Contributing barriers to loss to follow up from antenatal care services in villages around Addis Ababa: a qualitative study

Abstract

Background Problems during pregnancy, childbirth and postpartum are the major contributors to maternal and perinatal morbidity and mortality. Focused antenatal care is an intervention set to provide basic services for pregnant women, to reduce morbidity and mortality related to pregnancy. In Ethiopia, there is a significant loss to follow up from antenatal care services between the first and fourth visits. The aim of this study is to explore the potential contributing barriers to loss to follow up of pregnant women from antenatal care services in villages around Addis Ababa, the capital city of the country. Methods A qualitative research method was used, where 20 in-depth interviews (zonal, woreda and health center managers, midwives and health extension workers were the participants) and three focus group discussions (mothers who were lost to follow up, mothers who completed four sessions of antenatal care visits, and community volunteers were the participants) were conducted. A qualitative data analysis software, ATLAS.ti 8, was applied. Results Inability to deliver essential antenatal care services which occurs primarily due to shortage of the required medical equipment, drugs, and other supplies is a major barrier for sustainable attendance of antenatal care services followed by poor care, respect, and receptiveness of service providers. Lack and cost of transport as well as partners’ approval and support were also claimed to be part of the major barriers. Community culture and pervious maternal experiences as well as maternal sociodemographic factors like maternal age at time of pregnancy and educational status of mothers were also reported as barriers to seeking and completion of antenatal care services. Conclusions Both demand and supply side barriers play a significant role in the loss to follow up from antenatal care services. Availing essential antenatal care services, closer to the community by improving the infrastructure, health workforce and supply chain system is recommended.

RHD exon 5, 7 and 10 targeted non-invasive prenatal screening of fetal Rhesus-D (RhD) in selected RhD negative pregnant women in Ethiopia

“…Limited or no visits to the antenatal care unit of the hospital during the early weeks of the pregnancy, confines the recruitment of the subjects, hence fewer subject recruitment was observed in the first trimester of the pregnancy. The data from the study area debate multiple underlying factors responsible for the limited antenatal care visits or loss to follow up in the early weeks of pregnancy [ 12 ]. Nevertheless, the diagnostic accuracy of NIPT is higher in the second and third trimesters of the pregnancy [ 13 ], however, we didn’t set this as a base parameter for the recruitment of our subjects.…”

Dropout from a maternal and newborn continuum of care after antenatal care booking and its associated factors in Debre Berhan town, northeast Ethiopia

“…This is likely due to lack of timely transportation, long distance of health facilities, high workload, shortage of time, and costs involved. Even if health facilities are available in rural areas, there is a lack of healthcare providers, essential medication, and laboratory instruments ( 12 ). Furthermore, urban communities are more likely to be educated, and education was significantly associated with the continuum of care in our study.…”

“…Shortage of medical equipment, drugs, and other supplies; lack and cost of transport; culture; and previous maternal experiences, as well as maternal sociodemographic factors, that is, age at the time of pregnancy, rural residence, income, and low level of education, was a barrier to seeking and completing antenatal care services (12). Long distance to a health facility, poor antenatal counseling, lack of autonomy in healthcare decisions, no media exposure, inadequate provision of health education and promotion, poor knowledge of pregnancy complications, and danger signs were also among the factors influencing the higher rate of dropout from the continuum of care (6)(7)(8)11).…”

Health system-related barriers to prenatal care management in low- and middle-income countries: a systematic review of the qualitative literature

“…Stakeholders perceived lack of a good relationship between healthcare providers and PNC clients as a key barrier to PNC (Larsen et al, 2004;Conrad et al, 2012;Rahmani & Brekke, 2013;Andrew et al, 2014;Mahiti et al, 2015;Callaghan-Koru et al, 2016;Meyer et al, 2016;Alanazy et al, 2019;Maluka et al, 2020;Uldbjerg et al, 2020;Mourtada et al, 2021;Tsegaye et al, 2021;Udenigwe et al, 2021). Some of them reported that PNC providers have negative attitudes toward PNC clients (Larsen et al, 2004;Nyathi et al, 2017;Chimatiro et al, 2018;Nachinab et al, 2019;Uldbjerg et al, 2020) and they refuse to consider them seriously (Alanazy et al, 2019).…”

“…Manithip et al, 2013;Shabila et al, 2014;Baffour-Awuah et al, 2015;Mahiti et al, 2015;Callaghan- Koru et al, 2016;Manda-Taylor et al, 2017;Jacobs et al, 2018;Alanazy et al, 2019;Nachinab et al, 2019;Uldbjerg et al, 2020;Tsegaye et al, 2021) Primary Health Care Research & Development…”