title: Associations of Household Wealth and Individual Literacy with Prenatal Care in Ten West African Countries.
abstract: Objective To examine associations of household wealth and individual literacy with prenatal care in West Africa. Methods Data on women with recent births in Benin, Burkina Faso, Ghana, Guinea, Liberia, Mali, Nigeria, Niger, Senegal and Sierra Leone were obtained from 2006 to 2010 Demographic and Health Surveys (n = 58,512). Separate logistic regressions estimated associations of literacy and wealth quintiles with prenatal care, controlling for age, parity, marital status, rural/urban residence, religion, multiple births, pregnancy wantedness, and the woman's involvement in decision-making at home. Any prenatal care was defined by ≥1 prenatal care visit. Adequate prenatal care was defined as at least four prenatal care visits beginning in the first trimester, at least one with a skilled provider. Results Seventy-eight percent of women had any prenatal care; 23 % had adequate care. Women who were not literate had lower odds of having any prenatal care (odds ratio, OR 0.29; 95 % confidence interval, CI 0.26-0.33) and lower odds of adequate care (OR 0.73, CI 0.68-0.78). Women in the poorest wealth quintile were substantially less likely to have any prenatal care than women in the wealthiest quintile (OR 0.24, CI 0.11-0.18), and less likely to have adequate care (OR 0.31, CI 0.27-0.35). Conclusions for Practice A substantial percentage of women in West Africa have no prenatal care. Few have adequate care. Illiteracy and poverty are important risk factors for having little or no prenatal care. Increasing education for girls, promoting culturally appropriate messages about prenatal care, and building trust in providers may increase prenatal care.
authors.affiliation: Dickson Advanced Analytics, Carolinas HealthCare System, 720 E. Morehead St., Suite 202, Charlotte, NC, 28202, USA. yhenneko.taylor@carolinashealthcare.org.|Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA. yhenneko.taylor@carolinashealthcare.org.
authors.forename: Yhenneko J
authors.initials: YJ
authors.lastname: Taylor
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
authors.forename: Sarah B
authors.initials: SB
authors.lastname: Laditka
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
authors.forename: James N
authors.initials: JN
authors.lastname: Laditka
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
authors.forename: Larissa R Brunner
authors.initials: LR
authors.lastname: Huber
authors.affiliation: Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Boulevard, Charlotte, NC, 28223, USA.
authors.forename: Elizabeth F
authors.initials: EF
authors.lastname: Racine
mesh_terms: D000293:Adolescent; D000328:Adult; D000354:Africa, Western; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006801:Humans; D000067010:Literacy; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D011203:Poverty; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Demographic and Health Surveys; Literacy; Prenatal care; Wealth; West Africa