Late initiation of antenatal care and associated factors among women attending Itojo hospital, southwestern Uganda: a facility-based cross-sectional study.

Godfrey; Elizabeth Ninsiima; Jackson; Francis

doi:10.51168/bvfye104

Autori

Godfrey Department of Public Health, Faculty of Health Sciences, Bishop Stuart University, Mbarara, Uganda
Elizabeth Ninsiima Department of Public Health, Faculty Health sciences, Bishop Stuart University, Mbarara city, Uganda, Department of Clinical Research, SRF Research and Training Centres, Mbarara, Uganda, Department of Clinical Research, Soar Research Foundation, Mbarara, Uganda
Jackson Department of Public Health, Faculty of Health Sciences, Bishop Stuart University, Mbarara, Uganda
Francis Department of Public Health, Faculty of Health Sciences, Bishop Stuart University, Mbarara, Uganda

DOI:

https://doi.org/10.51168/bvfye104

Cuvinte cheie:

Antenatal care, late ANC initiation, first trimester, maternal health, pregnancy, Uganda, Ntungamo District

Rezumat

Background and Objective

Late initiation of antenatal care remains a concern in Uganda. This study determined the prevalence of late ANC initiation and identified factors associated with late initiation among women attending Itojo Hospital, Ntungamo District, southwestern Uganda.

Methods

A facility-based cross-sectional study was conducted among 356 women attending ANC, maternity and labour services at Itojo Hospital. Participants were enrolled consecutively. Data were collected using a structured interviewer-administered questionnaire and analysed using descriptive, bivariate and multivariable methods. Crude and adjusted prevalence ratios (cPRs and aPRs) with 95% confidence intervals (CIs) were estimated, with statistical significance at p<0.05.

Results

Among the 356 women, 109 (30.6%) initiated ANC after 12 weeks of gestation. Late initiation was independently associated with age, education, occupation, travel time and distance from the health facility. Women aged 30–34 years (aPR=1.77, 95% CI: 1.17–2.68) and 40–44 years (aPR=2.90, 95% CI: 1.48–5.68), those with primary education (aPR=3.66, 95% CI: 1.57–8.52), and students (aPR=2.47, 95% CI: 1.09–5.60) had higher prevalence of late initiation. Longer travel time was also associated with higher prevalence. Partner decision-making was associated with lower prevalence (aPR=0.20, 95% CI: 0.11–0.34), whereas family influence and requiring permission to attend ANC were associated with higher prevalence. Perceived facility accessibility (aPR=0.47, 95% CI: 0.32–0.70) and affordability (aPR=0.53, 95% CI: 0.30–0.93) were associated with lower prevalence.

Conclusion

Nearly one in three women initiated ANC late, indicating a substantial gap in timely ANC initiation. The hospital and district authorities should strengthen early pregnancy identification, community education, supportive household involvement and measures addressing physical and financial barriers to ANC.

Biografii autori

Godfrey, Department of Public Health, Faculty of Health Sciences, Bishop Stuart University, Mbarara, Uganda

is a professional soldier who has served since 1996 and has participated in peacekeeping missions in different countries. He has pursued training in public health, including a Bachelor of Public Health and a Master of Public Health. His interests include public health and contributing to health-related research and community wellbeing.
Elizabeth Ninsiima, Department of Public Health, Faculty Health sciences, Bishop Stuart University, Mbarara city, Uganda, Department of Clinical Research, SRF Research and Training Centres, Mbarara, Uganda, Department of Clinical Research, Soar Research Foundation, Mbarara, Uganda

is a Research and Community Engagement Officer at SRF Research and Training Centres (SRF-RTC) in Mbarara, Uganda. She holds a Bachelor of Environmental Science from Makerere University and is pursuing a Master of Public Health at Bishop Stuart University, Mbarara. She has experience in data management, research coordination, qualitative data translation and transcription, and supporting HIV-related programme implementation.
Francis, Department of Public Health, Faculty of Health Sciences, Bishop Stuart University, Mbarara, Uganda

is a Public Health Specialist, Assistant Lecturer at Bishop Stuart University, and Medical Director at Musmush Medical Centre in Mbarara, Uganda. His professional and research interests include public health, health service delivery, quality improvement, healthcare access, and health information systems. His research has included patient flow and quality of care among older adults in outpatient settings in southwestern Uganda, mobile telehealth systems and information accessibility, and the experiences and support needs of doctoral students in southwestern Uganda. He has experience in quantitative and

qualitative research and contributes to public health teaching, research, and healthcare delivery

Referințe

1. World Health Organization. WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. World Health Organization. 2016.

2. World Health Organization. WHO guideline on HIV service delivery. Geneva: World Health Organization; 2025.

3. Uganda Ministry of Health. Integrated National Healthcare Service Standards and Guidelines for Maternal and Child Health. Ministry of Health. 2022.

4. Abdo R, Demelash M, Seid AM, Mussema A. First trimester antenatal care contact in Africa: A systematic review and meta-analysis of prevalence and contributing factors. BMC Pregnancy Childbirth. 2023;23(1):742. doi:10.1186/s12884-023-06034-1

5. Uganda Bureau of Statistics, ICF. Uganda Demographic and Health Survey 2022. Uganda Bureau of Statistics and ICF. 2022.

6. Towongo MF, Ngome E, Navaneetham K, Letamo G. Factors associated with women’s timing of first antenatal care visit during their last pregnancy: Evidence from the 2016 Uganda Demographic and Health Survey. BMC Pregnancy Childbirth. 2022;22:829. doi:10.1186/s12884-022-05167-z

7. Acup W, Opollo MS, Akullo BN, Musinguzi M, Kigongo E, Opio B, et al. Factors associated with first antenatal care (ANC) attendance within 12 weeks of pregnancy among women in Lira City, Northern Uganda: A facility-based cross-sectional study. BMJ Open. 2023;13(7):e071165. doi:10.1136/bmjopen-2022-071165

8. Abebe GF, Alie MS, Girma D, Mankelkl G, Berchedi AA, Negesse Y. Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis. PLOS ONE. 2023;18(3):e0281038. doi:10.1371/journal.pone.0281038

9. Kisuule I, Kaye DK, Najjuka F, Ssematimba SK, Arinda A, Nakitende G, et al. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago Hospital, Kampala Uganda. BMC Pregnancy Childbirth. 2013;13:121. doi:10.1186/1471-2393-13-121

10. Kubahoniyesu T, Nishimwe C, Habtu M. First trimester antenatal care utilization and associated factors among adolescent mothers in Rwanda. Rwanda J Med Health Sci. 2023;6(2):239–50. doi:10.4314/rjmhs.v6i2.15

11. Bunanukye E. Factors associated with the rate of delayed first antenatal care visits among pregnant women attending Fort Portal Regional Referral Hospital, Western Uganda. Newport Int J Res Med Sci. 2023;4(1):50–61.

12. Nakyazze J. Late initiation of antenatal care, associated factors, and drivers among pregnant women attending Buwambo Health Centre IV, Wakiso District. Makerere University. 2024.

13. Atuhaire S, Mugisha JF. Determinants of antenatal care visits and their impact on the choice of birthplace among mothers in Uganda: a systematic review. Obstet Gynecol Int J. 2020;11(1). doi:10.15406/ogij.2020.11.00492