“I should have started earlier, but I was not feeling ill!” Perceptions of Kalenjin women on antenatal care and its implications on initial access and differentials in patterns of antenatal care utilization in rural Uasin Gishu County Kenya

Abstract

AimThe aim of this study was to explore how Kalenjin women in rural Uasing Gishu County in Kenya perceive antenatal care and how their perceptions impede or motivate earlier access and continuous use of antenatal care services.MethodsA study was conducted among 188 pregnant and post-natal mothers seeking care in 23 rural public health facilities. Gestational age at the initial antenatal care booking was established from their medical cards. Further researcher-administered questionnaire with closed and open-ended questions was used. Key informant interviews with traditional birth attendants (n = 6) and maternal and child health nursing officers (n = 6) were also conducted for triangulation. Descriptive statistics were applied using SPSS programme. The interviews of women who gave consent to be audio recorded (n = 52) were transcribed and thematically analysed using MAXQDA program, based on Andersen and Newman’s (1973) behavioural model of health services utilization.ResultsThe mean gestational age at booking initial biomedical care was 23.36 weeks. Only 18 patients (10%) booked before 13 weeks and 45% made four or more visits. The main reasons given for early booking were: illness in index pregnancy (42%) checking the foetus position and monitoring foetus progress (7%). The main reasons given for late booking were: no reason (31%), was not feeling sick (16%), fear or shame due to unexpected pregnancy (13%). Almost half of the respondents (44%) used both biomedical and traditional antenatal care services. Main reasons for visiting traditional care were to: check foetus position and reposition it (63%), collect medicinal herbs (31%), relief discomforts through massage (18%).ConclusionEarly antenatal care booking is meant for women with unpleasant physical signs and symptoms. Later ANC is meant to check foetus position and reposition it to cephalic presentation and monitor its progress and this is only possible if the foetus is large.

Implementation fidelity of nutritional counselling, iron and folic acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

“…This percentage is higher than the 80.2% in Kenya overall [1]. Late booking of ANC is also a common trend in other parts of Africa [30,[35][36][37] for various reasons and this strongly affects frequency fidelity and effectiveness of interventions. Khadim (2007) established a correlation between early registration to ANC services and iron supplement consumption among pregnant women in Senegal [21].…”

“…The predominant settlement pattern in Uasin Gishu County is rural (64.1%) [29] and malnutrition in Kenya is highly prevalent in the rural areas [1,2], hence the reason why this study was rural based. Data for this manuscript is part of a larger research project whose main objective was to investigate the social cultural context of nutrition in pregnancy and the utilization of nutrition intervention services in rural Uasin Gishu County [30].…”

Implementation fidelity of Iron and Folic Acid supplementation (IFAs) and associated challenges among pregnant women in Uasin Gishu County Kenya

“…This percentage is higher than the 80.2% in Kenya overall [1]. Late booking of ANC is also a common trend in other parts of Africa [45][46][47][48] for various reasons and this strongly affects frequency delity and effectiveness of interventions. Khadim (2007) established a correlation between early registration to ANC services and iron supplement consumption among pregnant women in Senegal [33].…”

Implementation fidelity of nutritional counselling, Iron and Folic Acid supplementation guidelines and associated challenges in rural Uasin Gishu County Kenya

“…This percentage is higher than the 80.2% in Kenya overall [1]. Late booking of ANC is also a common trend in other parts of Africa [30,[34][35][36] for various reasons and this strongly affects frequency delity and effectiveness of interventions. Khadim (2007) established a correlation between early registration to ANC services and iron supplement consumption among pregnant women in Senegal [21].…”