Article Text

Pregnancy-related healthcare utilisation in Agincourt, South Africa, 1993–2018: a longitudinal surveillance study of rural mothers
  1. Daniel E Sack1,
  2. Ryan G Wagner2,
  3. Daniel Ohene-Kwofie2,
  4. Chodziwadziwa W Kabudula2,
  5. Jessica Price2,
  6. Carren Ginsburg2,
  7. Carolyn M Audet1,2
  1. 1Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Mr Daniel E Sack; daniel.e.sack{at}vanderbilt.edu

Abstract

Introduction Pregnancy-related health services, an important mediator of global health priorities, require robust health infrastructure. We described pregnancy-related healthcare utilisation among rural South African women from 1993 to 2018, a period of social, political and economic transition.

Methods We included participants enrolled in the Agincourt Health and Socio-Demographic Surveillance System in Mpumalanga Province, South Africa, a population-based longitudinal cohort, who reported pregnancy between 1993 and 2018. We assessed age, antenatal visits, years of education, pregnancy intention, nationality, residency status, previous pregnancies, prepregnancy and postpregnancy contraceptive use, and student status over the study period and modelled predictors of antenatal care utilisation (ordinal), skilled birth attendant presence (logistic) and delivery at a health facility (logistic).

Results Between 1993 and 2018, 51 355 pregnancies occurred. Median antenatal visits, skilled birth attendant presence and healthcare facility deliveries increased over time. Delivery in 2018 vs 2004 was associated with an increased likelihood of ≥1 additional antenatal visits (adjusted OR (aOR) 10.81, 95% CI 9.99 to 11.71), skilled birth attendant presence (aOR 4.58, 95% CI 3.70 to 5.67) and delivery at a health facility (aOR 3.78, 95% CI 3.15 to 4.54). Women of Mozambican origin were less likely to deliver with a skilled birth attendant (aOR 0.42, 95% CI 0.39 to 0.45) or at a health facility (aOR 0.43, 95% CI 0.41 to 0.46) versus South Africans. Temporary migrants reported fewer antenatal visits (aOR 0.35, 95% CI 0.33 to 0.38) but were more likely to deliver with a skilled birth attendant (aOR 1.91, 95% CI 1.66 to 2.2) or at a health facility (aOR 1.4, 95% CI 1.24 to 1.58) versus permanent residents.

Conclusion Pregnancy-related healthcare utilisation and skilled birth attendant presence at delivery have increased steadily since 1993 in rural northeastern South Africa, aligning with health policy changes enacted during this time. However, mothers of Mozambican descent are still less likely to use free care, which requires further study and policy interventions.

  • maternal health
  • health systems
  • obstetrics
  • epidemiology

Data availability statement

Data are available on reasonable request, after approval of any requisite Agincourt Health and Demographic Surveillance Systems processes. All data cleaning and analysis code are available at https://github.com/dannysack/pregnancy_agincourt.

https://creativecommons.org/licenses/by/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Data availability statement

Data are available on reasonable request, after approval of any requisite Agincourt Health and Demographic Surveillance Systems processes. All data cleaning and analysis code are available at https://github.com/dannysack/pregnancy_agincourt.

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Footnotes

  • Handling editor Sanni Yaya

  • Twitter @danny_sack, @RyanGWagner, @Price_Jess

  • Contributors DES conceived, designed and led the project, including all aspects of the data analysis and manuscript writing. RGW, DO-K and CK contributed to the study design and analysis plan and made substantial contributions to the manuscript. JP and CG contributed to the analysis plan and made substantial contributions to the manuscript. CMA conceived and supervised all aspects of the project, including study design, analysis plan and manuscript writing and editing.

  • Funding This work was supported by the Fogarty International Center of the National Institutes of Health (D43 TW009337). DES was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number F30MH123219 and by NIGMS of the National Institutes of Health under Award Number T32GM007347. CMA was supported by the National Institute of Mental Health of the National Institutes of Health under Award Number R01MH113478. The MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt) acknowledges funding from The Wellcome Trust, UK (grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z) (https://wellcome.ac.uk/), the Medical Research Council, South Africa and the South African Department of Science and Innovation through the South African Population Research Infrastructure Network hosted by the South African Medical Research Council.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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