CHAPTER ONE

INTRODUCTION

1.1 Background

Antenatal care (ANC) is a type of care given to pregnant women and is considered a key maternal service in improving a wide range of health outcomes for women and newborns. The Antenatal Care (ANC) model recommended by the World Health Organization (WHO) calls for a minimum of eight ANC visits, with the first one occurring during the first trimester. Implementing appropriate ANC services and evidence-based techniques during ANC at the suggested period can benefit both the mother and the fetus.

They also promote maternal nutrition, give health education, and help to avert obstetric emergencies and other life-threatening situations. This is also an appropriate time for women to begin planning for birth and newborn care. According to WHO, early ANC refers to initiation of antenatal care as soon as possible after confirmation of pregnancy and or within the first 12 weeks of gestation whereas late ANC is starting ANC after 12 weeks of gestation (WHO, 2016).

Early initiation of antenatal care play a major role in detecting and treating some complications of pregnancy and forms a good basis for appropriate management during delivery and after childbirth. Failure to attend antenatal care early results in the potential for complications during pregnancy, delivery, and puerperium and hence increasing MMR (WHO, 2016).

Existing evidence from most developing countries indicates that few women seek ANC services early in the course of pregnancy. Late initiation of ANC has been associated to; maternal education, unemployment, lack of knowledge or misconceptions about the value/purpose of antenatal care, marital status, socioeconomic status, financial constraints (WHO, 2016).

Other researchers across the world have established that many factors can be associated with late ANC booking. These include social-demographic factors, social-economic factors and biological factors (Weldemariam et al., 2018). Other factors may be barriers faced by women in accessing health care and these barriers may also influence their decisions to attend ANC early.

Evidence from other studies done in Tanzania show that social-demographic factors such as not being married, being of ethnic groups with low income levels, are associated with late ANC booking (Sinyange et al., 2016). Studies have also shown that social-economic factors such as the educational level of the woman, wealth level, employment status, exposure to media, lack of knowledge about importance of early ANC are associated with late ANC booking(Shaokang et al., 2002).

Biological factors like null parity, previous fetal loss and HIV status may be associated with late ANC booking as seen in studies done in Nigeria, Tanzania, Kenya (world health Organization, 2016). Women may experience barriers in accessing health service such as long distances to health facilities, staff availability and attitudes at health facilities, lack of money for treatment and transport to the health facilities and long booking procedures (Sinyange et al., 2016).

However, data regarding this area of study is limited in Nyimba District despite the opportunities that exist to analyze routinely collected information such as the hospital records and, the understanding on possible factors which may be associated with late ANC booking in Nyimba District is even more limited.

Globally, around 210 million women become pregnant every year (Health-related Millennium Development Goals, 2015). There are 31 million stillbirths, 80 million unwanted pregnancies, and 47,000 women who die as a result of unsafe abortions. The global estimation of pregnant women who receive an ANC was 71%. In sub-Saharan Africa, 69% of pregnant women have at least one ANC visit (Health-related Millennium Development Goals, 2015).

Whereas the coverage of at least four ANC visits was lower, which was 44%. Of this, around 80% of women in the richest quintile have access to three or more ANC visits, while only 48% of the poorest women have the same level of access (Health-related Millennium Development Goals, 2015).  Most pregnant women were late in scheduling their first ANC appointment due to a lack of knowledge about when to begin their first ANC visit, the number of recommended visits, and a lack of familiarity with pregnancy symptoms.

Every day, over 800 women die from complications connected to pregnancy and childbirth around the world, with Sub-Saharan Africa, which includes Ethiopia, accounting for over 66% of those deaths (Ebonwu et al., 2018). According to the World Health Organization (WHO), 11,000 maternal deaths occurred in Ethiopia in 2015 during pregnancy, childbirth, and the postpartum period .

Postpartum hemorrhage, sepsis, pre-eclampsia, eclampsia, and delivery complications are the leading causes of maternal mortality in Ethiopia. Despite the fact that the majority of maternal deaths are preventable, many women lack access to evidence-based interventions including antenatal care (ANC) during pregnancy and related services during labor and the postpartum period due to poverty, a lack of awareness, and cultural aspects (Ebonwu J, et Al , 2018)..

One of the strategies used to reduce maternal mortality was timely and high-quality antenatal care. The predictors associated with late initiation of antenatal care varied across studies, including residence, education of the pregnant woman, husband’s occupation, parity and being planned, women who had no previous obstetrical complications, and those who lived far away from health care facilities, among others (Ebonwu et Al., 2018).

The rate of early booking ANC visits in Cameroon is low, as is evident by the Demographic and Health Survey (DHS) report in 2011 where only 34% of pregnant women did a booking visit within the first trimester.  Halle et al. reported a similar prevalence of 27.2% in a health centre in Buea .

These findings therefore demonstrates that late initiation of ANC visit is a major public health concern in Cameroon. To the best of our knowledge, no study has been conducted to identify the Factors of late first ANC booking in Cameroon.  In order to decrease child and maternal mortality, it is critical to know the time of the first ANC visit for pregnant women and the factors affecting it. Therefore, this study aimed to measure the prevalence and factors associated with late  ANC  booking at the Molyko health center Buea.

1.2 Problem Statement

It is very important for pregnant women to book for antenatal care early, preferably in the first trimester of pregnancy (Sinyange et al., 2016). This is necessary for detection and prevention of any possible complications of pregnancy for the mother and the unborn child; such practice can ensure good chances of safe delivery and delivery of healthy children (Moller et al., 2017).

The rate of early booking ANC visits in Cameroon is low, as is evident by the Demographic and Health Survey (DHS) report in 2011 where only 34% of pregnant women did a booking visit within the first trimester.  Halle et al. reported a similar prevalence of 27.2% in a health centre in Buea .

These rates are alarming as they may be an indication  that most pregnant women risk their lives as well as those of the unborn children and this contributes to high maternal and infant deaths which the country is experiencing. However, To the best of our knowledge, no study has been conducted to identify the Factors of late first ANC booking in Cameroon.

In order to decrease child and maternal mortality, it is critical to know the time of the first ANC visit for pregnant women and the factors affecting it. Therefore, this study aimed to measure the prevalence and factors associated with late  ANC  booking at the Molyko health center Buea.

1.3 Rationale

Globally, the rate of child mortality decreased from 90 to 43 deaths per 1,000 live births between 1990 and 2015. Reducing maternal and child mortality is one of the Sustainable Development Goals (SDGs) objectives (Oshinyemi, Aluko, et al., 2018). Whereas this achievement is not sufficient to meet the MDG target .

Therefore, for sustaining SDG, it is crucial to know the details about the prevalence and factors associated for the delay in ANC booking of pregnant women(Oshinyemi et al., 2018).  So, this study aims to determine the prevalence and factors associated with late ANC booking among pregnant women attending ANC at the Molyko health center Buea Southwest region.

1.4 Research Questions

1. What is the prevalence of late ANC booking among pregnant women attending ANC at the Molyko Health Center Buea?.
2. What are the factors associated with late ANC booking among pregnant women attending ANC at the Molyko Health Center Buea?.
3. What are the challenges faced by pregnant women attending ANC at the Molyko Health Center Buea?.

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