Factors associated with timing of first antenatal visit among pregnant women attending Webuye County Hospital, Bungoma County, Kenya

Abstract

Background: Timely Antenatal Care (ANC) is essential for quality neonatal and maternal outcomes. World Health Organization (WHO) recommends eight ANC visits during pregnancy, with the first visit being within 12 weeks of conception. According to the Bungoma health indicator report of 2017, less than 37% of pregnant women attended their first ANC before 20 weeks gestation. Objective: To determine and explore the factors associated with timely first ANC visits by pregnant women in Webuye County Hospital. Methods: This was a facility-based cross-sectional study employing mixed methods. Data collection was done from December 2019 to July 2020. The researcher recruited participants from the Webuye County Hospital Maternal Child Health clinic and used systematic sampling to enroll 354 for the quantitative arm. Pretested structured questionnaire was utilized in data collection. The data were cleaned and entered into Statistical Package for Social Sciences (SPSS) version 20.0. The researcher conducted data analysis using descriptive and inferential statistics to summarize data from categorical variables. Pearson’s Chi-square test was employed in both variate and multivariate models to test for the association between dependent and independent variables. The analyzed data was presented in tables. Purposive sampling was used to enroll 22 participants for the qualitative arm. In-depth interviews using pretested structured interviewer guide questionnaires with tape recording were used. Data were entered into N*vivo software. Data were analyzed using codes and grouped in themes. Results: Thirty-five point three percent of the women made their first visit during the first trimester (95% CI: 23–35%). Educational status of the women (secondary (OR = 3.21; CI 95%: 1.73, 6.22), the timing of antenatal care in the last pregnancy (second/third trimester) (OR = 0.19; CI 95%: 0.08, 0.41), and experiencing complications in the previous pregnancy (OR = 2.56; CI 95%: 1.43, 4.67) were significantly associated with appropriate timing of the first ANC. The research found that age was not statistically significant (p-value 0.144). A total of 22 pregnant women were interviewed for the qualitative arm. Fear of Covid-19, lack of spouse support, perceived quality of hospital services to be good, cultural beliefs, socioeconomic factors, and misconception of ANC emerged as major themes determining ANC timing. Conclusion: Women with higher education levels, those with previous early ANC attendance, those who experienced complications in previous pregnancies, and those who perceived hospital service to be good were more likely to attend ANC in the first trimester. Fear of Covid-19, lack of partner support, and sociocultural factors contribute to late ANC attendance. Recommendations: Efforts to improve literacy on the timing of ANC attendance in health facilities should be enhanced. Health facilities should ensure and maintain service quality.