Prenatal care and pregnancy outcomes: A cross-sectional study in Luanda, Angola Tazi Nimi a,b , Sílvia Fraga a , Diogo Costa a , Paulo Campos b , Henrique Barros a,c, ⁎ a Epidemiology Research Unit, Institute of Public Health University of Porto, Porto, Portugal b Faculty of Medicine of Agostinho Neto University, Luanda, Angola c Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal abstract article info Objective: To describe prenatal care in Angolan women delivered at a large tertiary care unit, and to explore the as- sociation between prenatal care and selected perinatal outcomes. Methods: We conducted a cross-sectional study between December 2012 and February 2013, involving 995 women aged 13–46 years, delivered at Lucrécia Paím Maternity, Luanda. Trained interviewers collected information on timing, frequency, place, and satisfaction with pre- natal care; sociodemographic and clinical characteristics; birth weight; and gestational age. Logistic regression models were fitted, and odds ratios with 95% confidence intervals (OR, 95%CI) estimated. Results: Quantitatively inadequate prenatal care (b 4 visits) was more common in younger, less educated, poorer women, followed in public institutions, and those who felt more dissatisfied with care. More visits, both in primiparas and multiparas, were independently associated with more cesarean deliveries. After adjustment, having fewer than four visits was significantly associated with low birth weight (OR 2.00; 95% CI, 1.15–3.50) and preterm delivery (OR 2.74; 95% CI, 1.69–4.44 for 2–4 visits); similar associations were found regarding late entrance into care. Conclusion: Early entrance into prenatal care and the recommended number of visits are major determinants of mode of delivery and pregnancy outcomes, constituting targets to improve perinatal health. © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Keywords: Angola Cross-sectional study Low birth weight Pregnancy outcomes Prenatal care 1. Introduction Maternal and infant mortality are subtle general indicators of social and economic development. More broadly they reflect how women and children are valued and human rights respected at a country level. Although evident improvements occurred during the last decade, as a response to the Millennium Development Goals (MDGs), maternal and infant health are major challenges in African countries [1–4]. Globally, the maternal mortality ratio fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100 000 live births in 2015, from 385 in 1990. The annual number of maternal deaths decreased by 43% from approximately 532 000 in 1990 to an estimated 303 000 in 2015. The approximate global lifetime risk of a maternal death fell considerably from 1 in 73 to 1 in 180. Low-resource regions accounted for approximately 99% of maternal deaths in 2015, with Sub-Saharan Africa alone accounting for roughly 66% [5]. The risk of a child dying before completing five years of age is still highest in the WHO African Region (81 per 1000 live births), and many countries in the Region still have rates above 100 deaths per 1000 live births. It is essential to end preventable child deaths and there is a critical role to expect from the continuity of care that prenatal visits and delivery in health institutions should promote [6]. The assessment of prenatal care uptake and quality are essential steps toward improving accessibility and birth outcomes [7,8]. The proportion of pregnant women initiating prenatal care during the first trimester of pregnancy is one of the standard clinical performance mea- sures to assess the quality of maternal health care. One expects prenatal care to constitute an important moment of contact between the health workers and the women, ideally also the partners, and an opportunity for health education, including knowledge on how to prevent and detect pregnancy complications, and the development of a birth plan toward a safe delivery [9,10]. WHO recommends a minimum of four prenatal care visits [11,12] but in Angola only 47% of pregnant women reach that number, with a large variability between provinces [13,14]. A set of routine activities were adopted by the Ministry of Health of Angola to improve prenatal care uptake and content, including confirmation and monitoring of the progress of pregnancy, assessment of maternal and fetal well- being, detection of problems complicating pregnancy, tetanus immuni- zation, anemia prevention, antimalarial intermittent preventive treat- ment, HIV counseling and testing, counseling on self-care at home, nutrition, and breastfeeding [13]. Prenatal care can be expected to influence the pregnancy outcome by changing attitudes toward mode of delivery or prevention of other International Journal of Gynecology and Obstetrics 135 (2016) S72–S78 ⁎ Corresponding author at: Institute of Public Health, University of Porto, Rua das Taipas, 135, 4050-600 Porto, Portugal. Tel.: +351 22 2061820; fax: +351 22 2061821. E-mail address: hbarros@med.up.pt (H. Barros). http://dx.doi.org/10.1016/j.ijgo.2016.08.013 0020-7292/© 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. Contents lists available at ScienceDirect International Journal of Gynecology and Obstetrics journal homepage: www.elsevier.com/locate/ijgo