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Factors Influencing the Utilization of Focused Antenatal Care Services in Malindi and Magarini Sub-Counties of Kilifi County, Kenya

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Factors Influencing the Utilization of Focused Antenatal Care Services in Malindi and Magarini Sub-Counties of Kilifi County, Kenya Supplement article Research Factors influencing the utilization of focused antenatal care services in Malindi and Magarini sub-counties of Kilifi county, Kenya Dorah Chorongo1, Fredrick Majiwa Okinda2,&, Eric Jimmy Kariuki3, Emily Mulewa1, Fredrick Ibinda4, Samuel Muhula2, George Kim- athi2, Richard Muga5 1Ministry of Health, Kenya, 2Amref Health Africa in Kenya, 3Unicef, 4KEMRI-Wellcome Trust Research Programme, Kenya, 5Uzima University, Kenya &Corresponding author: Fredrick Majiwa Okinda, Amref Health Africa in Kenya Cite this: The Pan African Medical Journal. 2016;25 (Supp 2):14. DOI: 10.11604/pamj.supp.2016.25.2.10520 Received: 13/08/2016 - Accepted: 02/10/2016 - Published: 26/11/2016 Key words: Attendance, antenatal care, health service delivery © Dorah Chorongo et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons At- tribution 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. Corresponding author: Fredrick Majiwa Okinda, Amref Health Africa in Kenya ([email protected]) This article is published as part of the supplement “Strengthening health systems in communities: the experiences of AMREF Health Africa” sponsored by African Medical Research Foundation Guest editors: Josephat Nyagero (Kenya), Florence Temu (Ethiopia), Sylla Thiam (Senegal) Available online at: http://www.panafrican-med-journal.com/content/series/25/2/14/full Abstract Introduction: globally, pregnancy related complications contribute to more than half of the deaths among women annually. Antenatal care (ANC) is important for the prevention of maternal and fetal mortality and morbidity. This study identifies the socio-demographic and economic characteristics; knowledge and attitude and; health service provision for focused antenatal care (FANC) services. Methods: a cross-sectional comparative study conducted among 385 women of reproductive age who visited 5 public health facilities in Malindi and Magarini Sub Counties. Data collection was conducted between June 2013 and September 2013 through structured questionnaires, Key Informant Interviews (KIIs) and Focused Group Discussions (FGDs) and analyzed through descriptive summary statistics and test of associations of the various variables using chi square. Results: about 35% of women sought 1st and 2nd ANC services at the health facilities. These women went ahead to complete the recommended 4 minimum visits as recommended by World Health Organization (WHO). Compared to Catholics, Muslims were less likely to attend a rural health facility (Odds ratio (OR) = 0.25, 95% Confidence Interval (CI) 0.10, 0.62, p=0.003). According to education levels, those with secondary (OR=0.07, 95% CI 0.03, 0.18, p<0.001) or tertiary (OR=0.09, 95% CI 0.03-0.17, p<0.001) levels of education were less likely to seek FANC at rural facility. Women seeking rural ANC services started at 2nd or 3rd trimester (OR=5.40 95% CI 2.97-10.06, p<0.001) while those in urban setup start at 1st trimester. Among the women who were aware of FANC, only 27% utilized its services. Long waiting hours, unavailability of services, and departmental disharmony were major causes of dissatisfaction to mothers visiting the facilities. Conclusion: utilization and awareness of FANC services in both rural and urban health facilities among women in Malindi and Magarini Sub Counties continues to be low which is associated by socio-demographic characteristics, and health facility inefficiencies. Thus there is need to standardize services across health facilities and increase awareness on FANC in both rural and urban. The Pan African Medical Journal. 2016;25 (Supp 2):14 | Dorah Chorongo et al. 1 Study setting and participants Introduction The study was conducted in Malindi and Magarini Sub Counties of Kilifi Worldwide pregnancy related complications contribute to more than half County in Kenya in Coast Region in four Divisions of Malindi, Magarini, of deaths among women annually. According to WHO, about 90-95% of Marafa and Lango Baya. Malindi and Magarini Sub-Counties borders Taita- these come from developing countries [1]. The launch of the Safe Mother- Taveta to the west, Tana Delta to the northwest and the Indian Ocean to hood Initiative (SMI) was seen as a major milestone in the race to reduce the east. It lies between latitudes 2.2o and 4o south and between longi- the burden of maternal mortality throughout the world, particularly in de- tudes 39o and 41o east with a total population estimated to be 436,371. veloping countries. It issued a call to action to reduce maternal mortality The Sub-County is cosmopolitan mainly composed of the Mijikend as fol- and morbidity by one half by the year 2000 [2]. lowed by Swahili/Bajuni tribe. Immigrants from upcountry comprise about 10% of the total population and Europeans consist of a smaller number Focused Antenatal Care (FANC) is a new model of antenatal clinic attend- (5%) [7]. The area which is majorly rural (86%) has the main religions ance introduced by WHO that is goal-oriented, which reduces the number being Christianity and Islam (40%). The Sub-County is also characterized of required antenatal visits to four, and provides focused services shown to by a shortage of health care workers with a nurse to population ratio of improve maternal outcomes. While being a strategy it is also an important 1:8594 and high infant mortality rate of 71/1000 [8]. The study involved determinant of safe delivery which provides an opportunity for women to mothers bringing their children (<5 years) to health facilities for immu- be educated to recognize and act on symptoms associated with potentially nization and weighing, women coming for family planning services and serious conditions like pre-eclampsia or a malaria infection and obstructed pregnant women attending ANC services. labour as a strategy for reducing maternal mortality. The World Health Or- ganization recommends that a woman without complications should have Sampling procedure at least four visits to get sufficient prenatal care [1]. Prenatal care is more Systematic sampling was applied to select respondents among women likely to be effective if women begin to receive care in the first trimester of who came for ANC, PNC pregnancy and continue to receive care throughout pregnancy [3]. How- ever, much work has yet to be done to assure maternal health for women Family planning and those bringing their children (<5 years) for immuni- worldwide. In order to reduce life-threatening risks and reduce mortal- zation. The sampling procedure involved choosing every third woman in ity, good-quality maternal health services by trained health workers must the queue as a respondent. Purposive sampling was applied to choose the be available and must be used. Therefore, safe motherhood strategies KII participants. A total sample of 385 respondents was arrived at 95% must be comprehensive in nature; even when quality health services are confidence level and 5% degree of accuracy (Mugenda Mugenda 1998). available, other limiting factors can get in the way of women using these services, such as social, economic and cultural factors [1]. Data collection techniques WHO recommended Focused Antenatal Care (FANC) package that pro- A semi structured interview schedule (questionnaire) was administered to motes the implementation of interventions to address the most prevalent all the women who met the inclusion criteria above. KII guide was used health issues affecting pregnant mothers and newborns [4]. The Kenya to get qualitative information from a sample of health workers and FGD Ministry of Health (MOH) has designed new guidelines for FANC services, guide was used to gather qualitative data. Six (6) KIIs were conducted placing emphasis on 4 ANC visits that focus on antenatal care, birth plan- to cover all the 4 divisions in the study area where 4 were distributed in ning and emergency preparedness. These visits are now used as an entry dispensaries across the divisions, 2 at the Sub county referral hospital point for a range of other reproductive health services, thus promoting while the 1 FGD were done in the Sub-County hospital for urban set up comprehensive integrated service delivery [5]. Proven effective antenatal and one for rural facility. interventions include serologic screening for syphilis, provision of malaria prevention, anti-tetanus immunization, and prevention of mother-to-child Ethical considerations transmission of HIV among others. Informed consent was sought from willing respondents before data col- lection. Letter of Authorization was also sought from Kenyatta University, Malindi and Magarini Sub-counties has implemented FANC activities as Kenya since the study was not going to be invasive in nature. stipulated by the National guidelines. However, there is a marked success in the first and second visits standing at (90% and 80% respectively) while the third and fourth visits stand at 50% and 35.2% respectively [6]. Various reasons have been given that mothers are starting clinics late and end up not completing the four ANC visits despite the efforts being put Results in place on health education. This warrants the study of the underlying factors for late prenatal attendance and incomplete utilization of the ser- Socio-demographic and economic characteristics vices offered during FANC. The study therefore sought to establish socio- demographic factors associated with utilizing focused antenatal care ser- A total of 385 respondents were interviewed. The average age was 25 vices determine the level of awareness and perception of clients towards (Standard error: 0.27) years. According to marital status, 317(86%) were frequency and timing of FANC services, the proportion of pregnant women married (from urban 70% and rural 90.8%), 33(9%) were single (17.2% who utilize FANC services correctly as stipulated in the FANC strategy and in urban and 4.8% in rural) and 20(5%) of them were either widowed the health service provision factors that influence frequency and timing in or divorced.
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