DETERMINANTS OF ANTENATAL CARE UTILIZATION AMONG PREGNANT WOMEN IN BUEA

Abstract

Antenatal care (ANC) is the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health condition for both mother and baby during pregnancy. Maternal mortality rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100,000 live births in 2015. In 2017 reports estimates MMR in Cameroon at 529 maternal deaths per 100,000 live births.

The objective of this study was to determine the barriers to the use of Antenatal care services by pregnant women in the BHD.

A hospital based cross-sectional analytical study, which ran for a period of 2 months (March 2021- May 2021). The participants involved were pregnant women of reproductive age (15years and above) attending antenatal care at the Buea Regional hospital and Solidarity Clinic who gave their consent to take part in the study. A structured questionnaire was used to collect socio-demographic data, obstetric and facility factors of all participants. Data was analyzed using SPSS version 25 software and statistical significance was set at p <0.05.

The proportion of inadequate ANC utilization was 56.2% versus 43.8% who adequately used the ANC services in the Buea health district. The factors that were associated with inadequate ANC utilization were; Women living with friends or alone (OR 6.50; 95% CI: 0.77-54.64; p=0.085), women with no previous ANC attendance (OR 2.25; 95% CI: 1.15-4.39; p=0.018), unemployment (OR 2.42; 95% CI: 1.17-5.00; p=0.017), women with no knowledge about ANC cost (OR 4.71; 95% CI: 1.01-22.11; p=0.049) and women with low income (OR 4.25; 95% CI: 1.08-16.77; p=0.039).

Conclusion: More than half of the pregnant women attending ANC did not meet up with the WHO recommendation of proper ANC utilization. Most women initiated ANC in the second trimester, majority of the women were among the low income group and unemployed.

CHAPTER ONE
INTRODUCTION

1 Background
Antenatal care (ANC) is the care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health condition for both mother and baby during pregnancy [1]. The components of ANC include; risk identification, prevention and management of pregnancy-related diseases; and health education and health promotion. [2]

Globally, the maternal mortality rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100,000 live births in 2015. Developing regions accounted for approximately 99% (302,000) of this estimated global maternal deaths in 2015, with sub-Saharan Africa alone accounting for roughly 66% (201,000).

This 2017 reports estimates MMR in Cameroon at 529 maternal deaths per 100,000 live births [1]. ANC is very important in our society as it helps reduce maternal and perinatal morbidity through detecting and treating pregnancy related complications, early detection of possible risk factors which will compromise the pregnancy, thus ensuring referral to an adequate level of care [2].

ANC reduces the maternal and perinatal morbidity and mortality directly, by detection and treatment of pregnancy-related complications, and indirectly, by identification of women and girls who are at increased risk of developing complications during labour or delivery, so that appropriate referrals can be done.

In 2015, countries met and put forth series of goals known as sustainable development goals (SDGs). These SDGs were aimed at reducing global maternal mortality to less than 70 deaths per 100000 live births by 2030, with no individual country exceeding a MMR of 140 maternal deaths per 100000 live births[3,4].

This global reduction of MMR and a positive pregnancy outcome can only be attained if the care delivered to women during pregnancy improve and they initiates antenatal care (ANC) early enough [5]. In 2016, a new guideline of WHO recommends a minimum of eight ANC contacts during pregnancy and that the first contact should be done before the 12th week of gestation [5, 6]. WHO defines late ANC as beginning ANC contact after 12 weeks of gestation [5].

A study done in the USA showed that, adolescents aged 15 years or younger had higher risks for maternal death, early neonatal death, and anemia compared with women aged 20 to 24 years. Moreover, all age groups of adolescents had higher risks for postpartum hemorrhage, puerperal endometritis, operative vaginal delivery, episiotomy, low birth weight, preterm delivery, and small-for-gestational-age infants [7]. Maternal mortality is the health indicator that shows the greatest differential between developing and industrialized countries [8].

Existing evidences have shown that in developing countries few women seek ANC services early in the course of pregnancy [9–12]. Some of the factors, which are associated to late commencement of ANC in our setting, are maternal education, unemployment, lack of knowledge or misconceptions about the value/purpose of antenatal care, marital status, socioeconomic status and financial constraints [11].

According to a report from Cameroon Demographic and Health survey (CDHS) 2018, only 41% of women had their first ANC visit in the first trimester, but this still marks an increase from only 34% in 2011. A study carried by Halle et al. reported a similar prevalence of 27.2% first ANC visit in the first trimester in a health Centre in Buea [13].

1.2 Problem Statement

According to a report by WHO in 2019, the main factors that stood as a barrier for women seeking Antenatal care were; poverty, distance to facilities, lack of information, inadequate and poor quality services and cultural believes and practices. Despite several efforts to reduce maternal mortality, maternal deaths remain high globally, particularly in low and middle-income countries (LMIC) [14].

Sub-Saharan Africa has the highest mortality or morbidity due to reproductive ill-health among pregnant women [15]. Despite this high level of antenatal care coverage in Cameroon so many women still lack access to appropriate pregnancy care [16-18], so they still die as a result of pregnancy and/or delivery related causes [17].

According to a study carried out in 2014 by G. E. Halle-Ekane et al, in Cameroon very few community-based surveys has been carried out on Antenatal care utilization. Also very little has been done to determine the impact of socio-economic factors on ANC attendance.

1.3 Rational/Justification

In order to improve health, barriers that will limit the utilization of quality ANC services must be identified and addressed at both health system and societal level. This study will provide relevant data on the impact of socio-economic factors on ANC and the determinants, which limits women of childbearing ages and pregnant women from fully receiving quality ANC. The data that will be generated from this study will go a long way to improve on the quality of ANC delivery on the part of the government and appropriate utilization by women in order to reduce maternal mortality and morbidity.

1.4 Research Goal

The goal of this research is to provide adequate data on the barriers to the use of ANC and measures to improve the use of ANC in our setting.

1.5 Research Questions

What are the barriers associated with the utilization of Antenatal care services?
What are there socio-economic impacts on women who attend ANC?