Use of prenatal care services in Darfur, Sudan

Prenatal care is one of the most effective ways of reducing maternal mortality and morbidity, and its underuse has been associated with adverse maternal outcomes [1], [2]. A number of socioeconomic and cultural factors can act as barriers to the use of prenatal care [3].

There is little published data regarding the use of prenatal care in Sudan—the largest country in Africa with 40 million inhabitants. However, previous reports have suggested that the high maternal and perinatal mortality rates in Darfur could be reduced by increasing women’s use of prenatal care services [2], [4].

A community-based cross sectional household survey was conducted to investigate factors associated with use of prenatal care services in Alfasher, Darfur, between January and March 2008. Structured questionnaires were used to gather data from women who had been pregnant within the last 2 years, or were more than 13 weeks pregnant, to identify the women's experiences of prenatal care and the associated factors of age, parity, and education. The questionnaire was provided by an investigator in the local language. All women gave informed consent to participate.

Statistical analysis of the data was performed using SPSS (SPSS, Chicago, IL, USA). The proportion of women who accessed prenatal care services was calculated, and logistic regression models were built using prenatal care as the dependent factor and age, parity, and education level of women and their partners as independent variables. Confidence intervals of 95% were calculated and P<0.05 was considered significant.

A total of 402 women were enrolled in the study, 59.6% of whom were pregnant. The mean age of the women was 26.5±6.4 years and the mean parity was 3.6±2.6. Of the studied population, 58.2% of women had previously accessed prenatal care services, while 41.8% had not. The most significant predictor of prenatal care use was if the couple had been educated to at least secondary school level, while age and parity did not significantly affect the use of prenatal care services (Table 1). Among the 168 women (41.8%) who had never accessed prenatal care services, the reasons given included: travel distance (53 women, 31.5%); saw no benefit (48 women, 28.6%); services were not available (14 women, 8.3%); too expensive (18 women, 10.7%); and the perception that prenatal care was harmful (3 women, 1.8%).

Table 1. Factors associated with use of prenatal care services in Darfur, Sudan

	Variable	OR	95% CI	P value
	Age, y	0.9	0.9–1.0	0.2
	Parity	1.0	0.8–1.1	0.9
	Education level
	≥secondary level: Women	4.4	1.2–16.3	0.02
	≥secondary level: Partner	3.7	1.2–11.1	0.02

Abbreviations: OR, odds ratio; CI, confidence interval.

In Ethiopia, greater prenatal care use (76.7%) has been reported and, in accordance with the present study, education level showed a significant association with its use [3]. Therefore, we suggest that the low level of prenatal care use in Darfur could be addressed by improving reproductive health education. Health education using a wide range of media should be a priority to increase awareness and use of prenatal care in this region.