Factors associated with late ANC initiation among pregnant women in select public health centers of Addis Ababa, Ethiopia: unmatched case–control study design

Abstract

BackgroundAlthough Ethiopia has shown remarkable achievements in reducing maternal mortality in the last 10 years, the prevalence of late antenatal care (ANC) initiation is still high in the country.ObjectiveThe primary purpose of this study was to identify the factors related to late ANC initiation among pregnant women in selected public health centers in Addis Ababa, Ethiopia.Subjects and methodsA total of 402 pregnant women (cases=134, controls=268) were recruited using multistage sampling. The design selected for the study was unmatched case–control. EpiData version 3.02 and SPSS version 20.0 were used for data entry and statistical analysis, respectively. Binary logistic regression model was used to model the odds of late ANC initiation.ResultsThe odds of attending ANC late were significantly higher for mothers with a monthly household income of <US$45.5 (AOR=6.67; 95% CI: 2.40, 18.60), who were educated up to eighth grade or below (AOR=2.17; 95% CI: 1.03, 4.60), who had unplanned pregnancy (AOR=2.73; 95% CI: 1.03, 7.23), who did not receive advice from health extension workers or TV/radio (AOR=5.21; 95% CI: 2.49, 10.88), who stayed for <5 years in Addis Ababa (AOR=3.93; 95% CI: 1.89, 8.12), and who was charged >$8.50 to start the ANC service (AOR=3.04; 95% CI: 1.98, 4.67).ConclusionLow educational level, low income of the household, unplanned pregnancy, stay for <5 years in Addis Ababa, not getting advice from health extension workers or local TV/radio and higher cost associated with initiation of the first ANC service were the main predictors of late ANC initiation. Therefore, any intervention which would need to improve early ANC initiation should focus on economic empowerment of women, and tailored health education for migrant women should be strengthened.

Late initiation of antenatal care and associated factors among pregnant women in Addis Zemen primary hospital, South Gondar, Ethiopia

“…According to our study, the odds of booking ANC late increased by 72% among mothers who paid for transport to get to ANC service compared to those who did not pay. This result is consistent with a study done in Addis Ababa [18]. The possible reason could be that mothers, especially from rural areas are expected to travel long distance to reach health facilities; so they may need wait until they get money for transport.…”

“…According to our study, mothers who had unintended pregnancy had 2.31 times increased odds of booking ANC late compared to mothers with planned pregnancy. This result is consistent with those of other studies done in different parts of Ethiopia [18, 21, 23, 27, 32, 35], Zambia [22] and South Africa [10]. The possible reason might be that mothers with unintended pregnancy may miss a support from their partners or families which may decrease their good health seeking behavior [36].…”

Association between pregnancy intention and late initiation of antenatal care among pregnant women in Ethiopia: a systematic review and meta-analysis

“…The studies were conducted from 2013 to 2019 in various regions of the country. Of the fourteen studies included in the final analysis, six studies were conducted in the SNNP region [ 34 – 36 , 38 , 42 , 43 ], four were conducted in the Amhara region [ 12 , 37 , 39 , 44 ], and three were conducted in Addis Ababa [ 29 , 41 , 45 ]. The remaining study was conducted in Tigrai region [ 40 ].…”

“…Of the total included studies, 13 studies were crosssectional [12,29,[34][35][36][37][38][39][40][41][42][43][44] and only one study was a casecontrol study design [45]. They had an overall of sample size 6390 pregnant women in Ethiopia, and the study sample sizes ranged from 256 to 997 participants.…”

Trends of delayed first antenatal care visit among pregnant women in Ethiopia based on the EDHS 2000-2016 data: Multivariate decomposition analysis

“…This nding was supported by the study done in public health centers in Addis Ababa, Ethiopia in which women who had no occupation were more likely to delay the rst antenatal care visit [31]. The possible reason might be women who had no occupation were more likely to be economically dependent and consequently unable to access maternal health services recommended by health workers [32]. This implies that women who had no occupation or were not employed may not get important information about antenatal care visits from others in the workplace.…”