:Middle Aged; D010298:Parity; D011203:Poverty / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data*; D012423:Rural Health / Q000706:statistics & numerical data; D012675:Senegal; D012923:Social Class; D014038:Toilet Facilities; D014504:Urban Health / Q000706:statistics & numerical data; D055815:Young Adult