Relationship between time of antenatal care booking and pregnancy outcomes among mothers delivering at Entebbe and Nebbi general hospitals

Abstract

Introduction: The transition of fetus immersed in the amniotic fluid to life outside the womb is not always smooth and can result in adverse and/ or non-adverse events to the mother and/or the baby. In Wakiso and Nebbi districts, maternal mortality ratio is estimated at 505 per 100,000 live births and 304 per 100,000 live births respectively. The proportion of low birth weight stands at 9.8% of babies born in Wakiso and 10.9% babies born Nebbi districts. The cause of such poorer outcomes are not well established but widely reported that may be associated with late and irregular antenatal care attendance. Objective: The study set out to investigate the relationship between the time of the first antenatal care booking and pregnancy outcomes in Wakiso and Nebbi districts. Methods: A cross sectional analytical study design was adopted, where the factor of interest was gestation age at the first ANC booking and the outcome variable was the pregnancy outcome comprising of maternal and neonatal outcomes. A total of 422 respondents were enrolled from both Entebbe and Nebbi general hospital maternity after delivery and followed up in the first 24 hours post-delivery to document maternal and neonatal outcomes. Mothers who met the eligibility criteria and gave informed consent to participate in the study were consecutively enrolled into the study based on the sample size proportions computed for Entebbe and Nebbi General Hospitals. Data was collected through interviewer administered structured post-delivery quantitative questionnaires, with pre-coded response categories. Data was coded, serialized and entered in the computer using SPSS software, and then exported to Stata for analysis. Stata version 12 was then used for univariate and bivariate analysis. Cross tabulations was done to generate proportions per variable Pearson Chi square was done at bivariate analysis to find out the factors which were significantly associated with gestation age at first ANC booking, and any significant association between pregnancy outcomes and gestation age at first ANC booking (early or late). Results: Most of the respondents (34.6%) were in the age group of 25 – 29 years. Majority of the respondents (76.5%) were married, and most of the mothers (43.1%) had secondary education. Early ANC attendance in both Entebbe and Nebbi hospital was found at 21.3%, lower than even half of the ministry health target for early ANC booking. Individual factors that were found significantly associated with gestation age at first ANC booking were age [x2 =10.6757, p=0.030], education level of the respondents [x2 =42.4549, p<0.001], financial support [x2 =4.7237, p=0.0313] and knowledge of the best time to start ANC [x2 =11.37, p=0.0034]. The health system factors that were associated with gestation age at first ANC booking included; type of health facility visited for ANC [x2 =8.1442, p=0.0252], distance to the health facility [x2 =5.6192, p=0.0531], long waiting time at the ANC clinic [x2 =8.6275, p=0.0037] and the challenge of unfriendly health workers [x2 =3.86, p=0.0493]. There was no statistically significant association between pregnancy outcome and gestation age at first ANC booking. Conclusion:Early ANC booking in Wakiso and Nebbi districts is still low below the ministry of health set target of 50%. Individual and health system factors were found significantly associated with gestation age at first ANC attendance. The relationship between pregnancy outcomes and early or late ANC booking was not statistically significant. Interventions targeting improvements of early ANC attendance and pregnancy outcomes should focus on addressing the individual and health system factors associated with early or late ANC booking