The moderating role of partners' education on early antenatal care in northern Ghana

Paschal Awingura Apanga; Maxwell Tii Kumbeni; James Kotuah Sakeah; Ayokunle A Olagoke; Olufemi Ajumobi

doi:10.1186/s12884-022-04709-9

The moderating role of partners' education on early antenatal care in northern Ghana

BMC Pregnancy Childbirth. 2022 May 5;22(1):391. doi: 10.1186/s12884-022-04709-9.

Authors

Paschal Awingura Apanga¹, Maxwell Tii Kumbeni², James Kotuah Sakeah³, Ayokunle A Olagoke⁴, Olufemi Ajumobi⁵

Affiliations

¹ University of Nevada, Reno, School of Public Health, Reno, USA. awingura@yahoo.com.
² Oregon State University, College of Public Health and Human Sciences, Corvallis, USA.
³ University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada.
⁴ University of Illinois at Chicago, School of Public Health, Chicago, USA.
⁵ University of Nevada, Reno, School of Public Health, Reno, USA.

Abstract

Background: Early antenatal care (ANC) is essential for improving maternal and child health outcomes. The primary aims of this study were to 1) estimate the association between partners' education attainment and early ANC, and 2) determine whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC.

Methods: Data were obtained from a cross-sectional study conducted from April to May 2021 among 519 mothers with a live birth in the past year in the Nabdam district in the Upper East Region in northern Ghana. Generalized estimating equations were used to assess whether partners' level of education modified the relationship between mothers' education, mothers' age, planned pregnancy, employment status and early ANC. Effect modification was assessed on the additive and multiplicative scales using adjusted prevalence ratios (aPR) and corresponding 95% confidence intervals.

Results: Mothers whose partners had secondary or higher education had a 26% higher prevalence of early ANC compared to mothers whose partners had less than a secondary level of education (aPR: 1.26, 95% CI: 1.05,1.51). There was evidence of effect modification by partners' education on the relationship between planned pregnancy and early ANC on both the additive (Relative excess risk due to interaction [RERI]: 0.61, 95% CI: 0.07,0.99), and multiplicative (ratio of PRs: 1.64, 95% CI: 1.01,2.70) scales. Among mothers whose partners had less than secondary education, mothers who had teenage pregnancy (i.e., aged 18-19 years old during pregnancy) were less likely to have early ANC compared to those who did not have teenage pregnancy (aPR: 0.71, 95% CI: 0.53,0.97). Among mothers whose partners had a secondary or higher education, early ANC was more prevalent among employed mothers compared to those who were unemployed (aPR: 1.27, 95% CI: 1.02,1.57).

Conclusions: Our findings suggest that whilst mothers whose partners had a secondary or higher education were more likely to initiate early ANC, supporting such women to plan their pregnancies can further increase the coverage of early ANC.

Keywords: Ghana; early antenatal care; education; effect modification; partner.

MeSH terms

Adolescent
Adult
Child
Cross-Sectional Studies
Educational Status
Female
Ghana
Humans
Mothers*
Pregnancy
Prenatal Care*
Young Adult