Abstract:
Early initiation and frequent antenatal care (ANC) attendance during pregnancy is
important to identify and mitigate risk factors in pregnancy and to encourage women to
have skilled attendants at childbirth. However, a 2008—2009 survey carried out on
health facilities in Kenya indicated that 92% of pregnant women attended ANC services
at least once but only 47% attended four or more visits as recommended by World
Health Organization and Kenya’s guidelines on focused antenatal care. Youth
comprised over half (55%) of the proportion who didn’t utilize ANC services properly
and thus experienced higher proportions of morbidity and mortality compared to other
adult expectant women. This study aimed at determining factors associated with ANC
attendance among the youth. A prospective hospital-based cross-sectional study was
conducted among 235 youth aged between 15—24 years who had delivered at Pumwani
Maternity Hospital during the study period. Maternity Delivery Register (MDR) was
used to identify and recruit eligible study participants. A sampling frame constituting of
serial numbers assigned to the mothers was made. Using Computer Generated Random
Numbers (CGRN), ten mothers were selected every day from the sampling frame for
participation. Quantitative data was collected using pre-tested structured questionnaires.
Descriptive statistics such as proportions were used to summarize categorical variables.
Chi-square or Fishers’ Exact Tests were used to test for the strengths of associations.
Variables identified to be significantly associated with ANC attendance at bivariate
analysis were further analyzed at multivariate analysis using binary logistic regression.
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Prevalence Adjusted Odds Ratios (PAOR) with their respective 95% confidence
intervals (CI) was used to estimate the strengths of associations. Threshold for statistical
significance was set at p <= 0.05. Data analysis was performed using Scientific Package
for Social Sciences (SPSS) version 20.0 software. Among the 235respondents, 80.0%
were in their first pregnancy (primiparous) with majority (77.4%) being married. A
few(39.1%) were living more than 10 km from the hospital with majority (95.7%)
having lived in Nairobi for over one year. Slightly over half (52.3%) had attained
Secondary level of education with 37.9% having attained Primary level. Only 46.0%
had desired and timely pregnancies with over half (54.0%) having unwanted and
mistimed pregnancies. Majority (80.0%) had attended ANC services in public funded
health facilities with 56.6% having attended the recommended four or more ANC visits.
Over half (58.7%) had attended their first ANC visit after the recommended four months
of pregnancy with majority (68.1%) having initiated ANC attendance during second
trimester of pregnancy. A few (17.9%) initiated during the third trimester. Majority
(94.9%) were knowledgeable by expounding on the importance of regular ANC
attendance with 95.3% having positive attitudes towards ANC services by believing in
the services. Factors such as unfriendly/poor treatment from the clinic staffs (51.9%),
when a sexual partner refuse to take responsibility for the pregnancy (65.5%), high costs
associated with ANC services (91.1%), fear of testing HIV positive (90.2%), unwanted
and mistimed pregnancies (69.8%) were determined as barriers towards proper
utilization of ANC services. Being within the age groups of 18—24 years (PAOR 4.95,
xv
95% CI 0.088—0.727), paying between Ksh 100—2,000 for ANC services received
(PAOR 2.89, 95% CI 1.441—5.814), desired and timely pregnancies (PAOR 2.263,
95% CI 1.308—3.913) and early initiation of ANC attendance (PAOR 4.95, 95% CI
2.737—8.99) were significantly and independently associated with ANC attendance at
multivariate binary logistic regression analysis. Poor utilization of ANC services during
pregnancy was observed among the youth Programs targeting to improve ANC
attendance are required to enhance early enrolment and proper utilization of ANC
services.