View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Trepo - Institutional Repository of Tampere University BARRIERS TO UTILIZATION OF FOCUSED ANTENATAL CARE AMONG PREGNANT WOMEN IN NTCHISI DISTRICT IN MALAWI Christina Leah Banda Master’s Thesis University of Tampere Tampere School of Health Sciences (Public Health) April, 2013 ABSTRACT University of Tampere Tampere School of Health Sciences/Public Health BANDA CHRISTINA LEAH: BARRIERS TO UTILIZATION OF FOCUSED ANTENATAL CARE AMONG PREGNANT WOMEN IN NTCHISI DISTRICT IN MALAWI Master’s Thesis, 88 pages, 9 appendices Supervisor: Dr. Tarja I. Kinnunen Public Health April 2013 _____________________________________________________________________ Background Maternal mortality remains a huge public health problem in developing countries. One of the strategies to improve maternal health is the implementation and appropriate use of focused antenatal care (FANC) services. Utilization of FANC is influenced by several factors that vary from one country to another. Aim The aim of the study was threefold; first to assess the level of knowledge of women on importance of FANC; second to determine factors associated with low utilisation of focussed antenatal care services among pregnant women in Ntchisi district in Malawi; and third to establish the current practices and perceptions of health care providers towards FANC. Methods This was a cross sectional quantitative study conducted among pregnant women, postnatal mothers and health workers from 12 health facilities in Ntchisi district in Malawi. The study included pregnant women who were 36 weeks’ gestation and above and postnatal mothers whose infants were below 6 weeks of age. A total of 120 pregnant women, 84 postnatal mothers and 36 health workers were enrolled in the study. Two structured questionnaires were used to obtain information from study participants, one for both pregnant and postnatal mothers and a different one for health workers. In the present study low utilisation of FANC services among pregnant women was determined based on number of visits. SPSS software was used to generate descriptive statistics and cross tabulations with Ȥ²-test were performed to explore associations between variables. Results Almost all (96%) participating women had at least some knowledge of FANC, also 85% of the participating women agreed that FANC would enable them to receive vaccines, supplements and malaria prophylaxis. Maternal age range of between 20-25 years and higher parity were significantly associated with low utilization of FANC (P<0.05). Long distance to the health facility, seeking permission to start and use FANC, were also significantly associated with low utilization of FANC (P<0.001). Maternal perception of showing off the pregnancy was associated with late initiation of FANC visits (P<0.001). Fear associated with witchcraft was marginally associated with low FANC utilization. Almost all health workers (94%) were conversant with FANC guidelines and principles, only 72% implemented FANC guideline on individualized health education. A positive perception towards FANC among health workers was also shown in this study. Conclusion The study has shown that majority of participating mothers knew the importance of FANC. Low utilization of FANC among pregnant women and postnatal mothers in Ntchisi district has been shown to be influenced by higher parity, Age range between 21-25 years, long distance, seeking permission and pregnancy associated beliefs notably witchcraft. Health workers are acquainted with FANC and demonstrated a positive perception. Health education aimed at promoting uptake of FANC services should be intensified in the district to ultimately improve maternal and infant health. Key words Focused antenatal care, maternal mortality, developing countries, pregnant women, low utilization Table of contents 1. INTRODUCTION ................................................................................................................................... 1 2. LITERATURE REVIEW ......................................................................................................................... 3 2.1 Maternal health ................................................................................................................................ 3 2.2 Antenatal care .................................................................................................................................. 6 2.2.1 Description of antenatal care ........................................................................................................ 6 2.2.2 Benefits of antenatal care ............................................................................................................. 8 2.3 Focused antenatal care ..................................................................................................................... 8 2.3.1General overview of FANC .......................................................................................................... 8 2.3.2 Aim and objectives of FANC ................................................................................................... 11 2.3.3 FANC in Malawi ....................................................................................................................... 12 2.3.4 Demographic and socio-cultural factors and FANC/ANC........................................................... 12 2.3.5 General knowledge on FANC/ANC ........................................................................................... 14 2.3.6. Health care workers perspective ................................................................................................ 14 2.4 Conceptual Framework: Health Belief Model ............................................................................... 20 2.5 Summary of Literature review....................................................................................................... 23 3. AIMS OF THE STUDY ......................................................................................................................... 24 4. MATERIALS AND METHODS ............................................................................................................ 25 4.1 Study area ....................................................................................................................................... 25 4.2 Study subjects ................................................................................................................................. 28 4.3 Study design.................................................................................................................................... 29 4.4 Description of the main study variables......................................................................................... 29 4.4.1 Low utilization .......................................................................................................................... 29 4.4.2 Knowledge of women on importance of FANC .......................................................................... 30 4.4.3 Demographic and social and cultural factors associated with low utilisation of FANC ................ 30 4.5 Pre-testing ....................................................................................................................................... 31 4.6 Data handling ................................................................................................................................. 31 4.7 Ethical considerations .................................................................................................................... 31 4.8 Data analysis and statistical methods ............................................................................................ 32 5. STUDY RESULTS ................................................................................................................................ 33 5.1 Participating mothers ..................................................................................................................... 33 5.1.1 Demographic characteristics ...................................................................................................... 33 5.1.2 Knowledge on FANC ................................................................................................................ 34 5.1.3 FANC utilization ....................................................................................................................... 36 5.1.4 Demographic and sociocultural factors related to low utilization of FANC ................................. 37 5.2 Health care workers ....................................................................................................................... 41 5.2.1 Demographic characteristics ...................................................................................................... 41 5.2.2 Training and current practices .................................................................................................... 41 5.2. 3. Health care workers perception towards FANC ........................................................................ 42 6. DISCUSSION OF STUDY FINDINGS ................................................................................................. 44 6.1 Knowledge about FANC ................................................................................................................ 44 6.2 Demographic and Socio-cultural factors associated with