Late Initiation Of Antenatal Care Research Articles

Determinant Factors of Antenatal Clinic on Female Sex Workers Attendance within Nairobi County, Kenya

Globally antenatal care (ANC) initiation is at 58.6% but varies in different continents. Sub-Sahara has the lowest level of ANC care where women attend at least four times during pregnancy. Recent survey in Nairobi County found out that majority of women attends only one antenatal visit during pregnancy. The aim of the study was to explore determinants of antenatal clinic attendance among female sex workers in Nairobi County. A quantitative cross-sectional descriptive study among FSWs (18-49years) was carried out. Simple random sampling and self-administered questionnaires were used for data collection. Data analysis was done using descriptive and inferential statistics. The results show that 132 (32.8%) FSWs were aged 30 to 34 years, 242 (60.0%) were not married. 346 (85.9%) had unplanned pregnancy. Late ANC initiation was due to 42.4% (171) attitude of HCWs, 67.6% (215) distance to the healthcare facility and 86.1% (347) longer waiting time. On inferential analysis, there was an association between occupation of respondent vs number of ANC attendance which was significant = 22.525, df 12, P = 0.032 at P < 0.05. Marital of respondent vs number of ANC attendance was significant =29.058, df 15, P=0.016 at P<0.05. The income level of respondents vs number of antenatal care visits was significant =17.557, df 6, P=0.007 at P<0.05. Thus, pregnant FSWs face discrimination during ANC visits. These research findings will form a basis for future studies as well as guide the Ministry of Health and other stakeholders to develop policies that will guide ANC services among FSWs. Outreach programs on ANC among FSWs should be implemented and there should ANC services that only target FSWs.

Support, not blame: safe partner disclosure among women diagnosed with HIV late in pregnancy in South Africa and Uganda

BackgroundHIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure.MethodsWe conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software.ResultsOur findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby’s safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the ‘right’ time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure.ConclusionHIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health.

Household food insecurity and associated factors among postpartum women in southern Ethiopia: a community based cross sectional study

Approximately two billion individuals, or 26.4% of the global population, live in moderate- to severely food-insecure circumstances. It was discovered that not receiving all recommended antenatal care throughout one's pregnancy is one of the effects of household insecurity. The majority of women in Ethiopia, one of the most food-insecure countries in the world, with 10% of the population facing food poverty, devote more of their time to household duties, making food insecurity in the home the primary effect of poor prenatal care utilization. The main objective this study was to assess the status of household food insecurity among postpartum women at Arba Minch town, southern Ethiopia. A community-based cross-sectional study was conducted among 381 mothers who were enrolled from December 1, 2022, to January 30, 2023. The total sample size was allocated proportionately to the number of postpartum women living in each kebeles taking from the town registry of health extension workers for immunization. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using the statistical package of Social Science Version 26 (SPSS). In this study, the prevalence of food insecurity was 30.2% (95% CI 25.5–34.5). The associated factors with household food-insecurity were maternal occupation (AOR = 0.5, 95% CI 0.27, 0.90), late antenatal care initiation (AOR = 3.5, 95% CI 2.13, 5.91), and low monthly income (AOR = 3.1, 95% CI 1.38, 6.93). Food insecurity among postpartum mothers in the study area is high. Families who are severely food insecure require quick assistance to lower poor maternal and neonate’s outcomes. Furthermore, enhancing the occupation of mothers is crucial in reducing the morbidities and mortality of food insecure mothers, such as delayed prenatal care services, anemia, low birth weight, and stillbirth.

Intimate partner violence is independently associated with poor utilization of antenatal care in Arba Minch town, southern Ethiopia: A cross-sectional study.

To ensure the best possible health conditions for both mother and fetus throughout pregnancy, skilled healthcare professionals provide antenatal care (ANC) to expectant mothers. Even though the introduction of antenatal care has reduced maternal mortality by 34% since 2002, some atypical behaviors, such as intimate partner violence, have had a significant impact on how often women seek out expert medical treatment during pregnancy. Hence, early identification of such risk factors is very important to decrease maternal mortality from preventable causes. To assess the prevalence and factors of intimate partner violence and associated factors among pregnant women at Arba Minch town, southern Ethiopia. An institution-based cross-sectional study was conducted among 403 mothers who were enrolled from December 1, 2022, to January 30, 2023. The total sample size was allocated proportionately to the number of women attending antenatal care at each public health facility. Thus, systematic sampling was applied. Kobo Toolbox was used for data collection and cleaning, which was then analyzed using IBM SPSS Version 26. Statistical significance was determined at a p-value of less than 0.05. In this study area, the prevalence of intimate partner violence among pregnant women was 35% (95% CI: 30.5-39). The associated factors of intimate partner violence were late initiation of antenatal care (AOR = 3.81, 95% CI: 1.7, 6.04), non-autonomous women (AOR = 1.8, 95% CI: 1.18, 3.14), inadequate antenatal utilization (AOR = 3.41, 95% CI: 1.8, 6.2), and a husband with an extra wife (AOR = 6.0, 95% CI: 4.2, 10.57).This study showed that more than one-third of pregnant women in this study area were facing intimate partner violence. Having extra wife, lack of women's autonomy, less antenatal care utilization and late initiation of antenatal care were associated with Intimate Partner Violence (IPV). Therefore, it is essential to greatly empower women and provide them significant prestige in the home.

Determinants of late initiation for Antenatal Care follow-up among pregnant mothers attending public health centers at Jimma Town, South West Ethiopia, 2021: unmatched case-control study

Background: The World Health Organization recommends that a woman without complications should have at least four antenatal care visits, the first of which should take place during the first trimester (not > 16 weeks). But a high proportion of pregnant women in most developing countries attended the first antenatal care at a late time. In Ethiopia, the magnitude of late antenatal care follow-up initiation is 64%, and in the study area, it is 68.7%. However, the determinants of the problem were not identified, particularly in the study area. Objective: To identify determinants of late antenatal care initiation among pregnant women attending antenatal care in public health centers in Jimma Town, South West Ethiopia, 2021. Methods: A facility-based unmatched case control study was conducted from May 1–30. The cases (n = 177) were mothers who attended their first antenatal care visit at >= 16 weeks of gestational age, and the controls (n = 177) were mothers who attended their first antenatal care visit at <16 weeks of gestational age during the data collection period. Data was collected through face-to-face interviews using a pre-tested, structured questionnaire. Descriptive and summary statistics were done. Bivariate and multivariable logistic regression analysis was done using SPSS version 21.0 to identify candidate variables at P-value <0.25 and determinants of late antenatal care initiation at P-value <0.05, respectively. Results: The current study identified that age > 25 years (AOR = 2.623, 95% CI 1.059– 6.496), poor knowledge about antenatal care (AOR = 3.856, 95% CI 1.266–11.750), lack of history of abortion (AOR = 3.326, 95% CI 1.082–10.224), place of previous delivery (AOR = 3.926, 95% CI 1.023–15.063), recognizing pregnancy through missed periods (AOR = 3.631, 95% CI 1.520–8.674), pregnancy-related pain (AOR = 3.499, 95% CI 1.423–8.603), and lack of family support (AOR = 2.647, 95% CI 1.092–6.415) were determinants of late antenatal care initiation. Conclusion: Age > 25 years, poor knowledge about antenatal care, lack of history of abortion, place of previous delivery, recognizing pregnancy through missed period, pregnancy related pain, and lack of family support during antenatal care booking were determinants of late antenatal care initiation. Health facilities and respective health care providers should provide health education at the facility level regularly, with due attention to late antenatal care initiation

Risk of low birthweight and late antenatal care initiation in an ethnically diverse maternal cohort

Abstract Background Babies born with low birthweight (LBW,< 2500 g) are vulnerable to infant mortality, restricted growth, poorer development, and long-term health complications. Antenatal care (ANC) can improve maternal and infant outcomes; women are recommended to have first antenatal visit by 10 weeks’ gestation. Ethnic minority women are significantly more likely to initiate ANC later than recommended gestational week compared to white women. This study examined associations between late ANC initiation (first appointment >10 weeks gestation) and LBW in an ethnically diverse maternal cohort in the UK. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births during April 2015 - October 2022 from a large UK National Health Service maternity unit in an ethnically diverse area. Logistic regression models were used to examine associations between late ANC initiation and prevalence of low (<2500 g); very low (VLBW, <1500 g) and extremely low (ELBW, <1000g) birth weight. Results Of 39,785 singleton births recorded, more than one third (34.6%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi backgrounds. Birthweight was reported for 39,698 (99.78%) neonates; among them 8.9% had LBW, including 1.0% VLBW and 1.1% ELBW. More than one third (34.8%) of mothers had first appointment at > 10 weeks, including 26% during 11-19 weeks and 8.8% at > 20 weeks. Late ANC initiation was associated with increased risk of LBW for neonates: OR = 1.15 [95% CI: 1.07, 1.23] and 1.60 [1.44, 1.78] for ANC initiation at > 10 weeks and ≥20 weeks respectively (vs ≤ 10 weeks). Mothers who started care at ≥ 20 weeks were 5.37 times (95% CI: 4.31, 6.70) more likely to have a baby born with ELBW (vs ≤ 10 weeks). Conclusions Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight, highlighting the need for targeted primary and secondary interventions. Key messages • Neonates born to mothers who started antenatal care late in ethnically diverse neighborhoods are more likely to have low birthweight. • Targeted programmes and services are needed to support mothers in ethnically diverse neighborhoods to start antenatal care on time.

Development and validation of a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit, Northwest, Ethiopia, retrospective follow-up study

BackgroundPrematurity is the leading cause of neonatal morbidity and mortality, specifically in low-resource settings. The majority of prematurity can be prevented if early interventions are implemented for high-risk pregnancies. Developing a prognosis risk score for preterm birth based on easily available predictors could support health professionals as a simple clinical tool in their decision-making. Therefore, the study aims to develop and validate a prognosis risk score model for preterm birth among pregnant women who had antenatal care visit at Debre Markos Comprehensive and Specialized Hospital, Ethiopia.MethodsA retrospective follow-up study was conducted among a total of 1,132 pregnant women. Client charts were selected using a simple random sampling technique. Data were extracted using structured checklist prepared in the Kobo Toolbox application and exported to STATA version 14 and R version 4.2.2 for data management and analysis. Stepwise backward multivariable analysis was done. A simplified risk prediction model was developed based on a binary logistic model, and the model’s performance was assessed by discrimination power and calibration. The internal validity of the model was evaluated by bootstrapping. Decision Curve Analysis was used to determine the clinical impact of the model.ResultThe incidence of preterm birth was 10.9%. The developed risk score model comprised of six predictors that remained in the reduced multivariable logistic regression, including age < 20, late initiation of antenatal care, unplanned pregnancy, recent pregnancy complications, hemoglobin < 11 mg/dl, and multiparty, for a total score of 17. The discriminatory power of the model was 0.931, and the calibration test was p > 0.05. The optimal cut-off for classifying risks as low or high was 4. At this cut point, the sensitivity, specificity and accuracy is 91.0%, 82.1%, and 83.1%, respectively. It was internally validated and has an optimism of 0.003. The model was found to have clinical benefit.ConclusionThe developed risk-score has excellent discrimination performance and clinical benefit. It can be used in the clinical settings by healthcare providers for early detection, timely decision making, and improving care quality.

A mixed-method study examined the reasons why pregnant women late initiate antenatal care in Northeast Ethiopia.

Timely initiation of antenatal care visits is crucial for ensuring optimal care and health outcomes for women and children. However, late antenatal care initiation among pregnant women in low-income countries including Ethiopia is acknowledged in the literature. Therefore, this study examined why pregnant women initiate antenatal care late in Northeast Ethiopia. This study was done using a mixed design approach that included phenomenology and retrospective cross-sectional designs. A retrospective cross-sectional study was deployed among randomly selected 632 medical charts of women who had antenatal care visit in Legambo District primary hospital and health centers. Kaplan Meier curve was used to estimate survival time. Bi-variable and multivariable Cox-proportional hazard regression models were fitted using R-studio-1.2.5033 to identify independent predictors of antenatal care initiation time. Six vignette-based focused group discussions were held with pregnant women who had been purposefully selected. Then, a qualitative content analysis that was informed by the phenomenological theory was done. This study indicated that only 195 (30.9%) of women timely initiated their antenatal care follow-up. In a survival analysis, all 632 women contributed 12,474 person-weeks giving a timely antenatal care initiation rate of 15.6 per 1000 person-weeks. According to the multivariable Cox regression models, late antenatal are initiation was found among pregnant women with an unknown last normal menstruation period, no living children, no bad obstetric history, not accompanied by their partner during antenatal care visit, and who lived in a >5-kilometer radius of health facility. In a qualitative analysis, being uncertain whether the pregnancy had occurred, believing that they have a very low probability of experiencing any complications, negative experience with healthcare providers, negative influence from their immediate contacts such as the mother and mother-in-law, and socio-cultural beliefs like "Qare" were found as major reasons why they started antenatal care follow-up late. Most pregnant women in Legambo district, northeastern Ethiopia, initiate their antenatal care visits late. Based on the findings of this study, strengthening the pregnant women identification program and performing regular pregnant women's conference will help to achieve early initiation of antenatal care visits. To lessen the negative influence of their immediate contacts, it will also good to include these old moms and husbands in the conference of pregnant women.

Burden And Determinants of Anaemia Among Pregnant Women Attending Antenatal Clinic at Rural Healthcare Centers in The Ada West District of Ghana

Introduction: Anaemia during pregnancy is known to be a major contributor to maternal and neonatal morbidity, therefore affecting most pregnant women especially those in developing countries. Preventable causes such as poor maternal nutrition and infections causes severe complications in maternal and neonatal health. This study, therefore, aimed to determine the burden and determinants of anaemia among pregnant women attending antenatal clinics at rural facilities in the Ada West District of Ghana. Methodology: The study was quantitative and employed a cross-sectional study design. A simple random sampling technique was applied to enlist respondents (n=345). Data was collected with the aid of validated and structured questions and was administered one on one with respondents. Data gathered were analysed with the (STATA version 17). Descriptive and inferential statistics were conducted on the data collected and findings were depicted graphically and on tables. In the bivariate and multivariate models, an alpha value less than 0.05 was considered statistically significant between the dependent and independent variables. Results: The prevalence of anaemia among pregnant women was 51.0%. Unemployment and travelling long distances (&gt;5km) were associated with anaemia. Again, late initiation to antenatal care, third trimester of pregnancy, and birth spacing of less than four years in addition to malaria parasite infection significantly contributed to anaemia. However, sleeping under insecticide-treated nets protected pregnant women from anaemia. Conclusion and Recommendation: The prevalence of anaemia was high and factors such as unemployment, long distance to a health facility, late initiation of antenatal care, third trimester in pregnancy, and birth spacing less than a year, in addition to malaria parasite infection significantly predicted anaemia among pregnant women. Health education through mass media and during antenatal care clinics by health care practitioners would help reduce the occurrence of anaemia among pregnant women. Regular antenatal visits and testing of malaria parasite infection for pregnant women would also be beneficial in reducing the occurrence of anaemia. Further investigations are recommended to explore pregnant women's knowledge of anaemia and associated burden in the district.

Assessing Focused Antenatal Care Awareness and Utilization Among Pregnant Women in Enugu State, Nigeria: A Cross-Sectional Survey.

Focused antenatal care (FANC) is a newer and better approach to antenatal care for pregnant women than the traditional model. FANC emphasizes individual assessment and decision-making by both the provider and the pregnant woman, resulting in better health outcomes for both mother and baby. Despite the adoption of FANC care in Nigeria, maternal mortality indices have not significantly decreased. This study aimed to assess the level of awareness and utilization of FANC among pregnant women in Nigeria, as well as the factors that influence its utilization. This study was conducted in Enugu, Nigeria, using the antenatal clinics of three major tertiary hospitals. A cross-sectional design was used, and a sample size of 300 pregnant women was selected using systematic random sampling. Data were collected using a structured, self-administered questionnaire and analyzed using IBM Statistical Package for Social Sciences (SPSS) version 26. The findings were presented using frequencies, tables, charts, and figures, and Fisher's exact test was used to determine the relationship between respondents' knowledge of focused antenatal care and their demographic factors. A study involving 300 pregnant women in Nigeria found that only 15% of them had heard of focused antenatal care (FANC) and just 7.3% had good knowledge of its components, which was attributed to the low level of education among the respondents (X2=16.68, p=0.001). Health talks during antenatal visits were the most common source of information on FANC. The study also revealed that late initiation of antenatal care (n=144, 48%) in current pregnancy and (n=106, 54.6%) among those previously pregnant, as well as insufficient attendance, were identified as risk factors for maternal mortality. Long waiting times (n=196, 65.3%) and overcrowded healthcare facilities (n=110, 36.7%) were the major causes of dissatisfaction with antenatal care services among the respondents. Pregnant women preferred delivering at tertiary hospitals or private hospitals due to the perceived better quality of care and personal preference. These findings could inform targeted interventions to improve knowledge and awareness of FANC among pregnant women, particularly those with lower levels of education. This study provides important insights into the low awareness and utilization of FANC among pregnant women in Enugu, Nigeria, highlighting the need for targeted interventions to improve knowledge and awareness of FANC. The study's findings have important implications for the development of maternal and child health policies and interventions aimed at improving the utilization of healthcare services during pregnancy and childbirth in Nigeria. Further research that includes qualitative methods could provide more nuanced information on pregnant women's experiences and perspectives on FANC.

The magnitude and determinants of delayed initiation of antenatal care among pregnant women in Gambia; evidence from Gambia demographic and health survey data

BackgroundDespite gains throughout the 20th century, maternal health remains a major public health concern. Despite global efforts to enhance access to maternal and child healthcare services, women in low- and middle-income countries still have a high risk of dying during pregnancy and after birth. This study aimed to determine the magnitude and determinants of late antenatal care initiation among reproductive age women in Gambia.MethodSecondary data analysis was conducted using the 2019-20 Gambian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had an antenatal care visit for the last child were included in this study. The total weighted sample size analyzed was 5310. Due to the hierarchical nature of demographic and health survey data, a multi-level logistic regression model was performed to identify the individual and community level factors associated with delayed first antenatal care initiation.ResultIn this study, the prevalence of delayed initiation of initial antenatal care was 56% ranged from 56 to 59%. Women with age 25–34 [Adjusted Odds Ratio = 0.77; 95% CI 0.67–0.89], 35–49 [Adjusted Odds Ratio = 0.77; 95% CI 0.65–0.90] and women reside in urban area [Adjusted Odds Ratio = 0.59; 95% CI 0.47–0.75] respectively had lower odds of delayed first antenatal care initiation. While women with unplanned pregnancy [Adjusted Odds Ratio = 1.60; 95% CI 1.37–1.84], no health insurance [Adjusted Odds Ratio = 1.78; 95% CI 1.14–2.76] and previous history of cesarean delivery [Adjusted Odds Ratio = 1.50; 95% CI 1.10–2.07] had higher odds of delayed initiation of antenatal care.ConclusionDespite the established advantages of early antenatal care initiation, this study revealed that late antenatal care initiation is still common in Gambia. Unplanned pregnancy, residence, health insurance, history of caesarian delivery, and age were significantly associated with delayed first antenatal care presentation. Therefore, focusing extra attention on these high-risk individuals could reduce delayed first antenatal care visit and this further minimizes maternal and fetal health concerns by recognizing and acting early.

Factors Associated with Late Antenatal Care Initiation for Pregnant Women Aged 15-49 Years in Sierra Leone Using the 2019 Demographic Health Survey

Background: Antenatal care (ANC) is acknowledged as a critical maternal service in improving a wide variety of health outcomes for women and children as a result of better awareness of the importance of women being braced physically, mentally, and even logistically for delivery. Therefore, the timely initiation of ANC is critical to women. Objective: This study seeks to identify the factors affecting the timely initiation of ANC among women aged 15-49 in Sierra Leone. Methodology: This study adopted an analytical cross-sectional study using secondary data from the Sierra Leone Demographic and Health Survey. Frequencies and percentages were used to describe the explanatory variables. A multivariate logistic regression was conducted to identify the factors influencing the timely initiation of ANC in Sierra Leone. Results: The prevalence of timely initiation of antenatal care was 55.42%. Women residing in the northern (aOR=1.51, 95%CI 1.09-2.09), northwestern (aOR=1.87, 95%CI 1.33-2.61), southern (aOR=1.64, 95%CI 1.22-2.20) and western regions (aOR=2.00, 95%CI 1.38-2.89) had a high likelihood of starting antenatal late compared to those residing in the eastern region. Furthermore, women from the Limba (aOR=3.10, 95%CI 1.25-7.69), Sherbo (aOR=2.80, 95%CI 1.02-7.69) and Korankoh (aOR=2.79, 95%CI 1.13-6.85) ethnic groups had a higher likelihood of starting antenatal late compared to women from the creole ethnic group. Women who had no problem seeking for permission from their husbands for healthcare (aOR=0.71, 95%CI 0.55-0.89) and women who took healthcare decisions together with their husbands (aOR=0.83, 95%CI 0.70-1.00) had a lower likelihood of late initiation of antenatal care compared to those who had a big problem seeking for permission from their husbands for healthcare and respondents who took healthcare decisions alone. Conclusion: Findings from this study reveal that the timely initiation of antenatal care among women aged 15-49 years in Sierra Leone is low. Also, region of residence, ethnicity, husband’s authorization for seeking healthcare and decision making on healthcare are the factors influencing the timely initiation of antenatal care in Sierra Leone among women aged 15-49. It is recommended that women empowerment programs be organized regularly to educate women on the need to make their personal healthcare decisions. Government must also build more health facilities in the other regions of the country, with more skilled maternal healthcare training in the country to ensure equal distribution of health workers.

Late initiation of antenatal care among pregnant women in Addis Ababa city, Ethiopia: a facility based cross-sectional study

BackgroundAntenatal care (ANC) is the care given to pregnant women to prevent poor feto-maternal outcomes during pregnancy. The World Health Organization recommends first ANC visit be started as early as possible within in 12 weeks of gestation. Although there is improvement in overall ANC coverage, a sizable proportion of pregnant women in Ethiopia delay the time to initiate their first ANC visit. Therefore, this study aimed to investigate factors associated with late ANC initiation among pregnant women attending public health centers in Addis Ababa, Ethiopia.MethodsA facility-based cross-sectional study was conducted among 407 randomly selected pregnant women who attended ANC at selected public health centers in Addis Ababa from December 2020 to January 2021. Data were collected using pretested and structured questionnaires through a face-to-face interview and reviewing medical records. Binary and multivariable logistic regressions were fitted sequentially to identify predictors for late ANC initiation. Adjusted odds ratios with 95% CI were computed to measure the strength of associations and statistical significance was declared at a p-value < 0.05.ResultThis study showed that 47% of pregnant women started their first ANC visit late.The age of 30 years and above, being married, unplanned pregnancy, having a wrong perception about the timing of the first ANC visit, and not having ANC for previous pregnancy was significantly associated with late ANC initiation.ConclusionNearly half of the women initiated their first ANC visit late. Tailored interventions aimed at promoting early ANC initiation should target married women, women with an unplanned pregnancy, women who perceived the wrong timing of their first ANC, and those who have no ANC for their previous pregnancy.

Fear of COVID-19 and poor accessibility of comprehensive care has caused delay in initiation of antenatal care among pregnant women in Southwest Ethiopia: the need for disaster resilient and accessible maternal health care.

Antenatal care (ANC) is care provided to pregnant women in order to ensure positive health outcomes for both mother and baby. Late ANC contact lacks the opportunity to provide interventions that are effective early in the pregnancy. A huge proportion of pregnant women present late. The aim of this study was to identify determinants of late enrollment in the ANC among pregnant women in public health centers in Ilu Ababor Zone, South-West Ethiopia. A facility-based case-control study was conducted on 270 randomly selected pregnant women (135 cases and 135 controls). A pretested interviewer-administered questionnaire was used to collect data. Multi-variable logistic regression was run to identify the determinants of late ANC initiation. The adjusted odds ratio (AOR) and its 95% confidence interval (CI) were used to determine statistical significance at a P-value of 0.05. A total of 270 pregnant women were interviewed, making a response rate of 97%. Unplanned pregnancy [AOR: 2.8; 95% CI: (1.3, 6.0)], lack of information on time of ANC initiation [AOR: 2.7; 95% CI:(1.02, 5.0)], older age [AOR: 2.2; 95% CI:(1.01, 4.7)], not attending ANC in the previous pregnancy [AOR: 4.07; 95% CI: (1.8, 9.5)], and fear of COVID-19 were determinants of late initiation of ANC in the study area. Age, pregnancy and care-related factors, and fear of COVID-19 were determinants of late initiation of ANC. Community-based provision of comprehensive information on planned pregnancy and the ANC is important. A resilient system has to be built to deliver essential health services during emergencies like COVID-19.

Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal cohort

Abstract Background Ethnic minority status and maternal socio-economic deprivation are linked to delayed access to health care during pregnancy. The link between late antenatal care initiation and neonatal outcomes in settings with high ethnic diversity and social disadvantage is seldom explored. This study examined associations between late antenatal care initiation (first antenatal appointment &amp;gt;12 weeks gestation) and neonatal outcomes of preterm birth (&amp;lt;37 weeks gestation) and low birth weight (&amp;lt;2500 g) in an ethnically diverse socially disadvantaged maternal cohort. Methods A retrospective cross sectional study using routinely collected anonymous data of singleton births between April 2007 - March 2016 from a large UK National Health Service maternity unit in an ethnically diverse, socially disadvantaged area. Univariate and multivariate logistic regression models were used to examine the associations between late antenatal care initiation and prevalence of preterm birth and low birth weight. Results Of the 46,307 singleton births recorded, more than one third (34.8%) were to mothers from Black African, Black Caribbean, Indian, Pakistani, and Bangladeshi mothers. Gestational week at first antenatal appointment was available for 99.31% births among which 79.2% had their first appointment at ≤ 12 weeks, 12% at 13-20 weeks, and 8.8% at &amp;gt; 20 weeks. Mothers who booked at 13+ weeks were significantly more likely to have a preterm and/or low birth weight baby. Compared to mothers who booked at ≤ 12 weeks, those booking at &amp;gt; 20 weeks were 4.08 times (95% CI: 3.29,5.07) as likely to have an extremely preterm baby (&amp;lt;28 weeks of gestation) and 3.12 (CI 2.66, 3.67) times as likely to have a baby born with extremely low birthweight (&amp;lt;1500g). Conclusions Mothers in ethnically diverse socially deprived areas who started antenatal care late were at increased risk of adverse neonatal outcomes. Targeted intervention programmes and services are needed to support these mothers. Key messages

Antenatal care attendance and sociocultural predictors of antenatal care initiation in Tolon, Ghana

Background/Aims Data on sociocultural determinants of late antenatal care initiation during pregnancy are scarce. This study evaluated pregnant women living in Tolon and the sociocultural factors that influence antenatal care initiation. Methods This study was cross-sectional. The odds of late antenatal care initiation were determined using binary logistic regression models and qualitative data were presented as illustrative quotations. Results The prevalence of late antenatal care initiation was high (72%). A woman and her spouse’s education were both found to impact antenatal care initiation, with formal education making early initiation more likely (P&lt;0.001), although spouse’s education was not significant in the adjusted model. In both the unadjusted and adjusted models, women who experienced pregnancy ‘outdooring’ rites to announce their pregnancy were more likely to initiate antenatal care late than those who did not (P&lt;0.001). Conclusions There was a positive relationship between pregnancy rites and late antenatal care initiation. The district health directorate needs to intensify campaigns against traditional pregnancy rituals that negatively impact early antenatal care initiation.

Disparities in the timing of antenatal care initiation and associated factors in an ethnically dense maternal cohort with high levels of area deprivation

BackgroundLate access to antenatal care is a contributor to excess mortality and morbidity among ethnic minority mothers compared to White British in the UK. While individual ethnicity and socioeconomic disadvantage are linked to late antenatal care initiation, studies have seldom explored patterns of late initiation and associated factors in ethnically dense socially disadvantaged settings. This study investigated disparities in the timing of antenatal care initiation, and associated factors in an ethnically dense socially disadvantaged maternal cohort.MethodsA retrospective cross-sectional study using routinely collected anonymous data on all births between April 2007—March 2016 in Luton and Dunstable hospital, UK (N = 46,307). Late initiation was defined as first antenatal appointment attended at > 12 weeks of gestation and further classified into moderately late (13–19 weeks) and extremely late initiation (≥ 20 weeks). We applied logistic and multinomial models to examine associations of late initiation with maternal and sociodemographic factors.ResultsOverall, one fifth of mothers (20.8%) started antenatal care at > 12 weeks of gestation. Prevalence of late initiation varied across ethnic groups, from 16.3% (White British) to 34.2% (Black African). Late initiation was strongly associated with non-White British ethnicity. Compared to White British mothers, the odds of late initiation and relative risk of extremely late initiation were highest for Black African mothers [adjusted OR = 3.37 (3.05, 3.73) for late initiation and RRR = 4.03 (3.51, 4.64) for extremely late initiation]. The odds did not increase with increasing area deprivation, but the relative risk of moderately late initiation increased in the most deprived ([RRR = 1.53 (1.37, 1.72)] and second most deprived areas [RRR = 1.23 (1.10, 1.38)]. Late initiation was associated with younger mothers and to a lesser extent, older mothers aged > 35 years. Mothers who smoked during pregnancy were at higher odds of late initiation compared to mothers who did not smoke.ConclusionsThere is a need to intensify universal and targeted programmes/services to support mothers in ethnically dense socially disadvantaged areas to start antenatal care on time. Local variations in ethnic diversity and levels of social disadvantage are essential aspects to consider while planning services and programmes to ensure equity in maternity care provision.

Trends and determinants of late antenatal care initiation in three East African countries, 2007-2016: A population based cross-sectional analysis.

Early antenatal care is critical for the mother and newborn's health. Antenatal care is often delayed in Sub-Saharan Africa. The study aims to examine the trends and determinants of late antenatal care initiation in the Democratic Republic of Congo, Kenya, and Tanzania from 2007-2016. The study employed Demographic Health Surveys data of reproductive-age women seeking antenatal care in the Democratic Republic of Congo (2007-2013/14), Kenya (2008-2014), and Tanzania (2010-2015/16). Bivariate and multivariate analysis was conducted per survey, taking sampling weights into account. The determinants of late antenatal care initiation were measured using multivariate logistic regression models and the trends were assessed using prediction scores. Late antenatal care initiation declined in Tanzania (60.9%-49.8%) and Kenya (67.8%-60.5%) but increased in the Democratic Republic of Congo (56.8%-61.0%) between surveys. In the Democratic Republic of Congo, higher birth order was associated with antenatal care initiation delays from 2007-2014, whilst rural residency (AOR:1.28;95%CI:1.09-1.52), lower maternal education (AOR:1.29;95%CI:1.13-1.47) and lower-income households (AOR:1.30;95%CI:1.08-1.55) were linked to antenatal care initiation delays in 2014. In Kenya, lower maternal education and lower-income households were associated with antenatal care initiation delays from 2008-2014, whilst rural residency (AOR:1.24;95%CI:1.11-1.38) and increased birth order (AOR:1.12; 95%CI:1.01-1.28) were linked to antenatal care initiation delays in 2014. In Tanzania, higher birth order and larger households were linked to antenatal care initiation delays from 2010-2016, whilst antenatal care initiation delays were associated with lower maternal education (OR:1.51;95%CI:1.16-1.97) in 2010 and lower-income households (OR:1.45;95%CI:1.20-1.72) in 2016. Except for the Democratic Republic of Congo, the sub-region is making progress in reducing antenatal care delays. Women from various geographic, educational, parity, and economic groups exhibited varying levels of delayed antenatal care uptake. Increasing women's access to information platforms and strengthening initiatives that enhance female education, household incomes, and localise services may enhance early antenatal care utilisation.

‘I fear my partner will abandon me’: the intersection of late initiation of antenatal care in pregnancy and poor ART adherence among women living with HIV in South Africa and Uganda

BackgroundMany women in sub-Saharan Africa initiate antenatal care (ANC) late in pregnancy, undermining optimal prevention of mother-to-child-transmission (PMTCT) of HIV. Questions remain about whether and how late initiation of ANC in pregnancy is related to adherence to antiretroviral therapy (ART) in the era of national dolutegravir roll-out.MethodsThis study employed a qualitative design involving individual interviews and focus group discussions conducted between August 2018 and March 2019. We interviewed 37 pregnant and lactating women living with HIV selected purposively for early or late presentation to ANC from poor urban communities in South Africa and Uganda. Additionally, we carried out seven focused group discussions involving 67 participants in both countries. Data were analysed thematically in NVivo12.ResultsWomen described common underlying factors influencing both late ANC initiation and poor ART adherence in South Africa and Uganda. These included poverty and time constraints; inadequate health knowledge; perceived low health risk; stigma of HIV in pregnancy; lack of disclosure; and negative provider attitudes. Most late ANC presenters reported relationship problems, lack of autonomy and the limited ability to dialogue with their partners to influence household decisions on health and resource allocation. Perception of poor privacy and confidentiality in maternity clinics was rife among women in both study settings and compounded risks associated with early disclosure of pregnancy and HIV. Women who initiated ANC late and were then diagnosed with HIV appeared to be more susceptible to poor ART adherence. They were often reprimanded by health workers for presenting late which hampered their participation in treatment counselling and festered provider mistrust and subsequent disengagement in care. Positive HIV diagnosis in late pregnancy complicated women’s ability to disclose their status to significant others which deprived them of essential social support for treatment adherence. Further, it appeared to adversely affect women’s mental health and treatment knowledge and self-efficacy.ConclusionsWe found clear links between late initiation of ANC and the potential for poor adherence to ART based on common structural barriers shaping both health seeking behaviours, and the adverse impact of late HIV diagnosis on women’s mental health and treatment knowledge and efficacy. Women who present late are a potential target group for better access to antiretrovirals that are easy to take and decrease viral load rapidly, and counselling support with adherence and partner disclosure. A combination of strengthened health literacy, economic empowerment, improved privacy and patient-provider relationships as well as community interventions that tackle inimical cultural practices on pregnancy and unfair gender norms may be required.

Magnitude and Factors Associated with Late Initiation of Antenatal Care Booking on First Visit Among Women in Rural Parts of Ethiopia.

Early antenatal care visits enhance early detection and treatment of pregnancy problems, resulting in optimal delivery management. This study aimed to assess the late initiation of antenatal care visits among pregnant women in rural parts of Ethiopia. A 2016 Ethiopian Demographic and Health Survey provided the data for this study and a population-based cross-sectional study was conducted during data collection. Only 3065 women from rural areas were included in this study due to having complete information from all eligible women aged 15 to 49 who participated in the interview during data collection. SPSS-20 and R-4.1.2 statistical software were used to examine the data. The factors associated with the late initiation of antenatal care visits were identified using descriptive analysis and a binary logistic regression model. This finding revealed that only 31% of women visited their initial antenatal care within the first 3months. The distance between the health facility and the participants was a concern for 87.7% of the participants. Our research found that women's education, maternal age, region, media access, women's occupation, distance from the health facility, wealth index, pregnancy complication, and pregnancy plan all had significant effects on the late initiation of antenatal care visits. When compared to the reference group, women with a secondary and above education (AOR = 1.52, p-value = 0.02), women in age group 30-34 (AOR = 1.57, p-value = 0.02), and women in age group 35-39 (AOR = 1.56, p-value = 0.03), women with media access (AOR = 2.4, p-value = 0.04), richer women's (AOR = 1.29, p-value ≤ 0.001), women with pregnancy previous complication (AOR = 1.58, p-value ≤ 0.001), and women who had plan to the pregnancy (AOR = 1.26, p-value = 0.02) were more likely to start visiting ANC service earlier. In addition, private worker mothers, housewife women, and mothers having distance problems were less likely to visit antenatal care service before or at 12weeks of gestation compared to those mothers in reference categories of each variable. In Ethiopia, particularly in rural areas, early registration to antenatal care visits was extremely low. Community-based services such as media coverage, education, transportation, and raising awareness about the need of receiving antenatal care services early are required to encourage expecting mothers to attend their ANC appointment on time.