Under-utilization of antenatal care services in Timor-Leste: results from Demographic and Health Survey 2009-2010.
BACKGROUND
Timor-Leste is a young country in the Asia-Pacific region with a high maternal mortality rate of 557 per 100,000 live births. As most maternal deaths can be prevented by providing quality antenatal care (ANC) and skilled assistance during childbirth, understanding the barriers to the utilization of ANC services can enhance program implementation. This study aimed to investigate the prevalence and factors associated with the under-utilization of ANC services in Timor-Leste.


METHODS
Timor-Leste Demographic and Health Survey (TDHS) 2009-2010 was a nationally representative multi-stage cross-sectional study involving 11,463 households and 9,828 childbirths. Information on last born child was recorded for 5,895 mother-child pairs. Factors influencing under-utilization of ANC were assessed using hierarchical logistic regression analysis.


RESULTS
Only 3311 (55.2, 95% confidence interval (CI) 53.1 to 57.3%) made the recommended four ANC visits, while 2584 (44.8; 95% CI 42.7 to 46.9%) of them reported attending three or less ANC services. Significant factors positively associated with the under-utilization of ANC were low wealth status (odds ratio (OR) 2.09; 95% CI 1.68 to 2.60), no maternal education (OR 1.54; 95% CI 1.30 to 1.82) or primary maternal education (OR 1.21; 95% CI 1.04 to 1.41), no paternal education (OR 1.34; 95% CI 1.13 to 1.60), and having a big problem in permission to visit health facility (OR 1.65; 95% CI 1.39 to 1.96).


CONCLUSIONS
Despite the apparently good progress made in re-establishing the healthcare infrastructure, 45 % of mothers remained in need of a focused intervention to increase their use of ANC services. Further prenatal care program should pay attention to women with low wealth status and those and their partners who are uneducated. Moreover, women should be encouraged to make decision on their own health.
Nepal Development Society, Bharatpur, Nepal. khanal.vishnu@gmail.com.
Vishnu
V
Khanal
National Hospital Guido Valadares, Ministry of Health, Dili, Timor-Leste. joniadacruz@yahoo.com.
Jonia Lourenca Nunes
JL
Brites da Cruz
Nepal Development Society, Bharatpur, Nepal. shivarajmishra@gmail.com.
Shiva Raj
SR
Mishra
School of Public Health and Community Medicine, BP Koirala Institute of Health Sciences, Dharan, Nepal. rkarkee@gmail.com.
Rajendra
R
Karkee
School of Public Health, Curtin University, Perth, Australia. Andy.Lee@curtin.edu.au.
Andy H
AH
Lee
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006306:Health Surveys / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012923:Social Class; D049648:Timor-Leste / Q000453:epidemiology; D055815:Young Adult