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      Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda

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          Abstract

          Background

          Mothers who attend antenatal care late miss the opportunity of early detection of HIV and STDs, malaria and anaemia prophylaxis, health education and treatment or prevention of complications. Whereas many women in Mulago hospital make their first antenatal care visit after 20 weeks of gestation, the reasons for coming late are not documented. The objectives were to determine the gestation age at which pregnant women make their first antenatal care visit and the reasons for late coming.

          Method

          The study was conducted in June 2012 among women with a gestation age of more than 20 weeks on their first antenatal care visit. We collected data on gestation age (from weeks of amenorrhea or based on ultrasound scan) and reasons for coming late.

          Results

          Four hundred women participated in the study. Their mean age was 25.2 years with a standard deviation of 5.2 years. The majority of the participants were Catholics (n = 126, 31.5%), they lived in a distance of greater than five kilometers from the hospital (n = 201, 50.3%) and had attained secondary education (n = 220, 55.0%). The mean of their weeks of amenorrhea was 27.9 (± 4.6) weeks. The results showed that 291 (72.7%) of the study participants did not know the right gestation age at which a pregnant woman should start attending antenatal care. One hundred and ten (27.5%) agreed that they did not have money for transport to bring them to the hospital while 37 (9.3%) thought that they had to pay for the antenatal care services. Two hundred thirteen (53.3%) reported that they did not have any problem with their current pregnancy and so they saw no reason to come early for antenatal care, even though some of these knew the right gestation age at which they should make their first antenatal care visit.

          Conclusion

          Pregnant women who come late for antenatal care in Mulago hospital, Uganda are not well-informed about the right gestation age at which they should make their first antenatal care visit and/or of the importance of early attendance at antenatal care.

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          Most cited references8

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          Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities.

          Appropriate antenatal care is important in identifying and mitigating risk factors in pregnancy but many mothers in the developing world do not receive such care. This paper uses data from the 1993 Kenya Demographic and Health Survey to study the variations in the use of antenatal services in Kenya. The analysis is based on modelling the frequency and timing of antenatal visits using three-level linear regression models. The results show that the use of antenatal care in Kenya is associated with a range of socio-economic, cultural and reproductive factors. The availability and accessibility of health services and the desirability of a pregnancy are also important. Use of antenatal care is infrequent for unwanted and mistimed pregnancies; even women who use antenatal care frequently appear to be less consistent if a pregnancy is mistimed. The results also indicate that women are highly consistent in the use of antenatal care during pregnancies. The intra-woman correlation coefficient for the frequency of antenatal visits ranges between 50% and 80% with greater correlation for wanted pregnancies to women in urban areas.
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            Why do women seek antenatal care late? Perspectives from rural South Africa.

            Despite the widespread availability of free antenatal care services, most women in rural South Africa attend their first antenatal clinic late in pregnancy and fail to return for any followup care, potentially leading to avoidable perinatal and maternal complications. Using interviews with pregnant women from the rural Hlabisa district of South Africa, we documented perceptions of health and health care during pregnancy and investigated factors shaping the utilization of antenatal care. Our findings indicate that most women in this setting do not perceive significant health threats during pregnancy, and in turn view more than one antenatal care visit as unnecessary. In contrast, women perceive labour and delivery as a time of significant health risks that require biomedical attention, and most women prefer to give birth in a health facility. This paradox, in which health care is important for childbirth but not during pregnancy, is embodied in most women's primary reason for seeking antenatal care in this setting: to receive an antenatal attendance card that is required to deliver at a health facility. Health education programs promoting antenatal care are required to explain the importance of effective antenatal care toward maternal and child health.
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              Use of antenatal care services in Kassala, eastern Sudan

              Background Antenatal care is named as one of the four pillars initiatives of the Safe Motherhood Initiative. While many of routine antenatal care procedure have little effect on maternal mortality and morbidity, some of these have been ascertained as beneficial. The aim of this study was to investigate coverage of antenatal care and identify factors associated with inadequacy of antenatal care in Kassala, eastern Sudan. Methods A cross-sectional community-based study was carried out in Kassala, eastern Sudan during September-October 2009. Household surveys were conducted. Structured questionnaires were used to gather data from women who had been pregnant within the last year, or pregnant more than 14 weeks. Results Out of 900 women investigated for antenatal care coverage, 811(90%) women had at least one visit. Only 11% of the investigated women had ≥ four antenatal visits, while 10.0% had not attended at all. Out of 811 women who attended at least one visit, 483 (59.6%), 303 (37.4%) and 25 (3.1%) women attended antenatal care in the first, second and third trimester, respectively. In logistic regression analyses, while maternal age and residence were not associated with inadequacy of antenatal care (<2 visits), high parity (OR = 2.0, CI = 1.1-3.5; P = 0.01) and husband education ≤ secondary level (OR = 2.4, CI = 1.3-4.2; P = 0.002) were associated with inadequacy of antenatal care. Conclusions Antenatal care showed a low coverage in Kassala, eastern Sudan. This low coverage was associated with high parity and low husband education.
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                Author and article information

                Contributors
                Journal
                BMC Pregnancy Childbirth
                BMC Pregnancy Childbirth
                BMC Pregnancy and Childbirth
                BioMed Central
                1471-2393
                2013
                25 May 2013
                : 13
                : 121
                Affiliations
                [1 ]School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
                [2 ]Department of Obstetrics and Gynecology, College of Health Sciences, Makerere University, Kampala, Uganda
                [3 ]Department of Medical microbiology, College of Health Sciences, Makerere University, Kampala, Uganda
                Article
                1471-2393-13-121
                10.1186/1471-2393-13-121
                3665546
                23706142
                a98b1c36-d258-428b-a5fd-b51c3cecc781
                Copyright © 2013 Kisuule et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 November 2012
                : 23 May 2013
                Categories
                Research Article

                Obstetrics & Gynecology
                timing of first antenatal visit,antenatal care,mulago hospital
                Obstetrics & Gynecology
                timing of first antenatal visit, antenatal care, mulago hospital

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