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Abstract：
BACKGROUND: Nigeria has unimpressive maternal and child health indicators. Compliance with the WHO guidelines on the minimum number of antenatal care (ANC) contacts could improve these indicators. We assessed the compliance with WHO recommended standards on ANC contacts in Nigeria and identify the associated factors.
METHODS: Nationally representative cross-sectional data during pregnancy of 21,785 most recent births within five years preceding the 2018 Nigeria Demographic Health Survey was used. The number of ANC contacts was categorised into \"None\", \"1-3\", \"4-7\" and \"8 or more\" contacts based on subsequent WHO guidelines. Descriptive statistics, bivariable and multivariable multinomial logistic regression was used at p = 0.05.
RESULTS: About 25 % of the women had no ANC contact, 58 % had at least 4 contacts while only 20 % had 8 or more ANC contacts. The highest rate of 8 or more ANC contacts was in Osun (80.2 %), Lagos (76.8 %), and Imo (72.0 %) while the lowest rates were in Kebbi (0.2 %), Zamfara (1.1 %) and Yobe (1.3 %). Respondents with higher education were twelve times (adjusted relative risk (aRR): 12.46, 95 % CI: 7.33-21.2), having secondary education was thrice (aRR: 2.91, 95 % CI: 2.35-3.60), and having primary education was twice (aRR: 2.17, 95 % CI: 1.77-2.66) more likely to make at least 8 contacts than those with no education. Respondents from households in the richest and middle wealth categories were 129 and 67 % more likely to make 8 or more ANC contacts compared to those from households in the lowest wealth category respectively. The likelihood of making 8 ANC contacts was 89 and 47 % higher among respondents from communities in the least and middle disadvantaged groups, respectively, compared to the most disadvantaged group. Other significant variables were spouse education, health care decision making, media access, ethnicity, religion, and other community factors.
CONCLUSIONS: Compliance with WHO guidelines on the minimum number of ANC contacts in Nigeria is poor. Thus, Nigeria has a long walk to attaining sustainable development goal\'s targets on child and maternal health. We recommend that the maternal and child health programmers should review existing policies and develop new policies to adopt, implement and tackle the challenges of adherence to the WHO recommended minimum of 8 ANC contacts. Women\'s education, socioeconomic status and adequate mobilization of families should be prioritized. There is a need for urgent intervention to narrow the identified inequalities and substantial disparities in the characteristics of pregnant women across the regions and states.
METHODS: Nationally representative cross-sectional data during pregnancy of 21,785 most recent births within five years preceding the 2018 Nigeria Demographic Health Survey was used. The number of ANC contacts was categorised into \"None\", \"1-3\", \"4-7\" and \"8 or more\" contacts based on subsequent WHO guidelines. Descriptive statistics, bivariable and multivariable multinomial logistic regression was used at p = 0.05.
RESULTS: About 25 % of the women had no ANC contact, 58 % had at least 4 contacts while only 20 % had 8 or more ANC contacts. The highest rate of 8 or more ANC contacts was in Osun (80.2 %), Lagos (76.8 %), and Imo (72.0 %) while the lowest rates were in Kebbi (0.2 %), Zamfara (1.1 %) and Yobe (1.3 %). Respondents with higher education were twelve times (adjusted relative risk (aRR): 12.46, 95 % CI: 7.33-21.2), having secondary education was thrice (aRR: 2.91, 95 % CI: 2.35-3.60), and having primary education was twice (aRR: 2.17, 95 % CI: 1.77-2.66) more likely to make at least 8 contacts than those with no education. Respondents from households in the richest and middle wealth categories were 129 and 67 % more likely to make 8 or more ANC contacts compared to those from households in the lowest wealth category respectively. The likelihood of making 8 ANC contacts was 89 and 47 % higher among respondents from communities in the least and middle disadvantaged groups, respectively, compared to the most disadvantaged group. Other significant variables were spouse education, health care decision making, media access, ethnicity, religion, and other community factors.
CONCLUSIONS: Compliance with WHO guidelines on the minimum number of ANC contacts in Nigeria is poor. Thus, Nigeria has a long walk to attaining sustainable development goal\'s targets on child and maternal health. We recommend that the maternal and child health programmers should review existing policies and develop new policies to adopt, implement and tackle the challenges of adherence to the WHO recommended minimum of 8 ANC contacts. Women\'s education, socioeconomic status and adequate mobilization of families should be prioritized. There is a need for urgent intervention to narrow the identified inequalities and substantial disparities in the characteristics of pregnant women across the regions and states.
摘要：
背景：尼日利亚的母婴健康指标并不令人印象深刻。遵守世卫组织关于产前护理（ANC）接触者最低数量的指南可以改善这些指标。我们评估了尼日利亚ANC接触者对世卫组织推荐标准的遵守情况，并确定了相关因素。
方法：使用了2018年尼日利亚人口健康调查前五年内21,785例怀孕期间具有全国代表性的横断面数据。ANC联系人的数量被分类为“无”，\"1-3\",根据世卫组织后续指南，“4-7”和“8个或更多”联系人。描述性统计，使用双变量和多变量多项逻辑回归，p=0.05。
结果：约25%的女性没有ANC接触，58％的人至少有4个触点，而只有20％的人有8个或更多的ANC触点。8个或更多ANC触点的最高比率是Osun（80.2％），拉各斯（76.8%），和Imo(72.0%)，而最低的比率是Kebbi(0.2%)，赞法拉（1.1%）和约贝（1.3%）。受过高等教育的受访者为12倍（调整后相对风险（aRR）：12.46，95％CI：7.33-21.2），受过中等教育的人是三次(RR：2.91，95%CI：2.35-3.60)，与没有受过初等教育的人相比，接受初等教育的人至少有8次接触的可能性增加了两倍（aRR：2.17，95％CI：1.77-2.66）。与最低财富类别的家庭相比，来自最富有和中等财富类别的家庭的受访者分别有129％和67％的可能性与8个或更多的ANC联系。在来自最低和中等弱势群体社区的受访者中，进行8次ANC接触的可能性分别高出89％和47％，分别,与最弱势群体相比。其他重要变量是配偶教育，医疗保健决策，媒体访问,种族,宗教,和其他社区因素。
结论：世卫组织关于尼日利亚ANC接触人数最少的指南的遵守情况较差。因此，尼日利亚在实现儿童和孕产妇健康的可持续发展目标方面还有很长的路要走。我们建议妇幼保健计划人员应审查现有政策，并制定新的政策，实施并应对遵守世卫组织建议的至少8名ANC联系人的挑战.妇女的教育，应优先考虑社会经济地位和家庭的充分动员。有必要采取紧急干预措施，以缩小各地区和各州孕妇特征中已查明的不平等和巨大差异。
方法：使用了2018年尼日利亚人口健康调查前五年内21,785例怀孕期间具有全国代表性的横断面数据。ANC联系人的数量被分类为“无”，\"1-3\",根据世卫组织后续指南，“4-7”和“8个或更多”联系人。描述性统计，使用双变量和多变量多项逻辑回归，p=0.05。
结果：约25%的女性没有ANC接触，58％的人至少有4个触点，而只有20％的人有8个或更多的ANC触点。8个或更多ANC触点的最高比率是Osun（80.2％），拉各斯（76.8%），和Imo(72.0%)，而最低的比率是Kebbi(0.2%)，赞法拉（1.1%）和约贝（1.3%）。受过高等教育的受访者为12倍（调整后相对风险（aRR）：12.46，95％CI：7.33-21.2），受过中等教育的人是三次(RR：2.91，95%CI：2.35-3.60)，与没有受过初等教育的人相比，接受初等教育的人至少有8次接触的可能性增加了两倍（aRR：2.17，95％CI：1.77-2.66）。与最低财富类别的家庭相比，来自最富有和中等财富类别的家庭的受访者分别有129％和67％的可能性与8个或更多的ANC联系。在来自最低和中等弱势群体社区的受访者中，进行8次ANC接触的可能性分别高出89％和47％，分别,与最弱势群体相比。其他重要变量是配偶教育，医疗保健决策，媒体访问,种族,宗教,和其他社区因素。
结论：世卫组织关于尼日利亚ANC接触人数最少的指南的遵守情况较差。因此，尼日利亚在实现儿童和孕产妇健康的可持续发展目标方面还有很长的路要走。我们建议妇幼保健计划人员应审查现有政策，并制定新的政策，实施并应对遵守世卫组织建议的至少8名ANC联系人的挑战.妇女的教育，应优先考虑社会经济地位和家庭的充分动员。有必要采取紧急干预措施，以缩小各地区和各州孕妇特征中已查明的不平等和巨大差异。
