Patient factors associated with gestational age at first presentation to antenatal clinic at four facilities in the Masquassi hills sub district, North West Province, Republic of South Africa
Manwana, Jean-Paul Kipangu
Background Research has shown that women who do not obtain adequate prenatal care significantly reduce their chances of a favourable pregnancy outcome. Despite antenatal care services being provided free of charge in South Africa, only 53.9% of women attend antenatal care before the gestational age of 20 weeks or less as recommended by the World Health Organisation (WHO) and National Department of Health (NDOH).The interventions aimed at reducing unfavourable pregnancy outcomes are most effective during prenatal care, it is crucial to identify factors that prevent pregnant mothers from presenting early. It is believed that the findings of this study will give us an insight into the rate of early ANC attendance and will also be useful to policymakers and facility managers, especially at the Primary Health Care (PHC) level, in optimising patient care and improving healthcare services. Aims and objectives Therefore, the objectives of this study were: 1 To establish the gestational age at which pregnant women present to first antenatal visit in Maquassi Hills sub district. 2 To describe participants’ socio-demographic profile, health status and obstetrical characteristics 3 To explore knowledge and attitudes that affect timing of first presentation. 4 To determine any association between first ANC presentation and socio-demographic, obstetric factors, knowledge and attitudes towards ANC. 5 To determine predictors for first antenatal attendance. Method This was a cross-sectional study conducted in four publicly funded primary health facilities in the Maquassi Hills sub district, between August and October 2015. A total of 127 participants were directly interviewed using a structured questionnaire to obtain information about their socio-economic characteristics, ANC and services rendered. Most of the information required for the study was obtained from the Maternity booklet. This included demographic data, obstetric history, medical history, and gestational age. Data analysis was done using Microsoft Excel 2014. A chi-square test was used to determine associations between time of the first presentation and each variable; and a multiple variable regression was used to determine predictors of early attendance. Results Most participants interviewed were: Tswana speaking (72.4%), with a mean age of 26.5 years (SD = 5.9), had a high school education (84.6%) and were mostly single (70.6%). This study showed that 68.9% of the respondents presented to their first antenatal booking within the recommended time of less than 20 weeks. The average period of presentation was 16.3 weeks (SD = 6.0). No statistically significant association was found between socio- demographic, obstetrical characteristics and the timing of the first antenatal visit. All the participants knew that the right time to book an appointment was before 20 weeks as the best perceived time for initiation of ANC. However, there was a statistically significant difference in the best perceived time between those who booked early (2 months [1.99 months (SD =1.145)]) compared with those who booked later (3 months [2.83months (SD = 1.595)]) (p = 0.006). The multivariate analysis showed that participants who perceived three months as the best time for booking were 1.5 times more likely to book later (OR= 1.589, 95% CI 1.227-2.059) compared with those who perceived that the best time was at two months. The most frequent reason given for booking early was to confirm pregnancy (64.0%) and (31.1%) initiated ANC because they were ill. Long waiting times and staff attitude were reported by participants (91.3%) and (5%) respectively as barriers to early ANC visit. Conclusion The findings of this study show that most participants booked antenatal care timely and all participants knew the right time to initiate ANC. However, there is incongruity between knowledge and practice for the 30% who presented late. This could be attributed to the long waiting time and staff attitude mentioned by some of the participants. There is a need therefore to address the demotivating factors such as long waiting time, and staff attitude in order to promote early ANC booking/attendance.
A research report submitted to the Faculty of Health Sciences in partial fulfilment of the requirements for the degree of Master in Family Medicine Department of Family Medicine University of the Witwatersrand, Johannesburg, 2017.