ABSTRACT.

Background; Antenatal care (ANC) is a critical component of maternal health aimed at ensuring the wellbeing of both mother and child during pregnancy (World Health Organization, [WHO], 2016), globally, approximately 86% of pregnant women receive antenatal at least once with 65% receiving at least 4 visits or more throughout their pregnancy. Aim:  knowledge, practices and factors associated with the utilization of antenatal care among pregnant women in the ndongo communityMethodology: the research designed used was a community based cross sectional study and 100 study participants were conveniently selected from the quarters. The data was collected mainly by the use of pre tested structured questionnaires and analyzed with excel. Results: the data indicate that 40% of women identify the WHO recommended 8 or more ANC visit, demonstrating modern awareness. However 30% believe that 4 visits are adequate and 20% consider fewer than 4 visit sufficient. Encouragingly, 70% of respondents correctly indicated that, ANC should commence as soon as pregnancy is confirmed, aligning with WHO recommendations. Regarding ANC services, 65% correctly identified that, comprehensive services, including health education, vaccinations and screenings are provided during visit. However 35% lack complete understanding highlighting the need for enhanced information dissemination. A majority 75% recognized the importance of iron and folic acid supplementations in prevented anaemia and birth defects, though 10% remained unaware of this critical facts. Conclusion: the knowledge was high, factors associated with the utilization of the ANC were high and practice of ANC was relatively low. Recommendations: improved health education, this can be achieved by utilizing community health workers, local media and outreach programs.

Keywords: Antenatal Care Services, knowledge, pregnant women, Community

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Antenatal care (ANC) is a critical component of maternal health, aimed at ensuring the well-being of both mother and child during pregnancy. It is widely recognized as a strategy to reduce maternal and infant mortality rates, promote early detection of complications, and improve maternal health outcomes (World Health Organization [WHO], 2016). However, the extent of ANC utilization remains suboptimal in many regions, especially in low- and middle-income countries, where barriers such as cultural beliefs, economic constraints, and lack of awareness hinder women’s access to these vital services (JHPIEGO, 2014). Antenatal care (ANC) is a critical component of maternal healthcare that ensures the well-being of both mothers and their newborns. The global prevalence of ANC utilization has been steadily improving, but significant disparities persist between regions and countries.

Globally, According to the World Health Organization (WHO), approximately 81% of pregnant women globally received at least one ANC visit in 2018, indicating widespread engagement with antenatal services (WHO, 2020). However, the percentage of women receiving the recommended four ANC visits remains lower, especially in low- and middle-income countries (LMICs), where factors such as socio-economic status, geographic location, and education levels impact access to care. In sub-Saharan Africa, for instance, ANC coverage is lower, with only 64% of pregnant women receiving the recommended number of visits (WHO, 2020). In Ethiopia, about 60% of women attended at least one ANC visit, but only 32% adhered to the full recommended four visits (Feleke et al., 2018). In South Asia, countries like India and Bangladesh have made progress in ANC utilization; however, there are significant gaps, particularly in rural areas. In India, the National Family Health Survey (NFHS-5) found that 79% of women received at least one ANC visit, but only 60% attended the full schedule (IIPS, 2020). This discrepancy reflects the challenges faced by women in rural and economically disadvantaged areas who may encounter barriers such as distance, financial limitations, and cultural factors that hinder regular ANC attendance (Rahman et al., 2018). In contrast, countries in Latin America, such as Mexico and Brazil, exhibit high levels of ANC utilization, with 94% and 91% of pregnant women, respectively, attending at least one ANC visit (Gómez et al., 2020). Nevertheless, even in these regions, access to care can be uneven, with rural areas often lagging behind urban centers. In Europe and North America, ANC utilization is generally high, with the United States reporting that 93% of pregnant women attended at least one ANC visit, and approximately 90% followed the recommended schedule of four visits (Martin et al., 2019). However, significant racial and socioeconomic disparities exist, particularly among African-American women, who face higher rates of maternal mortality despite high ANC utilization (Laditka et al., 2020). Middle Eastern countries such as Turkey have reported high ANC attendance rates, with 95% of pregnant women receiving at least one ANC visit (Ergin et al., 2019). However, regional variations persist, particularly in rural and marginalized communities. Overall, while global ANC utilization has increased, particularly in high- and middle-income countries, substantial gaps remain in low-income regions, particularly in rural and hard-to-reach areas. Addressing these barriers—such as improving healthcare infrastructure, reducing transportation and financial barriers, and increasing health education—remains essential to ensuring universal access to high-quality ANC and achieving better maternal and child health outcomes worldwide. Continued efforts to reduce these gaps are critical to improving maternal and neonatal health outcomes globally, particularly in low-resource settings where the need for effective ANC is greatest.

In Africa, Antenatal care (ANC) utilization varies significantly across the continent, with notable disparities between countries and regions. According to the World Health Organization (WHO), the average ANC coverage in sub-Saharan Africa is about 64%, with many countries still struggling to meet the recommended standards for maternal health care (WHO, 2020). In East Africa, for example, countries such as Ethiopia report that 60% of pregnant women attend at least one ANC visit, but only about 32% complete the full schedule of four visits, as recommended by WHO (Feleke et al., 2018). In West Africa, countries like Nigeria and Ghana show similarly low rates of full ANC utilization, with only 55% and 63% of women attending the recommended number of visits, respectively (Khana et al., 2019). Factors such as poverty, inadequate transportation infrastructure, and cultural barriers contribute to these low rates, particularly in rural areas where access to healthcare services is limited. On the other hand, countries in North Africa, such as Morocco and Egypt, report higher ANC utilization, with over 80% of women attending at least one ANC visit and a significant proportion following the recommended schedule (El-Khoraibi et al., 2020). However, even in these regions, disparities remain, especially in rural communities. The low ANC coverage in sub-Saharan Africa continues to contribute to the region’s high maternal and neonatal mortality rates, which are among the highest globally. Efforts to improve ANC coverage are crucial in addressing these disparities, focusing on enhancing healthcare infrastructure, increasing health education, and reducing financial and geographical barriers to access (UNICEF, 2020). These steps are essential to ensuring that more African women receive timely and adequate prenatal care.

In Cameroon, the utilization of antenatal care (ANC) has been a significant focus of maternal health efforts in recent years. According to the World Health Organization (WHO), about 88% of pregnant women in Cameroon received at least one ANC visit in 2018, which is relatively high compared to many other African countries (WHO, 2020). However, despite this encouraging figure, the percentage of women attending the recommended four ANC visits remains lower. The Cameroon Demographic and Health Survey (DHS) reported that only 56% of pregnant women in the country completed the full set of four visits in 2018, significantly below the WHO target (Institut National de la Statistique [INS] et ICF International, 2019). The factors contributing to this gap include limited access to healthcare facilities, especially in rural areas, where only 46% of women attend the full ANC schedule (Fokam et al., 2019). Additionally, barriers such as socio-economic status, lack of education, and cultural beliefs around pregnancy and childbirth play a role in limiting ANC utilization. Despite these challenges, urban areas in Cameroon, particularly the capital city, Yaoundé, show higher ANC attendance rates, with 74% of women completing all four visits, highlighting the urban-rural divide (INS et al., 2019). Efforts to increase ANC utilization in Cameroon have focused on improving access to maternal health services, such as the expansion of healthcare facilities in underserved regions and the promotion of education on the benefits of regular ANC visits. Moreover, the government and international organizations are working to address logistical and financial barriers, such as transportation and out-of-pocket costs, to ensure that more women can access the full range of ANC services (UNICEF, 2020).

1.2 Problem statement

Maternal and child mortality has been a major concern in our world today. Maternal and child mortality account for

During our internship in the Molyko integrated health center, we realized that children from the Ndongo community had co-genital abnormalities which could be avoided during ANC.

1.3 Rationale of the study

The rationale for this study lies in addressing the barriers women face in utilizing the antenatal care services.

Understanding the knowledge, practice, and socioeconomic factors influencing ANC utilization among pregnant women will help identify gaps and inform strategies to improve ANC update ultimately reducing maternal and neonatal mortality.

1.4 Research Question.

1.    What knowledge does pregnant women have regarding ANC services in the Ndongo Community?

2. What is the practice of pregnant women towards the utilization of ANC Services in the Ndongo Community ?
3. What factor is associated with ANC Services among pregnant women in the Ndongo community?

1.6 Research Objectives

1.6.1 General Objective.

To assess the knowledge, practices and factors associated with the utilization of Antenatal Care among pregnant women in the Ndongo community?

1.6.2        Specific objectives

1.    To assess the knowledge of pregnant women  regarding ANC services in the Ndongo Community?

2. To evaluate the practice of pregnant women towards the utilization of ANC Services in the Ndongo Community ?
3. To identify the factor associated with ANC Services among pregnant women in the Ndongo community

1.7 Significance of the study.

The study highlights the importance of understanding the knowledge, practices, and factors influencing ANC service utilization to improve maternal and neonatal outcomes. By identifying barriers and enablers, the findings can inform targeted interventions to increase ANC uptake, particularly in underserved populations, reducing maternal and infant mortality (WHO, 2020; Titaley et al., 2019). This research can guide investigate to enhance ANC services utilization and improve overall health system.