This categorisation mirrors methods employed previously in analysing multiple providers for antenatal care [ 17].
Because the Caribbean is a lower-prevalence setting where there are fewer stand-alone VCT sites, most VCT providers, including those who conduct trainings, have multiple responsibilities – providing antenatal care and treatment for sexually transmitted infections along with VCT services.
Maternal age, education, marital status, parity, antenatal care, multiple pregnancy and facility (as a random effect) were included as confounders in the multivariate models.
Of the many complex sociocultural factors that influence the timing of maternal engagement with antenatal care, multiple deprivation and poor social support remain key factors.
Lack of antenatal care, multiple gestations and undernourishment were associated with increased odds for delays while formal employment and severe neonatal jaundice were associated with deceased odds for delays.
A population-based cohort study in rural Ghana (a lower-middle-income country) found an association of antepartum stillbirth with previous stillbirth, increasing maternal age (>35 years), primiparity, multiple pregnancies and no antenatal care attendance [ 8].
Similarly, maternal occupation, lack of antenatal care, multiple gestations, preterm birth, severe neonatal jaundice and undernourishment were significantly associated with delays beyond 42 days in the bivariate analyses and all factors except preterm birth were predictive of delays after multivariable logistic regression.
Multiple gestations carry significantly higher risks for both the mother and fetuses [ 3], leading to recommendations for specialised antenatal care for multiple pregnancies.
Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks.
Antenatal care, a multiple purpose strategy, is another cost-effective option for reducing neonatal and maternal morbidity and mortality [ 8, 9].
