Introduction

Antenatal care service, which is among strategies to maintain maternal and fetal well being, is strongly recommended to be initiated early during pregnancy. Late first visit is one of the three common problems throughout sub Saharan Africa (SSA) posing difficulty in accomplishing world health organization (WHO) recommendation.

Objective

The objective of this study was to determine the proportion and associated factors of timely first ANC visit among pregnant mothers in Dessie Referral Hospital.

Methods and Materials

Institution based cross sectional study design was applied. The consecutive sampling technique was used to select 284 pregnant mothers and participants are interviewed by using structured questionnaire.

Results

It is revealed that timely ANC visit was found as 27.3%. maternal educational status and knowledge of the time for first ANC visit were statistically significant variables with the mother having first ANC visit timely at a p- value <0.05.

Conclusion

The study concluded thatutilization timely first ANC visit is affected by the maternal educational level and ANC awareness.

Keywords:Socio demographics, Antenatal care, Determinative Components, Pregnant women

Antenatal care, which is given to pregnant mothers, is widely used for prevention, early diagnosis and treatment of general medical and pregnancy related complications [1]. It aims to prevent maternal and prenatal mortality and morbidity. Approximately 536,000 maternal deaths occur annually, of which over 95 % occur in sub Saharan Africa and Asia [2]. In sub Saharan Africa mothers’ risk of dying from treatable or preventable complications of pregnancy and child birth over the course of their life time is 1 in 22 compared to 1 in 7,300 in the developed regions [3].

The utilization of ANC from a trained provider is important to monitor the pregnancy and reduce morbidity and mortality risks for the mother and child during pregnancy and delivery [4]. Early ANC and regular follow up of service usually provide a range of opportunities for delivering health information and interventions that can significantly enhance the health of the mother and the fetus [5].

The standard of care when evaluating mothers with a potentially complicated first trimester pregnancy is to take a detailed history of the risk factors and ascertain the clinical course because it will help to have enough time for essential diagnosis and treatment regimen. But this will happen only if the mothers come to health institutions early in the first trimester.

An additional 300 million women suffer from short- or long-term illnesses related to child bearing [6]. In many developing countries, complications of pregnancy and childbirth are the leading causes of death among mothers of reproductive age. A mother dies from complications from childbirth approximately every minute [7].

Early detection of problems in pregnancy leads to more timely referrals for mothers in high risk categories or with complications. This is particularly true in Ethiopia where three-quarters of the population live in rural areas and where physical barriers pose a challenge in providing health care.

For many years, like that of many other developing countries Ethiopia has been implementing a narrow focused maternal and child health programs.

According to the systematic review made on antenatal care as a means of increasing birth in the health facility and reducing maternal mortality, the minimum antenatal care visits recommended by WHO (4 visits) was possible only for less than about one-third of the pregnant mothers in some SSA countries like Niger (15%), Ethiopia (19%), Chad (23%), Burundi (33%), Mali and Rwanda (35% each) [8,9].

The 2016 EDHS results show that 62 percent of women who gave birth in the five years preceding the survey received antenatal care from a skilled provider at least once for their last birth. Three in 10 women (32 %) had four or more ANC visits for their most recent live birth [10].

S o c i o - d e m o g r a ph ic c h a r a c te r isti c s

The response rate was 95.4% (271). Most of theparticipants (82.7%) were in the age between 20 and 34 years. Among the participants 262 (96.7%) were married. Most of the participants (60.9%) were Amhara in ethnicity. Only 104 (38.4%) mothers were beyond secondary education. Nearly half of the participants were employed (57.5%).

Table 1: T h e d e m o g r a phic c h ar a ct e ri s tics of the mothers who attend ANC at Dessie Referral Hospital, 2018

Obstetric C h arac t eristics of t he parti c i p ants

From the total participants, 11.8% and 5.9% reported that they had encountered abortion and stillbirth respectively.

Table 2: The obst e tr i c s c h a r ac t e rist i c s of p r e gn a nt mo t h e rs a t t e ndi n g A N C s e rvi c e a t D e ss i e r e f e r r a l hospital, 2018

Kn o w l e d ge a b o u t A N C

Below half of pregnant mothers (42.8%) knew about ANC from health education. Thirty-five-point eight present of the participants got information about ANC from mass-media and 15.5% use both mass-media and health education as a source of information and the rest 5.9% of mothers don’t know about first ANC visit.

F i g . 1: Number of p r e g n a n t mothers a nd their sour ce s of info r mation about ANC

Seventy-three (26.9%) mothers know about the first ANC time. And around half of (53%) the mothers believed that ANC visit is important for both the mother and the fetus.

Table 3: Kno w ledge of pregn a n t m othe rs ’ a bout of A N C vis i t at Dessie Referral Hospital, 2018 .

P r e g n a n t m o t h er s ’ P r a c ti c e of A N C

Majority of the participants (83.7%) had ANC visit in their previous pregnancy. Regarding theircurrent pregnancy, 27.3% of them had attended their first ANC on time (before12 months).

Table 4: The practices p r e gn a nt mo t h e rs in utilizing ANC service a t D e ss i e r e f e r r a l hospital, 2018

Associa te d f a c to r s that de t e r m i n e f irst A N C visit

The result of multivariable logistic regression analysis showed that maternal educational status and knowledge of the time for first ANC visit were statistically significant variables with the mother having first ANC visit timely at a p- value <0.05.

Table 5: Variables that show statistically significant association by logistic regression analysis at Dessie Referral Hospital, 2018

Our study finding is in line with and different from some other study findings. This study found out the proportion of having timely first ANC visit as 27.3% which is almost incongruent with a finding in Durban, South Africa that is 23.4% [11]. This similarity might be due to sociocultural similarities between the two countries. But it is lower than the findings revealed by the studies done in Addis Ababa and Mekelle, Ethiopia that reported 40.2% and 48% respectively [12]. The difference can be justified due to accessibility and availability differences of health facility and public awareness differences among these cities.

In this study educational status of the mothersand knowledge of the time of first ANC visit are found as significantly associated with having timely first ANC visit. Mothers whose educational status beyond secondary education are eight times more likely to have timely first ANC visit than who cannot read and write. This finding is in line with finding found in Kwale District, Kenya which shows women with secondary education or above were more likely to attend ANC [13]. The similarity can be explained by the demographic similarity of the study subjects. The reason for time of first ANC visit knowledge became an associated factor can be justified as the more the mothers know about the time and benefits of first ANC visit, the higher they come on time for first ANC visit.

Con c lusion and Recommendations

Educational status of the mothers and knowledge of the time of first ANC visit are found as significantly associated with having timely first ANC visit. This shows that the utilization of first ANC visit is affected by the maternal educational level and ANC awareness. Based on these findings we recommend to Ministry of health and related stake holders can strive to make more girls to go beyond secondary education and health care providers particularly Health Extension Workers should extensively disseminate the knowledge about the time and the benefits of first ANC visit.

Conflict of Interest: The authors declared no conflict of interest.