CHAPTER ONE

1.0 INTRODUCTION 

This chapter consists of the background, the statement of problem, objective, and significance of study, justification of study, scope of study and the definition of terms.

1.1 BACKGROUND OF THE STUDY.

The WHO defines Antenatal care ( ANC) also called prenatal care are services given to pregnant women by health  professionals (WHO, 2006). ANC is composed of recording medical history, giving assessment of individual needs,  giving advice and guidance on pregnancy and delivery. Antenatal care (ANC) is critical for ensuring the health of both the mother and the unborn child. It is during ANC visits that health professionals can monitor the pregnancy, detect any complications early, and provide necessary interventions to reduce maternal and neonatal mortality. The World Health Organization (WHO) recommends that every pregnant woman begin ANC within the first 12 weeks of pregnancy to optimize outcomes. However, many women in rural areas, including those in the Muea community, tend to start ANC much later than recommended. Understanding the factors contributing to the late initiation of ANC in Muea is crucial for addressing maternal health disparities in the region.

Maternal health is a significant aspect of public health that influences not only the well-being of women but also the survival and health of their children. One of the critical components of maternal health is the timely initiation of antenatal care (ANC), which helps ensure both maternal and fetal health during pregnancy. Despite the global recognition of the importance of early ANC, many pregnant women, especially those in rural and underserved communities, initiate care later than recommended by health experts. The World Health Organization (WHO) recommends that pregnant women begin ANC during the first trimester (within 12 weeks of pregnancy) and attend regular follow-up visits to reduce the risk of complications. However, in many rural, a significant number of women begin ANC visits much later, which can result in adverse maternal and neonatal outcomes.

Cultural beliefs and social norms play a significant role in healthcare-seeking behavior, including the timing of ANC. In, many other rural African communities, pregnancy is often seen as a private matter. Some women may prefer to consult with traditional birth attendants (TBAs) or rely on traditional medicine during the early stages of pregnancy rather than seeking formal medical care. These practices, while deeply embedded in the community’s culture, can contribute to delays in seeking medical attention and can expose women to the risks of complications that might be better managed in a clinical setting.

Moreover, in some instances, the stigma associated with visiting health facilities for ANC can further discourage women from seeking care early in their pregnancy. The perception that ANC is only necessary in the case of complications may delay women from realizing the importance of early and regular ANC visits.

In the early 2000s, the government of Cameroon, along with international health organizations, began making efforts to improve maternal health care across the country. However, despite these efforts, the uptake of formal ANC services remained low in rural communities. Several factors contributed to this issue, including cultural beliefs, transportation challenges, and limited health education. Several studies in Ethiopia report that entry to ANC visit associated with socio demographic variables, parity, media exposure, lack of social support, and cultural factors even though these studies are not consistent (Black v et Al,

2013). The Ethiopian government has built an impressive work to improve the health of mothers through health extension workers (Lincetto et al , 2008) Federal democratic republic of Ethiopia ministry of public health 2010].There is also an improvement in ANC booking time from 6% in 2005 to 11% in 2011 (central statistical agency,2010). Despite of these improvements, still maternal mortality ratio (MMR) is unacceptable in Ethiopia (676/100.000 birth). Determinant of the utilization of ANC are varied depending on each country and many factors. In Netherlands, the government recommend at least 6 times to visit ANC while this number in Finland is fifteen (Raatikailen,Heiskanen,&Heinonen, 2007).One study identified the number of antenatal visits was 12 times in Brussels metropolitan region (Beckman.,2010).Until now ,the determinant of the approximated number of antenatal visits during pregnancy still debate and the guideline about the number of ANC visit during pregnancy is not yet unify ,it depends on each country and each culture (Bernloehr,Smith &Vydelingum ,2005).The  frequency of four or more antenatal visits in sub-Sahara Africa was surprisingly reported, with at least 70% of women reporting four or more visits in Ghana, Nigeria ,Tanzania and Zambia ,in Rwanda and Senegal, as opposed to 75% and 72% of women reported only two or three visits (WHO,2003).

A study carried out in Cameroon [Etienne B et al] identified distance to health facility as a risk factor for poor pregnancy outcomes in adolescence. Late initiation and inadequate use of prenatal care services are independently associated with multiple variables, including demographic characteristics, socio-economic factors, predisposition cultural and religious factors, social support, and factors related to healthcare providers, women’s awareness and attitude, unintended pregnancy, high-risk medical or obstetric history, and health behaviors.(Abbdo A,A.et Al, 2014) Therefore, researcher intended to identify and determine factors associated with late prenatal care initiation among pregnant women in the Muea community .In Cameroon, the national target was that 90% of women should be receiving at least one ANC visit during pregnancy (MOH, 2013).However, the utilization of ANC is disparity between rural and urban areas. Women in rural areas tended to receive or attended ANC later, had fewer visits and received much fewer services than urban women (Tran et al.,2011).it was shown that a large of Cameroonian women did not use ANC sufficiently. Only 29.3% of women received ANC visits more than 4 times,2-3 times was 47.4%, 1 time was 10.3%,and especially no ANC was 13%.A study of lieu ,.(2007) was carried out in three provinces in rural areas of Cameroon with 4,836 participants showed that among women who participated in that study,71% of 1,335 participants had any ANC, and just 58% women had enough ANC visits that were greater or equal 3 times according to recommendation from Ministry of Health.

The late initiation of antenatal care (ANC) among pregnant women is a critical issue affecting maternal and child health in many rural communities, including Muea. To understand the factors influencing delayed ANC initiation, it is important to define and explore several key concepts and frameworks that shape healthcare-seeking behaviors, particularly in maternal health Antenatal care refers to the medical care provided to pregnant women throughout the pregnancy period. The primary goal of ANC is to monitor the health of both the mother and fetus, detect potential complications, and provide necessary interventions to ensure positive maternal and neonatal outcomes. WHO recommends that ANC should ideally start within the first trimester (12 weeks) and include at least four visits to ensure comprehensive care. The timely initiation of ANC is associated with reduced maternal and child mortality and morbidity.

In this conceptual review, we’ve examined key concepts essential to understanding the delayed initiation of ANC among pregnant women in Muea. These include the nature of ANC itself, healthcare-seeking behavior, barriers to healthcare access, maternal health outcomes, and the role of social determinants in shaping health behaviors. By understanding these concepts, we can better address the factors influencing the timing of ANC initiation in Muea and design effective interventions to improve maternal and child health outcomes in the community.

1.2 STATEMENT OF PROBLEM

According to WHO (2013), every year nearly half a million women die as a result of complications during pregnancy, child birth and the period of 6 weeks following delivery and the majority (99%) of these deaths occur in developing countries. One of the aims of the millennium development goals is to reduce mother- child mobility and mortality. Several deaths mainly occur due to 5 major causes: hemorrhage, eclampsia, infections (sepsis), abortion complications and obstructed labor. Cultural beliefs and ideas about pregnancy also had an influence pregnancy on ANC use in that they may lead to attending ANC late. This prompted the researchers to find out the Factors Contributing to the late start of Antenatal care amongst pregnant women at the Muea Community. The findings from this study will help in deriving strategies to encourage the utilization of ANC by pregnant women.

1.3 OBJECTIVES

1.3.1 General Objectives

• To determine the factors that contribute to the late start of antenatal care (ANC) amongst pregnant women.

1.3.2 Specific Objectives

• To assess the knowledge of pregnant women on the importance of ANC amongst pregnant women in the Muea community
• To assess the Factors influencing the late start of ANC amongst pregnant women in the Muea community
• To assess the Effects of late start of ANC amongst pregnant women in the Muea community

1.4 RESEARCH QUESTIONS

• Do pregnant women have knowledge on the importance of ANC in the Muea Community?
• What factors influencing the late start of Antenatal care in the Muea community?
• What is the effect of the late start of ANC amongst pregnant women in the Muea community?

1.5 SIGNIFICANCE OF THE STUDY