Late Antenatal Care (ANC) Booking by Pregnant Women at Sakubva and Dangamvura Polyclinics in Mutare City, Manicaland Province from February to March 2012

Abstract

This study was conducted to find factors associated with late antenatal care booking by pregnant women attending Sakubva and Dangamvura polyclinics in Mutare, Zimbabwe. Pregnant women should book during the first trimester for early commencement of preventive services and ensure their vital signs are checked and monitored throughout the pregnancy in order to reduce complications. Women die from a wide range of complications which develop during pregnancy, childbirth or the postpartum period (WHO, 2005). Late ANC booking has been noted to be above 60% at Sakubva and Dangamvura polyclinics for the past three years. Despite efforts by health workers to promote early ANC booking, pregnant women continue to book late for antenatal services. The reasons for this late booking are unknown, hence the need to carry out this study. An unmatched 1:1 case control study was carried out from February to March 2012 at Sakubva and Dangamvura polyclinics, Mutare Zimbabwe. The sample comprised 90 cases, 90 controls and 16 nurses as key informants. A case was defined as a pregnant woman booking at or after 16 weeks of gestation period. A control was defined as a pregnant woman booking below 16 weeks of gestation period. An interviewer administered questionnaire was used for the pregnant women and a self administered questionnaire was used for the nurses. Univariate, bivariate and multivariate analysis was done using Epi info version 3.5.3 Statistical package. Pregnant women’s knowledge on best time to book for ANC was found to be high but limited on benefits of early booking and complications of late ANC booking. Some of the health workers were reported to have negative attitudes towards antenatal care. Factors found to be significantly associated with late ANC booking were size of household (OR 0.43, CI 0.22-0.85, p-value 0.01) and cost of ANC services (OR 2.50, CI 1.23-5.09 p-value 0.01). Women coming from households with more than 4 people were found to be more likely to book late. Pregnant women with barriers in seeking antenatal care services were found to be 3.0 times more likely to book late for antenatal care at Sakubva and Dangamvura polyclinics while holding other variables constant. While age and history of underlying medical conditions were initially found to be significant, they were found not to be statistically significant after logistic regression. The only two factors remaining significant barriers in seeking ANC services in Sakubva and Dangamvura were size of household, and cost of ANC services. It is therefore recommended that Mutare City Health Department implements community based health education interventions to create awareness on benefits of ANC, importance of early booking and complications of late ANC booking. The department should also review policies on user fees to make the services financially accessible to more clients.