Factors associated with antenatal care attendance among the youth who have delivered at Pumwani Maternity Hospital, Nairobi County, Kenya.

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. 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, 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.