Influence of early booking for antenatal care on antenatal and early pregnancy outcomes at Kenyatta National Hospital
Introduction: The value of antenatal care (ANC) includes enhanced level of knowledge in preparation for motherhood, early detection of pregnancy related complications and their corrective and preventive measures. Early booking for antenatal care (<16 weeks) in Kenya remains low, at 15%. This forms the basis for this study. Objective: To determine whether mothers who book early experience better birth preparedness, ANC investigations and pregnancy outcomes compared to those who book late. Study Design: A retrospective cohort study, where the exposure of interest was booking for antenatal care. Study Setting And Site: Kenyatta National Hospital (KNH) labour ward, antenatal/post natal wards, renal unit, ICU, and HDU Study Population: Exposed group had early booking (<16weeks) for antenatal care while the unexposed had late booking (>28weeks). Sample Size: A total of 300 participants, 150 for each group. Data Analysis: Chi square was used to determine association between birth preparedness, investigations, pregnancy outcomes and categorical variables and ANC booking. Odds ratio (OR) with 95% C.I and P-value less than 5% were used to test the strength of association Results: Late booking was associated with lower odds of birth preparedness evidenced by: lower knowledge of expected date of delivery (OR 0.26; P=0.005; 95% CI 0.1-0.66), and lower likelihood of having a birth plan in terms of desired place of delivery, preferred skilled birth attendant, birth companion, means of transport and blood donor (OR 0.24; P=0.006; 95% CI 0.09-0.67). Late booking was also associated with lower odds of emergency preparedness like knowledge of danger signs during pregnancy (OR 0.09;P=<0.001;95% CI 0.05-0.18) and postpartum emergency preparedness like knowledge of danger signs in puerperium (OR 0.16;P=<0.001;95% CI 0.08-0.33)and during infancy (OR 0.05;P=<0.001;95% CI 0.03-0.09).Late booking was associated with lower knowledge on modern family planning methods(OR 0.17;P=0.001;95% CI 0.10.29), and childhood immunization ( OR 0.1;P=<0.001;95% CI 0.06-0.17). Late booking was associated with lower likelihood of interventions like: Folic acid supplementation (OR 0.02; P=<0.001; 95% CI 0.01-0.03) and iron supplementation (OR 0.39; P=0.001; 95% CI 0.23-0.66). Women with primary level of education were more likely to book late compared to those with tertiary education, (OR 1.94; p= 0.033; 95% CI 1.05-3.57). Late booking was more likely among women residing in rural areas compared to those in urban areas (OR 0.33; 95% CI 0.11-0.93, p = 0.037). Late booking was also more likely among unemployed women compared to employed women (OR 0.54; 95% CI 0.31-0.96, p = 0.036). The differences in maternal and early neonatal outcomes were not statistically significant (OR 3.18; 95% CI 1.00-10.08, P=0.05) and (OR 0.81; 95% CI 0.45-1.45; P=0.479), respectively. CONCLUSION: Early booking for ANC tends to confer better birth preparedness, and better antenatal care interventions compared to late booking. The timing for antenatal care booking, however, seems not to influence the maternal and early neonatal outcomes.