Factors Associated With Early Versus Late Attendance of Pregnant Women to the Antenatal Clinic in Medina Hospital,mogadishu. ( a Comparative Cross-sectional Study: )

Abstract

Introduction: Antenatal care as defined by WHO is care provided by skilled health-care professionals to pregnant women and adolescent girls in order to ensure the best health conditions for both the mother and baby during pregnancy. Globally during the period 2007-2014 only 64% of pregnant women attended WHO recommended minimum four contacts for ANC, suggesting more needs to be done to address ANC utilization and quality. A number of studies have demonstrated the association between antenatal care attendance and reduction of premature birth, low birth weight, congenital malformations, congenital infections, neonatal tetanus, pre-eclampsia and anemia. So far no conclusive data was found on antenatal care in Somalia as a whole. Some surveys were done by NGOs but face conflict issues in the country. This study seeks to identify factors associated with ANC attendance in both groups, the early versus the late attendees. Broad Objectives: To determine the prevalence of early vs late attendance of ANC and compare the factors associated with them at Medina hospital, Somalia Methodology: This is a comparative cross-sectional study conducted among early versus late ANC attendees. The study was conducted at Medina hospital, Somalia. The study population targeted 247 women who attended the antenatal clinic. Participants were assured of privacy and confidentiality. Data management & analysis: Structured questionnaire was used to collect data. Data was analyzed using IBM statistic SPSS version 23. Descriptive analysis was used to present socio-demographic characteristic of women attending the clinic. Continuous data analyzed by use of mean & standard deviation. Categorical data analyzed and displayed by use of frequencies and proportions. Adjusted odds ratio (OR) and 95%Cl was used to quantify association. Statistical significance of association between variables was tested by the use of fisher’s or chi square with a p value<0.05 considered to be significant. T-test was used to determine whether continuous data were significantly associated with late attendance. Results: Out of the 247 women, 149 women attended ANC early (≤12 weeks) and 98 women attended ANC late (>12 weeks). The patient’s age ranged from 16 years to 46 years with mean age 28.4 ± 7.17 years. Various sociodemographic characteristics were significantly associated

with late antenatal care attendance Maternal age ≥ 26 years (p<0.001), higher number of residents in the household (p<0.001), distance >5km from the nearest health facility (p<0.022) and lack of easy access to antenatal care service (p <0.003) were associated with late attendance. Multiparity was also strongly associated with late attendance (OR=7.51; 95% CI 3.07-18.4; P-value<0.002).On the contrary, urban residence (OR 3.26, 95%CI 1.33 – 0.82, p <0.001) and higher educational attainment (OR 0.40, 95% CI 0.23-0.67, p<0.001) were associated with early attendance Conclusion: This study found that three fifths of antenatal clients in Somalia sought antenatal care in the first trimester. Higher educational attainment and lower maternal age were associated with early attendance while the opposite was associated with late attendance.