Utilization of antenatal care services by pregnant women in the first trimester of pregnancy in Kosirai division, Nandi county, Kenya

Abstract

Introduction: Antenatal care (ANC) is an effective health intervention for preventing maternal morbidity and mortality. Early ANC booking and adherence to scheduled appointments optimizes this benefit. However, factors determining its utilization in Kosirai Division are not well documented. Objectives: The study objectives were to determine the level of utilisation of ANC services and to describe socioeconomic, cultural and institutional factors associated with ANC utilization by women in the first trimester of pregnancy. Methodology: This was a cross-sectional descriptive study involving use of quantitative and qualitative methods. Study population were all pregnant mothers within Kosirai division. Sample size comprised of 196 pregnant women. Stratified sampling was used to sample participants. Data was collected using an interviewer administered semi structured questionnaire, focus group discussions and key informant interviews. Quantitative data was coded, entered into Microsoft access and exported to Stata version 12 for analysis. Qualitative data was recorded in tapes using a digital recorder, transcribed, translated, consolidated into emerging key themes and analyzed using content analysis. Results: Participants aged 15-24 and 35-49 years were 62(32%) and 98(50%), respectively. Majority (59%) were married and 28(14.4%) were employed. Two thirds of the respondents had attained at least a secondary level of education. Majority of the respondents were Christians, 191(99%). Up to 18(10%) respondents who utilized ANC services during first trimester failed to be offered ANC services due to various reasons such as lack of supplies, lack of staff, long waiting time, and bad attitude from the staff. The respondents who started ANC during the first trimester were 96 (52.2%). The mean gestational age at first ANC was 23±8.2 weeks. Public health facilities were mostly attended 180(94%). Husbands influence on utilization of ANC services were reported in 65%. The participants whose source of income was formal employment have 3 times, (OR=3.08 (1.07, 8.89)) increased chance of attending ANC during the first trimester 13 compared to those who are self-employed or have other sources of income (p=0.04). Focus group discussion and key informant interviews revealed that the utilization of ANC services in the first trimester in Kosirai division was very poor. It revealed that the main factors affecting uptake of ANC were poor health seeking behaviour, fear of HIV test, influence of traditional birth attendant, poor medical and laboratory supplies and poor ANC policy awareness. Conclusion: The level of utilization of ANC services was (52.2%) compared to FANC (100%) model but higher than Kenya demographic health survey (15%). The mean gestational age for start of ANC was 23 weeks, several weeks after first trimester elapse. Except for source of income (p=0.042), there was no association between socio-cultural and institutional factors and uptake of ANC services. Recommendation: Sensitize population and create awareness on importance of early ANC attendance. Emphasize the role of community leaders in empowering pregnant women to seek ANC services early. Stakeholders’ engagement in early ANC attendance through education and sensitization.