TITLE OF THE STUDY

FACTORS CONTRIBUTING TO DELAYED ANTENATAL BOOKING AMONG PREGNANT WOMEN IN KARAGWE DISTRICT

Presenter: Ernest Tumuombe Anthony 20th July.2007

INTRODUCTION
Delayed booking among pregnant women implies attending antenatal clinic for the fist time during that particular pregnancy with gestation age above 16weeks and early booking means attending at 16weeks of gestation age or before .(National Package of Essential Reproductive and Child health intervention 2000, Focused Antenatal Care ,2004,2006)

INTRODUCTION cont

Delayed antenatal booking is a major problem among pregnant women in Africa where by Tanzania is not excluded. In Karagwe district the situation is similar, having the magnitude of 60%. 40% in 2003, 38% 2004 and 42.5 in 2005 respectively.

Introduction cont

Stationary as well as mobile antenatal clinics has been introduced at least one in each village but with less impact. The factors contributing to the problem were not well known but hypothetically were thought to be lack of knowledge on advantages of early booking, social and cultural beliefs inaccessibility to antenatal services and lack of cooperation from husbands or partners.

Introduction cont

As it is continuously being advocated by the MOHSW that pregnant women should book ANC not later than 16weeks, In Karagwe district is still a problem. There fore this was the rationale to conduct the study to reveal the factors contributing to delayed ANC booking.

Research objectives
Broad objective To determine factors contributing to delay in booking among pregnant women in Karagwe District.

Specific objectives
1.
2.

3.
4. 5. 6.

To assess the level of knowledge of pregnant women on early booking To determine the accessibility of antenatal care services To determine gestation age at booking. To determine cultural belief associated with delayed booking. To determine the level of knowledge of service providers on early antenatal booking. To determine the information provided to the pregnant women concerning booking

Research questions..
What is the level of knowledge concerning early booking? What are the cultural beliefs associated with early booking? What is the gestation age at booking by age and parity?

Research questions cont

What are the advantages perceived towards early booking? At what extent are the husbands or partners do influence early booking? What information provided to the pregnant women concerning booking?

Methodology
Study design

Descriptive cross-section study. This is a survey aimed to quantify the distribution of a certain variables in a study population at one point of time.

Variables

Dependent variable Delayed antenatal booking. Independent variables 1. Gestation age at booking. 2. Level of knowledge on advantages of early booking 3. Accessibility of antenatal care services 4. Cultural briefs associated with antenatal care services 5. Support from husbands/partners towards ANC services 6. Information provided by service providers

Sample determination and sampling procedure

Total of 421 respondents were interviewed; 384 were pregnant women. Magnitude proportional formula was used to obtain 384 pregnant women who involved in interview. n=P(100-P ) =60(100-60)e2 =384 e2

5 were antenatal care service providers who were obtained conveniently in the study area. 32 were married men. Who were selected purposively.

Source varkvisser.

Study unit
Study unit was individual pregnant woman individual group of married men Individual antenatal service provider

Sampling procedure and sample size

District was selected purposively. Division was selected by Simple random sampling. Two wards were selected by Simple random sampling Study villages were selected purposively.

Sampling procedure and sample size cont

Antenatal clinics were selected purposively, as every village has only one. Pregnant women and ANC service providers were selected conveniently. FGD (6-9) respondents were obtained purposively

Data collection methods and tools

Data

collection methods used were; interviewing, review the pregnant mother MCH cards and focus group discussion .

Data collection tools.

Tools used were intervieweradministered questionnaire with both closed and open ended questions. FGD interview guide and tape recorder.

Ethical consideration

The introductory letter was obtained from the director of Primary Health Care Institute of Iringa, which introduced me to the District Authority, from there permission in writing was provided before I proceeded to the respected divisions. Wards, villages and During interview an individual consent was obtained as well as from FGD respondent respectively

DATA HANDLING
The questionnaires were labeled with numbers as per sample size (1-384 and 0-5) respectively. Questionnaire after being filled correctly was kept securely in the folder. At the end of the day the researcher counter checked if, questionnaire were properly filled and data entered into a master data sheet. The FGD results narrated, verbatim was translated and printed.

DURATION OF STUDY study was of six months duration from December 2006 to May 2007. DATA PROCESSING AND ANALYSIS Data processing and analysis was performed by using Excel data master sheet and Epi- info version 3.3.2. For FGD points has narrated and printed.
STUDY LIMITATIONS

There were no limitations during my study.

result dissemination
One copy will be kept in the institution library for future reference One to the sponsor who enabled me to accomplish this course To Karagwe council health management team for planning for intervention To my self also for development of proposal for an intervention.

RESEARCH FINDINGS

The distribution of respondents (pregnant women) age is shown in figure 1: below. n=384
Pregnant women age distribution
35.00% 30.00% 25.00% 24.20% 19.80% 31.80%

Percentage

20.00% 15.00% 10.00% 5.00% 0.00% 13.50%

8.60%

1.80%

0.30%

1 Age group 14-19 20-24 25-29 30-34 35-39 40-44 45-49

Figure 1: shows that the majority of pregnant women studied were aged between 20 and 24 years (31.8%); the least represented were women aged 45-49 years 0.3%. The mean age was 26 years, mode = 20 years, SD = 6. Range =26.

Figure 2: Distribution of respondents by level of education. n=384

Chart representing education level
50% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 32%

16% 2% No formal Did not Primary Secondary education complete school school (STD 7) education education (STD7) Education

The figure 2 shows that the majority (191) 49.7% have primary School education ,the minority 6 (1.6%) had secondary school education.

Table 3:Relationship between respondents level of education and booking behaviour. n=384
Level of education
GESTATION AGE AT BOOKING

16 weeks and below

No formal education
Did not complete primary education Primary education Secondary school education
10
9 18 4

Above 16 weeks
114
54 173 2

TOTAL

8.1%
14.3% 9.4% 66.7%

91.9%
85.7% 90.6% 33.3%

124
63 191 6

TOTAL

41

10.7%

343

89.3%

384

The table above shows that 4(66.7%) of respondents with secondary education booked early, at or below 16 weeks of gestation age compared to other lower levels of education. This difference is statistically significant. (2 = 21.78; P<0.05; df=3; CI=95%)

Table 6: Distribution of respondents by gestation age at booking. n=384

Gestation age at booking as per MCH card 16 weeks and below Above 16 weeks Total

Respondents 41 343 384

Percent 10.70% 89.30% 100.00%

The table shows that out of 384 respondents 343 (89.3%) booked later than 16 weeks of gestation age and only 41 (10.7%) booked at 16 weeks and below. Mean gestation age at booking was 24 weeks

Table 4: relationship between Parity and awareness on appropriate time for antenatal booking. n=384
Gravidity Awareness on appropriate time for antenatal Booking 16 weeks and below Above 16 weeks TOTAL

First pregnancy Second pregnancy and above

TOTAL

40 47.6% 154 51.3%

194 50.5%

44 52.4% 146 48.7%

190 49.5%

84 300
384

The table above depicts that the multipara,154(51.3%) slightly booked earlier compared to primgravida. However this difference is not statistically significant. (2 = 0.22, P>0.05, 95% confidence Interval)

Figure 4: respondents reasons for late booking

n=343
40% 35% 30% 25% 20% 15% 10% 5% 0% 4% 38%

16%

18%

16% 8%

Ashamed of young pregnancies

Not having any pregnancy problem

Un aware of reasons for early booking

Un aware when To avoid several Early she became months pregnancy can pregnant attendance not be detected by abdominal examination

Reasons for late booking

The above figure shows the reasons for late booking given by 343 respondents who booked late. Out of these 161 (38.4%) said they booked late to minimize months of attendance,75 (18%) booked late because they are unaware of early booking

Figure5: Distribution of respondents by level of knowledge on advantages of early booking n=384

Low knowledge 65.4

Level of knowledge

Moderate knowledge

28.1

Series1

High knowledge

6.5

10

20

30

40

50

60

70

Percentage

Figure 5 above shows that majority of the pregnant women 251(65.4%) involved in the study, had low knowledge on advantages of early booking.

Table 8: comparison of respondents level of knowledge on the advantages of early booking and gestation age at booking. n =384
LEVEL OF GESTATION AGE AT BOOKING KNOWLEDGE ON THE ADVANTAGES OF 16 weeks and Above 16 weeks TOTAL EARLY BOOKING below High knowledge Moderate knowledge Low knowledge TOTAL 12 48% 14 13% 15 6% 41 10.7% 13 52% 94 87% 236 94% 343 89.3% 25 108 251 384

The above table shows that 12(48%) of respondents with high knowledge on advantages of early booking, booked in appropriate time, compared to only 15(6%) with low knowledge.

Table 11: comparison between time taken to reach the antenatal clinic and gestation age at booking. n = 384
Time spent to reach the clinic GESTATION AGE AT BOOKING 16 weeks and below More than one hour Less than one hour TOTAL 20 10.4% 21 10.9% 41 10.7% Above 16 weeks 171 89.5% 172 89.1% 343 89.3% TOTAL 191 193 384

It is shown in the table above that there was a slight difference between those who spent more than one hour and less than one hour, 10.4% and 10.9% respectively. This is not statistically significant (2 = 0.0012, P> 0.05, 95% conf. int.)

Figure 7: assessing the knowledge of RCH service providers on advantages of early booking. n =5

High knowledge 40% low knowledge 60%

Figure above shows that 3 out of 5 (60%) had low knowledge on advantages of early booking compared to 2 (40%) who showed to have high knowledge on the same subject

FINDINGS FROM FOCUS GROUP DISCUSSION

Triangulation methods for this matter were used in order to enrich the research findings and they are incorporated in discussion.
Detailed in main document.

DISCUSSION
The study findings revealed that the majority of studied pregnant women booked at the antenatal care after 16 weeks of gestation age (table 6) the mean gestation age at booking being 23.6 weeks this shows that the condition is worse compared to what is actually seen in several reports. This is likely to be the cause of prevailing maternal and child death due to preventable conditions that would have been attended during early pregnancy.

DISCUSSION cont..
In a survey conducted in western Kenya two-thirds of pregnant women began attending the ANC in the third trimester (Van E et al 2006) Another crosssection study done in cape town which aimed at finding the role of urine pregnancy testing in facilitating access to antenatal care, revealed that the median gestation age at booking was 23 weeks. This resulted in limited quality antenatal care as screening and treatment programs were not utilized hence avoidable maternal and child morbidity and mortality persisted. (Abigail H,2006)

Knowledge on advantages of early antenatal care booking is one of the factors which can influence a pregnant woman to or not seek antenatal care at the required time
( Figure 4) When compared level of knowledge and booking behavior it has been found statistically that there is an association between understanding the advantages of early booking and Antenatal booking behavior.

DISCUSSION cont..
Those who had high knowledge booked earlier than those who had low knowledge. This clearly shows that communicating to the community the necessary information, with advantages of early booking could scale up booking at appropriate time.

DISCUSSION cont..
Regarding service providers level of knowledge, the research found out that they had no satisfactory knowledge in relation to advantages of early booking. (figure 7) But this number could not be representative to all RCH staff in the district. This hinder them from giving the timely appropriate information.

DISCUSSION cont..
Regarding the information provided to the pregnant women concerning booking. It was found that, the information given to pregnant mothers was not satisfactory enough to impart knowledge to pregnant mothers hence perceive the importance of booking early during pregnancy (table 12) this suggests insufficiency in health education pertaining to antenatal booking. hence leading to delay in booking.

DISCUSSION cont..
A study done by Abrahams N et al(2001) cape town South Africa, it was found that among other factors, antenatal care attendance was influenced by womens knowledge, also the expected benefits were weighed against anticipated costs before decisions were made. The findings highlight the importance of womens knowledge towards advantages of early booking, before they can take the proper decisions.

CONCLUSION
The research findings suggest that the problem of late booking is existing in the study population being 89.3%, mean gestation age at booking 24weeks, time spent to access the antenatal services and socio cultural beliefs were not identified as contributing factors to delay in booking. .

CONCLUSION cont..

The study found that, the key factors contributing to delay in antenatal booking are lack of appropriate education in relation to antenatal care particularly early booking, low knowledge among service providers that prevent them from transferring appropriate information to the community

RECOMMENDATIONS
To Council Health Management Team The Health Educator should design appropriate health education program and conduct health education to the community to scale up community education in relation to early antenatal booking. The health education program should include different health education approaches to attract different audiences. To make it feasible, the CHMT should include it in the Comprehensive Council Health Plan.

RECOMMENDATIONS cont

To conduct advocacy and mass campaigns to leaders and community at large on advantages of early antenatal booking. Service providers should be educated on appropriate methods of giving information to pregnant women and the community at large on health threats a pregnant woman can anticipate, and advantages of early booking in relation to threats alleviation.

RECOMMENDATIONS cont

The Health educator should develop/adopt health education materials and display them in the Reproductive and Child Health clinic. This will enable a bigger part of the community to have access to information. These materials should also be circulated to the community level

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