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 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.