Antenatal care quality and pregnancy outcomes in the northern region of Ghana: a mixed-methods analysis

Antenatal care (ANC) plays a crucial role in reducing maternal and neonatal morbidity and mortality rates. However, Ghana has observed high rates of adverse pregnancy outcomes despite the increase in ANC coverage. This gap has prompted the need to focus on the quality of ANC services. We investigated the associations between quality ANC, low birth weight (LBW), and preterm delivery (PTD) in the Tamale metropolis and explored perceived barriers to quality ANC service delivery. We conducted a mixed-methods analysis through a facility-based cross-sectional study of 420 postnatal women recruited randomly from five primary health facilities. Additionally, we selected 10 ANC service providers from these facilities through purposive sampling. Information on various services received by the respondents during prenatal care and birth outcomes was collected electronically using a semi-structured questionnaire. We conducted in-depth interviews with the service providers. We used logistic regression to determine the associations between ANC quality and pregnancy outcomes. A thematic analysis approach was used to analyse the qualitative data, ensuring the robustness and reliability of our findings. Our study revealed that 25.2% (95% CI: 21.1, 29.4) of participants received high-quality ANC. The prevalence of LBW and PTD was 27.6% (95% CI: 23.8, 32.4) and 24.05% (95% CI: 19.9, 28.1), respectively. Notably, women who received high-quality ANC had significantly lower odds of delivering LBW babies (AOR = 0.13; 95% CI: 0.05, 0.35) and preterm babies (AOR = 0.15; 95% CI: 0.08, 0.36). The primary barriers to delivering quality ANC services were identified as inadequate and/or a lack of qualified human resources and medical equipment and supplies. We observed that high-quality antenatal care during pregnancy was associated with a reduced risk of premature birth or low birth weight babies. Addressing staffing and logistical challenges can help pregnant women receive the essential services they require to avert adverse pregnancy outcomes.