Predictors of Timing of First Antenatal Clinic: A Systematic Review

Abstract

World Health Organization recommends that pregnant mothers do the first antenatal visit within the 12 weeks after conception. The goal of the review was to determine the predictors of first antenatal visit. A systematic review was conducted by retrieving and reviewing several papers that had been published in various journals. Boolean internet search method was used. Comprehensive search was conducted through various data bases such as Cochrane library, Google scholar, AMED, EMBASE Scopus and PubMed. Cochrane risk of bias tool was used to evaluate studies on the risk of bias. Articles reviewed included those papers that were published from January 2010 to July 2023. The reviews of the publication were done between October and November 2023. Articles that report the timing of first antenatal care were included. Only papers published in English were included. All abstracts with information of first antenatal care were included and then the full articles were retrieved for review. Data extracted included ANC attendance level, antenatal utilization, factors contributing to first antenatal visit timing, reasons for late antenatal visit after 16 weeks. Extraction also included year of publication, study design and the area where the study was done. After thorough searching, 9132 published papers were accessed through a method known as Boolean internet search. The initial screening established 56 papers without abstracts and ended up with 9076 papers. In step two, 8712 publications were removed because of quality, lack of relevance to timing of first antenatal care, not in English language while other were overview articles. In step three, 330 papers were excluded for being not related to predictors of first timing of antenatal care. Only 34 articles were considered eligible for the systematic review after inclusion and exclusion criteria was added. Narrative data synthesis was used to analyze data extracted from articles retrieved as per the inclusion and exclusion criteria. Results. Education appeared in 22 articles. Place of residence and distance were noted in 19 articles and 17 articles respectively. Several predictors of first antenatal visit were as follows: maternal age was observed in 21 articles, unplanned pregnancies (16), The level of attendance during first antenatal visit ranged from 47% to 57%. Conclusion Variables such as education, distance, quality of service complications of pregnancy and unplanned pregnancy were reported by many articles as predictors of early initiation of first antenatal visit. A big proportion of mothers do not utilize the first antenatal services. Recommendations it is recommended that awareness be created among communities on the importance of early antenatal visit.