All ETDs from UAB

Advisory Committee Chair

Pauline E Jolly

Advisory Committee Members

April P Carson

Berhanu Tameru

Cornelius A Turpin

Kui Zhang

Document Type


Date of Award


Degree Name by School

Doctor of Public Health (DrPH) School of Public Health


A prior study reported a 44.6% prevalence of adverse pregnancy outcomes in Kumasi, Ghana. This study investigated factors that may influence antenatal care (ANC) utilization and their association with adverse pregnancy outcomes; defined as low birth weight, stillbirth, preterm delivery or small for gestational age among pregnant women in Kumasi. A quantitative cross sectional study of 643 women, age 19-48 years who presented for delivery at select public hospitals and private traditional birth attendants from July through November 2011 was conducted. Information on socio-demographic characteristics and other factors associated with ANC attendance was collected using a structured questionnaire. Medical and obstetric/gynecological history was abstracted from maternal antenatal records. Chi-square test and logistic regression incorporating known potential confounders were used to assess the association between factors that influence ANC attendance and adverse pregnancy outcomes. Forty-nine percent of women identified cost as the major factor that influenced their ANC attendance. For these women, cost was associated with 2 fold increased likelihood of adverse pregnancy outcome (Adjusted OR = 2.15; 95% CI = 1.16-3.99 p = 0.0155). Parity was also associated with adverse pregnancy outcome and the strength of association stronger with increasing order of parity. Having > 5 children was associated with nearly 4 folds increased likelihood of having an adverse outcome compared to women with single deliveries (Adjusted OR = 3.77; 95% CI = 1.50-9.53 p = 0.0049). Distance was also associated with adverse birth outcome after adjusting for age, level of education and marital status (Adjusted OR = 2.24; 95% CI = 1.00-5.03; p = 0.0512). Cost of ANC attendance, distance and high parity were factors found to be associated with adverse pregnancy outcomes. Cost could be eliminated through a wider application of the Ghana National Health Insurance Scheme. Increasing awareness and educating pregnant women on the dangers of inadequate ANC attendance through antenatal health education would likely increase antenatal uptake and lower the high prevalence of adverse pregnancy outcomes experienced by women in Kumasi, Ghana.

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