An investigation of factors affecting the utilization of antenatal care services among women in post-natal wards in two Namibian hospitals in the Khomas region
Accepted: 2 July 2022
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Background. Antenatal care (ANC) services are the care provided by skilled healthcare professionals to pregnant women to ensure the best health for both mother and baby during pregnancy and after delivery. In Namibia, utilization of antenatal care services has been reported to be dropping from 97% in 2013 to 91% in 2016.
Objectives. The objectives of this study were to investigate the factors affecting the utilization of ANC services.
Methods. A quantitative approach and a cross-sectional analytical design were used to carry out the study. The study population was all mothers who delivered and were admitted to the postnatal ward of Intermediate Hospital Katutura and Windhoek Central Hospital during the time of the study. Data were collected from 320 participants using self-administered structured questionnaires. The data were analyzed using the Statistical Package for Social Science (SPSS) Version 25 software.
Results. Participants were aged between 16 and 42 years with a mean age of 27 years. The results show that 229 (71.6%) utilized ANC while 91(28.4%) did not utilize ANC services. Factors such as the negative attitude of health care workers, long distance to and from health facilities, lack of transport money to travel to and from the health facilities, lack of knowledge regarding antenatal care, attitude towards pregnancy, and others, were found as hindrances to the utilization of antenatal care services. Participants also indicated motivators for ANC utilization such as preventing complications, knowing their HIV status, getting health education, knowing the estimated date of delivery, and identifying and treatment of medical conditions. The study reveals the higher knowledge of participants on ANC utilization, most participants have the right to make decisions and had positive attitudes toward the quality of ANC services. The level of attitude toward pregnancy was associated with the utilization of antenatal care services with an odd ratio OR=2.132; and P=0.014.
Conclusions. The study identified factors that affect utilization of ANC services such as age, marital status, mother's education, partner’s formal education, negative attitude toward health providers, long distance to and from ANC health care facilities, fear of HIV test and results, Covid-19 regulations, inability to determine the pregnancy at the earlier stages and financial constraints Based on this study findings, it is recommended that the utilization of ANC might be improved through effective community mobilization and outreach maternity services to educate and improve awareness on the importance of ANC.
World Health Organisation. WHO recommendation on antenatal care for a postive pregnancy experience. 2016. Available from: https://apps.who.int/iris/bitstream/handle/10665/250796/9789241549912-eng.pdf;jsessionid=8B9AFB25EBA78C07946618D86B7FCFDB?sequence=1.
Ministry of Health and Social Services (MoHSS) and ICF International. The demographic and health survey, 2013. Available from: https://dhsprogram.com/pubs/pdf/fr298/fr298.pdf.
Ministry of Health and Social Services. Joint review of maternal, newborn, child and adolescent health and nutrtition programmers in Namibia. 2016
Ministry of Health and Social Services. Katutura intermediate hospital annual report. 2016
Ministry of Health and Social Services. Windhoek central hospital annual report. 2016
Nketiah-Amponsah E, Senadza B, Arthur E. Determinants of utilization of antenatal care services in developing countries: recent evidence from Ghana. Afr J Econ Manag Stud 2013;4:58-73. DOI: https://doi.org/10.1108/20400701311303159
Tran TK, Gottvall K, Nguyen HD, et al. Factors associated with antenatal care adequacy in rural and urban contexts-results from two health and demographic surveillance sites in Vietnam. BMC Health Serv Res 2012;15:12-40. DOI: https://doi.org/10.1186/1472-6963-12-40
Zhao Q, Huang ZJ, Yang S, et al. The utilization of antenatal care among rural-to-urban migrant women in Shanghai: a hospital-based cross-sectional study. BMC Public Health 2012;12:1012. DOI: https://doi.org/10.1186/1471-2458-12-1012
Pearce N. O4-2.5 Discussion: complexity, simplicity and epidemiology. J Epidemiol Commun Health 2011;65:A42. DOI: https://doi.org/10.1136/jech.2011.142976b.18
Sealy D, Roberts J. Factors associated with delayed antenatal care attendance in Malawi: results from a qualitative study. Med J Zambia 2017;44:17-25. DOI: https://doi.org/10.55320/mjz.44.1.62
Chol C, Hunter C, Debru B, et al. Stakeholders’ perspectives on facilitators of and barriers to the utilisation of and access to maternal health services in Eritrea: a qualitative study. BMC Pregnancy Childbirth 2018;18:1-12. DOI: https://doi.org/10.1186/s12884-018-1665-9
Mugo NS, Dibley MJ, Agho KE. Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey. BMC Pregnancy Childbirth 2015;15:1-13. DOI: https://doi.org/10.1186/s12884-015-0491-6
Olayinka A, Joel A, Bukola D. Factors influencing utilization of antenatal care services among pregnant women in Ife Central Lga , Osun State Nigeria National Hospital Abuja , Nigeria. Adv Appl Sci Res 2012;3:1309-15.
Asim M, Malik N, Siddiqui S, et al. Antenatal health care; a literature review of antenatal and postnatal health care utilization in Pakistan. The Professional Medical Journal 2017;24:495-9. DOI: https://doi.org/10.29309/TPMJ/2017.24.04.1531
Tripathi V, Singh R. Ecological and socio-demographic differences in maternal care services in Nepal. PeerJ 2015;9. DOI: https://doi.org/10.7717/peerj.1215
Tekelab T, Chojenta C, Smith R, et al. Factors affecting utilization of antenatal care in Ethiopia: A systematic review and metaanalysis. PLoS ONE 2019;14:1–24. DOI: https://doi.org/10.1371/journal.pone.0214848
Efendi F, Chen CM, Kurniati A, Berliana SM. (). Determinants of utilization of antenatal care services among adolescent girls and young women in Indonesia. Women and Health 2017;57:614-29. DOI: https://doi.org/10.1080/03630242.2016.1181136
Roy M, Mohan U, Singh S, et al. (2013). Determinants of utilization of antenatal care services in rural Lucknow, India. J Fam Med Prim Care 2013;2:55. DOI: https://doi.org/10.4103/2249-4863.109946
Okedo-Alex IN, Akamike IC, Ezeanosike OB, Uneke CJ. Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review. BMJ Open 2019;9:1–14. DOI: https://doi.org/10.1136/bmjopen-2019-031890
Tiruaynet K, Muchie KF. (2019). Determinants of utilization of antenatal care services in Benishangul Gumuz Region, Western Ethiopia: a study based on demographic and health survey. BMC Pregnancy Childbirth 2019;19:1–5. DOI: https://doi.org/10.1186/s12884-019-2259-x
Ziblim SD, Yidana A, Mohammed AR. (2018). Determinants of antenatal care utilization among adolescent mothers in the yendi municipality of northern region, ghana. GJG 2018;10:78–97.
Ndao-Brumblay SK, Mbaruku G, Kruk ME. Parity and institutional delivery in rural Tanzania: A multilevel analysis and policy implications. Health Policy Plan 2013;28:647-57. DOI: https://doi.org/10.1093/heapol/czs104
Tadesse E. (2020). Antenatal care service utilization of pregnant women attending antenatal care in public hospitals during the COVID-19 pandemic period. Int J Womens Health 2020;12:1181–8. DOI: https://doi.org/10.2147/IJWH.S287534
Nyathi L, Tugli AK, Tshitangano TG, Mpofu M. (2017). Investigating the accessibility factors that influence antenatal care services utilisation in Mangwe district, Zimbabwe. Afr J Prim Health Care Fam Med 2017;9:e1-e5. DOI: https://doi.org/10.4102/phcfm.v9i1.1337
Bwalya BC, Sitali D, Baboo KS, Zulu JM. Experiences of antenatal care among pregnant adolescents at Kanyama and Matero clinics in Lusaka district, Zambia. Reprod Health 2018; 15:1–8. DOI: https://doi.org/10.1186/s12978-018-0565-9
Fagbamigbe AF, Idemudia ES. Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey. Reprod Health 2015;12:88. DOI: https://doi.org/10.1186/s12978-015-0081-0
Sibiya MN, Ngxongo TSP, Bhengu TJ. Access and utilisation of antenatal care services in a rural community of eThekwini district in KwaZulu-Natal. Int J Africa Nursing Sci 2018:8:1-7. DOI: https://doi.org/10.1016/j.ijans.2018.01.002
Drigo L, Luvhengo M, Lebese RT, Makhado L. Attitudes of pregnant women towards antenatal care services provided in primary health care facilities of Mbombela Municipality, Mpumalanga province, South Africa. Open Public Health J 2020;13:569-75. DOI: https://doi.org/10.2174/1874944502013010569
Budhathoki S, Adhikari DB, Ramtel DR. Maternal health care services utilization amidst Covid-19 lockdown: retrospective study. IMJH 2020;6:1–9.
Shiferaw BB, Modiba LM.. Women’s perspectives on influencers to the utilisation of skilled delivery care: an explorative qualitative study in north west Ethiopia. Obstet Gynecol Int 2020:8207415. DOI: https://doi.org/10.1155/2020/8207415
Eke PC, Ossai EN, Eze II, et al. Exploring providers’ perceived barriers to utilization of antenatal and delivery services in urban and rural communities of Ebonyi state, Nigeria: A qualitative study. PLoS ONE 2021;16:1-18. DOI: https://doi.org/10.1371/journal.pone.0252024
Ali SA, Dero AA, Ali SA, Ali GB. (). Factors Affecting the Utilization of Antenatal Care among Pregnant Women in Moba Lga of Ekiti State, Nigeria. Int J Trad Compl Med 2016;2:41-5.
Keya KT, Rob U, Rahman MM, et al. Distance, transportation cost, and mode of transport in the utilization of facility-based maternity services: evidence from rural Bangladesh. Int Quart Commun Health Edu 2014;35:37–51. DOI: https://doi.org/10.2190/IQ.35.1.d
, Sumankuuro J, Crockett J, Wang S. Sociocultural barriers to maternity services delivery: a qualitative meta-synthesis of the literature. Public Health 2018;157:77–85. DOI: https://doi.org/10.1016/j.puhe.2018.01.014
Mondal D, Karmakar S, Banerjee A. Women’s autonomy and utilization of maternal healthcare in India: evidence from a recent national survey. PLoS ONE 2020;15:1–12. DOI: https://doi.org/10.1371/journal.pone.0243553
Diamond-Smith N, Sudhinaraset M, Montagu D. (). Clinical and perceived quality of care for maternal, neonatal and antenatal care in Kenya and Namibia: the service provision assessment. Reproductive Health 2016;13:1–13. DOI: https://doi.org/10.1186/s12978-016-0208-y
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