Late antenatal care initiation and its contributors among pregnant women at selected public health institutions in Southwest Ethiopia

Abstract

Introduction early commencement of antenatal care by pregnant women as well as regular visits has the potential to affect maternal and fetal outcomes positively. Even with antenatal care, the intervention requires fewer resources; however, most pregnant women in sub-Saharan Africa have begun late for antenatal care services. This study aimed to assess the magnitude and contributors of late antenatal care initiation among pregnant women at selected public health institutions of the Bench-Sheko Zone in southwest Ethiopia. Methods a cross-sectional study was conducted among 509 pregnant women attending the Antenatal Care (ANC) service at selected public health institutions. The data were collected using a structured and pre-tested questionnaire. The data were entered using Epi-data version 3.1 and analyzed using SPSS version 22. A binary logistic regression analysis was computed to determine the association using crude and adjusted odds ratios at 95% confidence intervals. Independent variables with a p-value of less than 0.05 in the multivariable logistic regression model were considered significant. Results of the 509 respondents interviewed, 337 (66%) reported late antenatal care initiation. The factors associated with late antenatal care initiation were mothers aged 25 years and above (AOR = 1.59, 95% CI [1.02, 2.48]), attended below secondary school (AOR =2.33, 95% CI [1.05, 5.19]), unplanned pregnancy (AOR=2.25, 95%CI [1.34, 3.77]), pregnancy recognition by missing period (AOR=0.61, 95%CI [0.39, 0.93]), perceived right time of ANC after 4 months (AOR=2.29, 95% CI [1.36, 3.85]), and did not get advice to have ANC (AOR=1.64, 95% CI [1.10, 2.45]). Conclusion the majority of pregnant women initiate their first antenatal care lately. We can conclude that late antenatal care initiation is a major problem in the study area. Therefore, providing continuous health education on the importance of initiating antenatal care visits early to prevent unwanted pregnancy outcomes is an important segment of intervention that can be done through health extension workers.

Why does the number of antenatal care visits in Ethiopia remain low?: A Bayesian multilevel approach

“…Women from rural areas were shown to have a reduced number of ANC visits compared with urban residents. This finding is supported by different studies conducted in Ethiopia [27,37,41], Guinea [45], Pakistan [46], the Philippines, and Indonesia [47]. This may be because women from rural areas have low access to health facilities and inadequate information on the importance of having an adequate number of ANC visits.…”

“…Different studies were conducted in Ethiopia, but the previous studies were conducted on utilization level [22,23], time of initiation [3,[24][25][26][27], and associated factors [3,12,26] rather than focusing on the number of visits, which may result in loss of information in classification count data. Further, the previous studies were conducted with the older recommendation of WHO, which emphasis on focused four ANC visits.…”

Health Workers' Perspectives on Antenatal Care and the Efficacy of a Community-Based Strategy in Augmenting ANC Follow-Up Contacts in Nyamira County, Kenya

“…Single interventions such as packaged health message improves ANC coverage and deliveries in health facilities 16 . Health information combined with the introduction and promotion of birth plans during ANC increased its utilization 17 . This has had a direct positive effect on health service utilization and increasing democratization of reproductive health decisions 18 .…”

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

“…The result from the 2016 Ethiopian DHS (EDHS) revealed only 20% of pregnant women in Ethiopia start their ANC during the first trimester of their pregnancy 12. Other studies in the country reported varying magnitudes of early initiation of ANC; the proportion was found to be 46.8% in Bahir Dar,13 21.71% in Southern Ethiopia,14 40.6% in Debre Markos,15 39.5% in Tselemt District of Tigray Region,16 27.5% in Axum,17 28.8% in Ilu-Ababor18 and 34% in Bench-Sheko Zone 19…”

“… 12 Other studies in the country reported varying magnitudes of early initiation of ANC; the proportion was found to be 46.8% in Bahir Dar, 13 21.71% in Southern Ethiopia, 14 40.6% in Debre Markos, 15 39.5% in Tselemt District of Tigray Region, 16 27.5% in Axum, 17 28.8% in Ilu-Ababor 18 and 34% in Bench-Sheko Zone. 19 …”