High Parity and Low Education are Predictors of Late Antenatal Care initiation among Women in Maternal and Child Health Clinics in Kwale County, Kenya

Norah M. Wekesa, Violet Wanjihia, Anselimo Makokha, Raphael W. Lihana, Judith A. Ngeresa, Satoshi Kaneko, Mohamed Karama


Background: Timely initiation of antenatal care (ANC) clinic attendance during pregnancy helps identify and reduce risk factors in pregnancy.  The World Health Organization (WHO) recommends at least four ANC visits during pregnancy with the first being in the first trimester. In most developing countries including Kenya, the first visit occurs late in some mothers. Aim: This study describes ANC attendance by mothers at clinics in Kwale County. It was conducted with the aim of determining factors affecting ANC attendance in two dispensaries in Kwale County. Design: A cross-sectional study using quantitative research methods was adopted. Results: Two hundred and eighty pregnant women at a gestational age of 20 weeks and above were recruited and interviewed. All the mothers made at least one ANC visit with 19.6% starting in the first trimester. About a quarter of the mothers (24.0 %) came for the first time at nine months gestational age.  There was a significant relationship between late ANC initiation and low or no formal education (p = 0.001) as well as higher parity (p = 0.0001). Mothers with no formal education were four times more likely to initiate ANC clinics late  compared to those with secondary or tertiary education (OR = 4.687; CI 1.765 – 12.447). The likelihood of mothers whose husbands had no formal education initiating ANC later was almost three times more likely as compared to those who had secondary or tertiary education (OR = 2.775; CI 1.107 – 6.960).  Multiparous women were more likely to initiate ANC clinics earlier compared to grand multiparous women (OR = 0.513; CI 0.223 – 1.183). Conclusion: Timely initiation and appropriate ANC attendance was low in Kwale. Low education level and high parity had a significant negative association with timely ANC initiation. There is need for community mobilization and enlightening on the importance of timely ANC attendance for mothers to reap the full benefits of maternal and child health care.

Keywords: Maternal, Antenatal, Child, Health, Parity, Multiparous, Grand multiparous.


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