International Multispecialty Journal of Health (IMJH) ISSN [2395-6291] [Vol-2, Issue-1, Jan.- 2016] Antenatal Care and its associates: A community based cross sectional study Dr. Mahendra Khanna,¹ Dr. Goverdhan Meena2, Dr. Paddma Khanna3, Dr. Naveen Kumawat4 and Dr. Suresh Kewalramani5 1 Senior Demonstrator, Department of PSM, SMS Medical College, Jaipur (Rajasthan) India 2Professor, Department of PSM, SMS Medical College, Jaipur (Rajasthan) India 3Professor, Senior Medical Officer, State Government of Rajasthan, India 3 First Year Resident, Department of PSM, SMS Medical College, Jaipur (Rajasthan) India 4 Assistant Professor, Department of PSM, SMS Medical College, Jaipur (Rajasthan) India Abstract— About 67,000 women in India die every year due to pregnancy related complications. So this present study was carried out on 300 mothers of field practice area of RHTC Naila, to find out status of ANC visit and its associates. In this community based cross sectional study 300 mothers were selected who had delivered within one year. It was found in this present study 86.33% of mothers had 3 or more than 3 ANC visits and only 13.67% mothers who had ANC visit for once or twice. And 94% beneficiary had received at least 100 IFA tablets mean IFA tab received by pregnant were 124±32SD. ANC service utilization by mothers was found to be associated with educational status of beneficiaries, place and mode of last delivery but not with other studied variables. ANCs adequately covered was maximum in SC i.e. 89.57% followed by OBC, ST and General caste. Mothers who had Institutional delivery had used ANC more adequately than who had delivery at home (96.95% v/s0%).Adequately covered ANC was significantly more in normal delivery than LSCS (93.12% v/s 83.33%). IFA tablet consumption by mothers was found to be associated with type of person registered their last delivery. Adequately number (>100 ) IFA tablets were consumed by significantly more proportion of mothers who were registered by ASHAs than by AWW and ANM. Key words: Mothers, Antenatal (ANC) Visits, Associating Factors, I. INTRODUCTION MMR in India during 2004-2006 was 254 per 100,000 live births with wide geographical variations, which slightly declined to 212 per 100,000 live births in 2007-2009 (SRS 2009).1 goals of MMR less than 100 per 100,000 live birth. Eight socioeconomically-backward states: Bihar, Chhattisgarh, Jharkhand, Madhya Pradesh, Orissa, Rajasthan, Uttaranchal, and Uttar Pradesh, accounted for majority of maternal deaths in India.2 The main causes of MMR are known, and more than 80% of maternal deaths could be prevented or avoided through either increasing the institutional deliveries or by improving the quality of care provided to the women.3-7 About 67,000 women in India die every year due to pregnancy related complications So this present study was carried out to find out status of ANC visit and its associates in field practice area of RHTC Naila, attached to SMS Medical College, Jaipur (Rajasthan) India II. Methods A community based cross-sectional observational study was carried out on 300 mothers who had children below one year residing in identified villages of field practice area of RHTC Naila Jaipur. Page | 6 International Multispecialty Journal of Health (IMJH) ISSN [2395-6291] [Vol-2, Issue-1, Jan.- 2016] Out of 27 villages of field practice area of RHTC Naila 10 villages was selected though simple random technique. Now from every village identified, 30 eligible mothers was identified to include in the study. For selecting mothers from each of identified village every house will be surveyed till desired number of mothers achieved from that village Data were collected from identified mothers in predesigned semi structured performa. Data thus obtained were entered in MS Excel 2007 worksheet. Significance of difference in proportions was inferred by Chi-square test and significance of difference in means was inferred by unpaired 't' tests. For significance ‘p value’ equal or less than 0.05 was considered significant. III. Results In this present study, out of these 300 mothers majority (204 i.e. 68%) of mothers had more than 3 ANC visits and 55 (18.33%) had 3 ANC visits and 30 (10%) had 2 ANC visits and 11 (3.67%) had only one ANC visit in their ANC period. So Present study indicate that the percentage of mothers who had 3 and more than 3 antenatal visits were 86.33%. There were 41 (13.67%) mothers who had ANC visit for once or twice. (Fig 1) In the present study 94% mothers had received at least 100 IFA tablets and remaining 6% had received less than 100 IFA tablet. Mean IFA tab received by pregnant were 124±32SD. (Fig 2) Figure 1 Figure 2 Number of ANC visits vise distribution of Mothers IFA tablet consumption vise distribution of Mothers It was also revealed that ANC service utilization of mothers was found to be associated with educational status of beneficiaries, place and mode of last delivery but not with other studied variables like age of beneficiaries, age at marriage of beneficiaries, caste, religion, occupation, socioeconomic status of beneficiaries. (Table 1) Page | 7 International Multispecialty Journal of Health (IMJH) ISSN [2395-6291] [Vol-2, Issue-1, Jan.- 2016] Table 1 Associating Factors with ANC Utilization by Mothers Type of Variables ANC Utilization by Mothers Test of Significance Association <3 ANC visit 3 and above ANC P Value LS (N=41) visit (N=259) Age (Mean ± SD) in Years 23.51±1.90 23.63±1.97 -0.334 No 0.716 NS Age at marriage 18.85±1.39 18.71±0.86 0.878 No (Mean ± SD) in Years 0.381 NS Caste General 10 48 OBC 6 36 2.391 SC 12 103 0.767 NS No ST 13 72 Religion Hindu 40 255 0.058 No Muslim 1 4 0.810 NS Type of Nuclear 18 116 Family Three 8 32 1.698 Generation 0.428 NS No Joint 15 111 Education Illiterate 12 34 Up to 24 162 9.80 Yes Secondary 0.007 S >Secondary 5 73 Occupation House wives 34 182 3.161 No Working 7 77 0.075 NS SES SES Class II 1 12 1.969 No SES Class III 19 143 0.792 NS SES Class IV 18 88 SES Class V 3 16 Yes 4 19 0.051 No BPL Card No 37 240 0.822 NS DHeolilvdeerry ANM 4 67 No Registration AWW 10 65 5.841 By ASHA 27 127 0.054 NS Place of Home 5 0 83.225 Yes Delivery Hospital 9 286 <0.001 S Type of Normal 19 257 1.763 Yes Delivery LSCS 4 20 0.184 S Page | 8 International Multispecialty Journal of Health (IMJH) ISSN [2395-6291] [Vol-2, Issue-1, Jan.- 2016] It was found that maximum proportion of adequately ANC covered was in SC i.e. 89.57% followed by OBC, ST and General caste. Likewise significantly more proportion of Institutional delivery had used adequate ANC services than mothers who had delivery at home (96.95% v/s0%). When mode of delivery and ANC service utilization was analyzed it was found that proportion of adequately covered ANC was significantly more in normal delivery than LSCS (93.12% v/s 83.33%).(Table 1) IV. Discussion This present study observed that 86.33% of mothers visited for ANC more than three times and only 13.67% mothers had ANC visit for once or twice. There was tremendous increase in the rate of mothers seeking antenatal care visits, which can be made out through the current observation of the studies when they are compared with observations made previously. In the annual report of maternal health programme (2013-2014) it was found that mother who had more than 3 ANC visit was only by 50.4% in DLHS-2 (2002-2004) 49.8 in DLHS-3 and 68.7 in CES (2009).8 Other studies had reported almost similar observations as that of present study. According NFHS-III (2005-2006)9 of India, mother who had at least 3 antenatal visits for their last birth was 73.8% for urban areas. Sharad D. Iyengar et al. (2009)10 in his study showed that seventy percent of women with more than four ANC visit, served by skilled attendants during child birth. Sharma et al. (2009)11 in his study found that 82% of mothers had more than three ANC visits. In this present study 94% beneficiary had received at least 100 IFA tablets and remaining 6% had received less than 100 IFA tables on further analysis mean IFA tab received by pregnant woman were 124. well comparable observations were of NFHS-3 fact sheet Rajasthan9. According to Sharad Iyenger et al. (2009),10 iron and folic acid tablets reached to 98% of women however 13% consumed tablets for 90 days or more. Observations made by other studies were well in resonance with the findings of present study. Say L et al (2007),12 in his studies showed that there is wide variation in the use of maternal health care. Methodological factors (inaccurate identification of population in need or range of potential confounders controlled for) played a part in this variation. Differences were also caused by factors relate to health care users (eg clinical availability etc) or by an interaction between such factors (eg perceived quality of care). Variation was usually framed by contextual issues relating to funding and organizing of health care or social or cultural issues. This review demonstrated variation in the use of maternal health care across population both within and between 23 developing countries. In his study he showed that factors related to place of residence and socioeconomic status account for variation in use of maternal health care. Women’s age, ethinicity, education, religion, culture clinical need for care, decision making power, costs location, quality of health care service plays important role. These factors interact in different ways to determine use of health care. He also concluded that in India, affluent rural women are unwilling to invite health workers at home. Shabana Roze Chowdhury et al. (2013),13 showed that, despite this free provision of facility based care, there was no marked increase in women’s use in institutions. The reasons are multidimensional: regional and social disparities continue to plague coverage and use of health services. Abeje G. et al. (2014)14 in his study concluded that age at first marriage, educational status of the women and gestational age at first ANC visit are independent predictors of delivery service utilization. Page | 9 International Multispecialty Journal of Health (IMJH) ISSN [2395-6291] [Vol-2, Issue-1, Jan.- 2016] Hence intensifying education for women and behavior change communication (BCC) intervention to increase early initiation and uptake of ANC service use in the first trimester and delayed marriage are recommended to promote institutional delivery service utilization. CONCLUSIONS In this present study 86.33% of mothers had 3 or more than 3 ANC visits and only 13.67% mothers who had ANC visit for once or twice. And 94% beneficiary had received at least 100 IFA tablets mean IFA tab received by pregnant were 124±32SD. ANC service utilization by mothers was found to be associated with educational status of mothers, place and mode of last delivery but not with other studied variables. ANCs adequately covered was maximum in SC i.e. 89.57% followed by OBC, ST and General caste. Mothers who had Institutional delivery had used ANC more adequately than who had delivery at home (96.95% v/s0%).Adequately covered ANC was significantly more in normal delivery than LSCS (93.12% v/s 83.33%). IFA tablet consumption by mothers was found to be associated with type of person registered their last delivery. Adequately number (>100 ) IFA tablets were consumed by significantly more proportion of beneficiary who were registered by ASHAs than by AWW and ANM. CONFLICT OF INTEREST None declared till now. REFERENCES 1. India. Ministry of Home Affairs . Special bulletin on maternal mortality rate in India 2004-06: sample registration system. New Delhi: Office of the Registrar General, Ministry of Home Affairs, Government of India; 2009 2. India. Ministry of Home Affairs . Special bulletin on maternal mortality in India 2007-09: sample registration system. New Delhi: Office of Registrar General, Ministry of Home Affairs, Government of India; 2011 3. Rifat Jan, Rafiq M.R: Iftikhar Munshi, S.M. Saleem: Assessment of free referral services under JSSK in district Ganderbal Kashmir; A cross sectional study. Journal of evolution of Med and Dental Sci/eISSN-2278-4802 PISSN 2278-4748/Vol. 14, Issue 57; Page 9919, July, 2015. 4. Meely Panda, Shasarka Shekhar Panda, Rashmi Ranjan Das, Sushree Samisha Naik, Aparajita Paida: Janani Shishu Suraksha Karyakram: This scheme enough for a sick newborn with congenital disorder. Primary health care: open access Journal 2167-1079; volume 5/Issue 1; 2015 5. Vikas Kumar, Sunil Kumar Misra, Suneel Kumar Kaushal, Subhash Chand Gupta, Khan Amir Maroof. Janani Suraksha Yojana : Its utilization and perception among mothers and health care providers in a rural area of North India. International Journal of Medicine and Public Health. 2015;5(2):165-168 6. Janmenjoy Mondal, Dipta Kanti Mukhopadhyay, Sujishnu Mukhopadhyay, Apurba Sinhababu. 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International Institute for Population Sciences . National Family Health Survey (NFHS-3) 2005-06: India. Vol. 1. Mumbai: International Institute for Population Sciences; 2007. pp. 208–14. 436-46 12. Say L, Rainer: A systemic review of inequalities in the use of maternal health care in developing countries: Examining scale of the problem and importance of context. Bull World Health Organ 85(10):812-9; Oct. 2007 13. Shabana Roze Chowdhury, KR Nayar A: Multidimensional approach to child survival needed. The Lancet Volume 381 Issue 9864 Page. 374, 2 February 2013 14. Abeje G. Azage M. Setegen T: Factors associated with institutional delivery service utilization among mothers in Bahir city administration, Amhara region, a community based cross sectional study. Rep. Health 1186/1742-4755-11-22; Mar. 2014 Page | 11