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Global Health Econ Sustain Antenatal care attendance

1. Introduction ANC visits (Afaya et al., 2020), even with good knowledge
about ANC services.
Maternal morbidity and pregnancy-related complications
are major health concerns in developing countries. Pregnant women in Ghana are expected to deliver in
According to the World Health Organization (WHO) a hospital facility supervised by a skilled birth attendant.
estimates, approximately 800 women die each day However, reports demonstrate low utilization of such
from pregnancy and childbirth complications (WHO, services. According to Ganle et al. (2019), factors
2019). Despite the availability of effective interventions influencing utilization include distance to the health facility,
at reasonable costs for the prevention and treatment making at least four antenatal visits, and registration for
of life-threatening maternal complications, many NHIS, among others. Manyeh et al. (2017) also identified
women, particularly in rural areas, continue to die due sociodemographic determinants such as age, educational
to pregnancy- and childbirth-related complications level, parity, and economic status as factors influencing
(Ngwenya, 2017). This ongoing issue is often attributed to delivery at hospital facilities. There are limited data on how
delays in seeking health care. local women in North and Central Tongu perceive safe
pregnancy and how they react to complications associated
In 2003, the Government of Ghana introduced the with pregnancy.
Ghana National Health Insurance Scheme (NHIS), and a
social intervention program aimed at providing equitable In areas of moderate-to-high transmission of malaria,
access and financial coverage for basic health-care services the WHO recommends a package of interventions for
(Okoroh et al., 2018; Wang et al., 2017). A maternal control, including the promotion and use of insecticide-
health policy implemented under the NHIS permits treated mosquito nets, the administration of intermittent
free registration for pregnant women and free access to preventive treatment in pregnancy (IPTp) with sulfadoxine-
antenatal care (ANC), delivery service, and 3 months of pyrimethamine (IPTp-SP) as part of ANC, and appropriate
post-delivery care. To register for the NHIS, a pregnant case management through prompt and effective treatment
woman must present proof of pregnancy, such as a current of malaria in pregnancy.
antenatal card, a pregnancy test result endorsed by a doctor Mafi-Adidome and Battor-Dugame are two district
or midwife, or an ultrasound scan report, all at her own capitals in the Volta region that are endemic to malaria
cost. due to their proximity to the Volta Lake. Each district
Although Ghana has seen significant improvement in capital has a health facility. Adidome Government
maternal health care under the NHIS (Dalinjong et al., Hospital (AGH) is located in Mafi-Adidome, whereas
2018; Twum et al., 2018), more effort is required to achieve Battor Catholic Hospital (BCH), a private hospital located
Sustainable Development Goal (SDG) 3.1, which aims in Battor-Dugame, is owned and managed by the Accra
for a maternal mortality ratio of less than 70 maternal Archdiocese of the Catholic Church under the office of
deaths/100,000 live births by 2030. Delay in identifying the Metropolitan Archbishop of Accra. Despite being
pregnancy-related complications has been reported NHIS accredited, patronage for ANC and delivery services
as a major cause of maternal morbidity and mortality, is generally low, particularly on non-market days when
especially in rural areas (Sageer et al., 2019; Sumankuuro transport services are not readily available. The maternal
et al., 2017). Key challenges to addressing this issue include mortality ratio in the study sites is around 98 maternal
breaking barriers to accessing critical health services, deaths/100,000 live births.
addressing inadequate financial capabilities of families Ghana benefits from the Roll Back Malaria program,
or mothers, proximity to health facilities, education, and a WHO initiative aimed at reducing malaria morbidity
other sociocultural factors. According to Apanga et al. by increasing the availability, coverage, and usage of
(2018, p. 1), “a lack of medical and laboratory equipment insecticide-treated mosquito nets. However, there is
and inadequate knowledge about the benefits of ANC are limited information on the knowledge about malaria
setbacks to the provision of effective and quality maternal among the inhabitants and the use of such preventive
care in the Upper East region of Ghana.” To improve the measures in the study areas. The aim of this study,
quality of ANC and reduce the risk of stillbirth and other therefore, was to investigate ANC attendance, knowledge
pregnancy-related complications, the WHO revised its about ANC, and knowledge about malaria and IPTp
initial recommendation of four antenatal visits to eight among pregnant women from a rural-urban community
(WHO, 2018). These new guidelines aim to ensure a accessing a private hospital (BCH) and a rural community
healthy pregnancy period and an effective transition to accessing a government hospital (AGH). The objectives of
positive labor and childbirth. Despite these initiatives, this study were (i) to evaluate knowledge of the importance
some women still fail to complete the WHO-recommended of ANC as well as knowledge of malaria and IPTp among

Volume 2 Issue 2 (2024) 2 https://doi.org/10.36922/ghes.2336