ABSTRACT

Background: Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical check-up’s, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins, which prevents potential health problems throughout the course of the pregnancy and promotes the mother and child’s health. The study aims to assess the prevalence of late ANC by pregnant women attending the Bolifamba heath Centre. Methods: the study employed a descriptive cross- sectional study.  Questionnaire were used for data collection in order to assess Late Antenatal Care and Associated Factors Amongst Pregnant Women. The study was carried out at the Bolifamba health centre for a time period of three months (January 2022 to March 2022). A sample size of 119 pregnant women who attended ANC at the Bolifamba health Centre were recruited, using convenient sampling technique. The data collected was analysed with the use of data analysis tools as SPSS version 25 and Microsoft Excel and presented in the form of tables and charts. Results: The study results showed that majority 37.8% respondents do start ANC visit as from 12 weeks, followed by 31.1% respondents who start at the 24^th week while the minimum of 15.1% respondents start A N C visit at 36 weeks. Also, on the factors associated with ANC late startup the study found that majority of the respondents 74 (62.2%) cited fear of the cost of laboratory test being an associated factor responsible for late startup of ANC while only a minimum of 37 (31%) of the respondents were of the opinion that fear of disclosure of pregnancy is a contributing factor of late startup of ANC and lastly, the study found that 80 (67.3%) respondents attest to low weight at birth as a consequence of late ANC visit by pregnant women. Conclusion: The study concludes that majority of pregnant women begins ANC visit at 12 weeks and also fear of the cost of laboratory test, fear of disclosure of pregnancy and fear of hospital setting were all related factors that affect the late start-up of ANC of pregnant women. Thus patients ought to be sensitized on the importance of early ANC attendance.

CHAPTER ONE

INTRODUCTION

1.1 Background

Prenatal care, also known as antenatal care, is a type of preventive healthcare. It is provided in the form of medical checkups, consisting of recommendations on managing a healthy lifestyle and the provision of medical information such as maternal physiological changes in pregnancy, biological changes, and prenatal nutrition including prenatal vitamins, which prevents potential health problems throughout the course of the pregnancy and promotes the mother and child’s health (Atinga, R., & Baku, A., 2013). 

Globally, the maternal mortality rate (MMR) fell by nearly 44% over the past 25 years, to an estimated 216 maternal deaths per 100,000 live births in 2015 (Alkema, L., 2016). Developing regions accounted for approximately 99% (302,000) of this estimated global maternal deaths in 2015, with sub-Saharan Africa alone accounting for roughly 66% (201,000). This 2015 report estimates MMR in Cameroon at 596 maternal deaths per 100,000 live births. In 2015, countries met and put forward a series of goals known as sustainable development goals (SDGs). SDG 3 calls for the acceleration of current progress in order to achieve a global MMR of 70 maternal deaths per 100,000 live births in 2030. This global reduction of MMR and a positive pregnancy outcome can only be achieved if the care offered to women during pregnancy improve and they initiates antenatal care (ANC) early enough. Antenatal care refers to the care that is given to an expectant mother from the time that pregnancy is confirmed until the onset of labour (Chalmers B, Mangiaterra V & Porter R, 2001).  This care enables the promotion of a positive pregnancy outcome. The components of ANC include: risk identification; prevention and management of pregnancy-related or concurrent diseases; and health education and health promotion. Recently in 2016, WHO recommends a minimum of eight ANC contacts during pregnancy and that the first contact should be done before the 12th week of gestation. Planning for a safe delivery is an integral part of ANC (Fawcus S, etal,1996).

Early initiation of antenatal care plays a major role in detecting and treating some complications of pregnancy and forms a good basis for appropriate management during delivery and after childbirth. Failure to attend antenatal care early results in the potential for complications during pregnancy, delivery, and puerperium and hence increasing MMR. Existing evidence from most developing countries indicates that few women seek ANC services early in the course of pregnancy. Late initiation of ANC has been associated to: maternal education, unemployment, lack of knowledge or misconceptions about the value/purpose of antenatal care, marital status, socioeconomic status, financial constraints. The rate of early booking ANC visits in Cameroon is low, as is evident by the Demographic and Health Survey (DHS) report in 2011 where only 34% of pregnant women did a booking visit within the first trimester. Halle et al. reported a similar prevalence of 27.2% in a health center in Buea. These findings therefore demonstrate that late initiation of ANC visit is a major public health concern in Cameroon. This study seeks to determine the prevalence and risk factors of late ANC in the Bolifamba Health Center.

1.2 Problem Statement

Pregnancy related deaths and disorders remains inadmissibly high at the global front claiming millions of women and infants’ life (WHO, 2016). It is a recommendation by the world health organization that, all pregnant women should have at least four antenatal visits throughout their pregnancy period (WHO, 2016). The Cameroonian Demographic and Health Survey conducted in 2011 indicated that only 34% of pregnant women start antenatal care in the first trimester, despite the government’s effort to increase the rate of ANC for pregnant women in the country. Globally, while 86 percent of pregnant women access antenatal care with skilled health personnel at least once, only three in five (62 percent) receives at least four antenatal visits which is even worse in countries with high maternal mortality rates such as sub-Saharan Africa (51.9%) and least developed countries including Cameroon (34%) (WHO, 2011). Cameroon, the under eliminate mother to child HIV transmission, prevent and treat malaria, reduce the prevalence 85% of pregnant women attended at least one ANC visit on average; they were 60% attending  for reducing maternal and infant rocketing death tolls in Cameroon. Power illustrated by the perfect matching of poverty and ANC services utilization maps, effectively ANC services are used. In turn, the availability, quality and physical, cultural and organizational and systemic(e.g., woman and spouse educational level, marital status, this situation greatly reduces the impact of priority interventions within the framework of the with predominant beliefs, perceptions and socio-cultural practices usually determine how

four antenatal care (ANC) visits to reduce the suffering endured by the families of those 4500

women dying every year from childbirth. Skilled attended delivery rate is only 61.8%. In 2010, at least four and 34% attended the critical first quarter visit. The World Health Organization stated that “half a million mothers and 10.6 million children will die globally in each year if governments do not increase their efforts to reduce maternal and child deaths” Bloom S, Lippeveld T, Wypij D., (1999). It is therefore important to investigate into the prevalence and risk factors of late ANC, to help with the implementation of necessary policies which can help deal with maternal deaths and help produce healthy babies. With the experience during internship and back at home seeing pregnant women who start ANC late and some who do not even attend it once make me to ask questions if pregnant women actually have knowledge on the consequences of late ANC. The researcher decided to carry out this piece of work to determine if pregnant women have adequate knowledge on the consequences of late ANC and Associated Factors Amongst Pregnant Women Attending the Bolifamba Health Center.

1.3. Rationale

According to the United Nations Inter-Agency Group for Child Mortality Estimation, maternal and child mortality rates are among the most important indicators of child health, nutrition, implementation of key survival interventions, and the overall social and economic development of a population (United Nations Inter-Agency Group, 2016). The health of pregnant women and their unborn babies cannot be underestimated, and as stated by the UN Secretary-General Ban Ki-moon cited in an overview document on WHO guideline on antenatal care that “To achieve every Woman every Child vision and the Global Strategy for Women’s, Children’s and Adolescents’ Health, we need innovative, evidence-based approaches to antenatal care” (WHO, 2016 ). Similarly, Dr. Janet Campbell, a passed civil servant in UK stated as early as 1929 that “the first requirement of maternity service is effective supervision of the health of the woman during pregnancy”. This conversely is the kind of service provided by antenatal care.

Therefore as public health agencies together with the world health organization, Cameroon health service and other non-governmental agencies continually puts up efforts and strategies in an attempt to make life in communities, regions, countries and the world at large become enjoyable, maternal health with a focus on ANC cannot be exempted because the death of a pregnant woman poses much burden and loss to the affected family and the community since two lives can be lost in the process (both the woman and the foetus). Issues of maternal health focusing on antenatal care therefore requires prompt attention in the field of health and research. While a lot of studies have been conducted in neighboring countries and other regions in Africa concerning antenatal care service utilization, none is done evaluate the prevalence and risk factors of late ANC in Bolifamba Health Center in Buea municipality (Cameroon). Therefore this study is justifiable because the knowledge gotten from it help in the implementation of new strategies in other to help increase the rate of ANC care for pregnant women in Buea municipality, Cameroon and the whole at large

1.4 Research Questions

      What is the time frame for first ANC Visit amongst pregnant women attending ANC in the Bolifamba Health Center?

     What are the factors associated with late start up of ANC amongst pregnant women in the Bolifamba Health Center?

    What knowledge do pregnant women in the Bolifamba Health Center have about the consequences of late ANC?

1.5 Objectives

1.5.1 General objectives

To determine the rate or frequency or prevalence of late ANC.

1.5.1 Specific objectives

To determine the time frame for first ANC Visit amongst pregnant women attending the Bolifamba Health Center.

To determine the factors associated with late start up of ANC amongst pregnant women in the Bolifamba Health Center.

To access the knowledge of pregnant women about the consequences of late ANC in the Bolifamba Health Center.