Factors associated with comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia: A community-based cross-sectional study

PLoS ONE, Volume 17, No. 10 October, Year 2022

Interpretation

Background Despite the current sustainable development goal period (i.e. SDG 3), the prevention of maternal and neonatal mortality is not satisfactory in Ethiopia. Keeping women knowledgeable about antenatal care and maintaining a positive attitude towards its uptake, particularly in the marginalized rural community is crucial. However, evidence regarding the knowledge and attitude of women towards antenatal care uptake is scarce. Therefore, this study aimed to assess factors affecting comprehensive knowledge of antenatal care and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia. Methods A community-based cross-sectional study was conducted from September 1st to October 15th, 2020. A multi-stage sampling technique was used to select 653 women. The data were collected using a semi-structured interview guide. Data were entered into EPI INFO 7.1.2 and analyzed by SPSS version 25. Both bivariable and multivariable logistic regression analyses were undertaken to identify factors associated with women’s knowledge of antenatal care and attitude towards its uptake. The level of significant association in the multivariable analysis was determined based on a p-value of < 0.05. Results Women’s knowledge of antenatal care and positive attitude towards its uptake was 56.5% and 75.2%, respectively. Older age (AOR = 7.2; 95% CI: 3.43, 15.1), media exposure (AOR = 3.69; 95% CI: 2.41, 5.65), history of abortion (AOR = 11.6; 95% CI: 3.3, 14.6), time to reach health facility (AOR = 4.58; 95% CI: 3.05, 6.88), and history of obstetric danger signs (AOR = 7.3; 95% CI: 3.92, 13.64) were factors significantly associated with knowledge of antenatal care. Furthermore, higher decision-making power (AOR = 8.3; 95% CI: 4.8, 13.83), adequate knowledge of antenatal care (AOR = 2.2; 95% CI: 1.26, 3.71), delivery attended by health extension workers (AOR = 2.3; 95% CI: 1.1, 5.1), and media exposure (AOR = 2.27; 95% CI: 1.30, 3.97) were predictors of a favorable attitude towards antenatal care utilization. Conclusion Although the majority of women in the present study had a favorable attitude towards antenatal care uptake, their knowledge level was inadequate. Strengthening access to transportation, mass media, involvement in household decision-making, and encouraging women to deliver at a health facility by a skilled provider may increase women’s knowledge and attitude towards antenatal care uptake, thereby improving maternal healthcare service uptake. A community-based cross-sectional study was conducted from September 1st to October 15th, 2020. This study was conducted in rural Sehala Seyemit district, Waghimra zone, Amhara regional state, Northern Ethiopia. Sehala Seyemit district is located 285 km northeast of Bahir Dar (the capital city of Amhara regional state) and about 799 km north of Addis Ababa (the capital city of Ethiopia). Accessing health services in the district is difficult because of the lack of transportation to each “kebeles” (which is the smallest administrative unit in Ethiopia). Maternal health services such as ANC, childbirth, and postnatal care are given for free in Ethiopia, including the study area. The district has 13 “kebeles”; 12 rural and 1 urban “kebeles”. Currently, the district has a population of 39,435. Over 90% of the population are farmers. Moreover, there are 3 health centers and 13 health posts serving the community. Furthermore, there were a total of 923 women who gave birth at home in the last 2 years (Sehala Seyemit Woreda report, unpublished data). All women who gave birth in the last two years in the selected “kebeles” during the data collection period were selected to be part of the study. All critically ill women throughout the data collection period were excluded. The sample size for this study was determined by using a single population proportion formula by considering the following assumptions: women’s attitude towards ANC in Mizan, Ethiopia-70.6% [4], 95% level of confidence, and 5% margin of error. Thus, n=(Zα/2)2p(1−p)d2=n=(1.96)2*0.706(1−0.706)(0.05)2 = 319. Where, n = required sample size, α = level of significant, z = standard normal distribution curve value for 95% confidence level = 1.96, p = women’s attitude towards ANC, and d = margin of error. By considering a design effect of 2 (since multistage sampling) and a 5% non-response rate, the minimum adequate sample size was 670. A multistage sampling technique was employed to select the study participants. In the first stage, eight kebeles were selected randomly among the 12 rural “kebeles”. In addition, the lists of home-delivered women from the selected kebeles were obtained from health extension workers (HEWs) and local administrators. Thereafter, the sampling frame was designed by numbering the list of women. Then, the total sample size was distributed to each selected “kebeles” proportionally. In the second stage, the women were selected by a simple random sampling technique using a table of random generation. Women’s knowledge of ANC (adequate/inadequate) and women’s attitude towards ANC uptake (favorable/unfavorable) were the outcome variables. Whereas age of the women, marital status, women’s educational status, women’s occupation, husband educational status, husband occupation, family size, exposure to mass media, time to reach the nearby health facility, parity, history of ANC, number of ANC, birth assistant, husband involvement in maternal and children’s health, household decision-making power, history of abortion, history of neonatal death, history of obstetric danger signs during pregnancy, and status of the pregnancy were the explanatory variables. Home delivery: Is defined as a birth that has taken place at the laboring woman’s own home, or her relative, or her neighbor rather than a birthing center without a skilled birth attendant [39]. Traditional birth attendant: Is a person who is traditionally experienced in attending labor to assist women in childbirth and give care during pregnancy and childbirth [38]. Comprehensive knowledge of ANC: Includes knowledge of ANC and pregnancy, knowledge of obstetric danger signs, knowledge of birth preparedness and complication readiness, knowledge of malaria prevention, knowledge of anemia prevention, knowledge of helminthic infection prevention, and knowledge of tetanus prevention during pregnancy. A total of 20 open and close-ended questions were designed to assess the comprehensive knowledge of ANC. Correct and/or “Yes” answers were coded as 1, whereas incorrect and/or “No”/don’t know answers were coded as 0. The minimum and maximum scores were 0 and 20, respectively. Thus, based on the summative score of variables designed to assess knowledge, a score above the mean was considered knowledgeable [4,5,40] (S1 File). Women’s attitude: Women’s attitude towards ANC was measured using 9 questions: 1) Want to have ANC follow up for next time 2) Intention to deliver in a health facility for the next pregnancy 3) Health care professionals providing antenatal care is good 4) All pregnant women should have ANC follow up 5) Timely ANC follow up will be safer for both mother and baby 6) Want to pay for ANC if it is with fee 7) Husbands should be present during ANC follow-up 8) Advice regarding proper health during pregnancy can be gotten outside the hospital 9) Follow up during pregnancy may decrease antenatal and postnatal complications. Each question has a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). The total score was 9–45 and women who scored above the mean value were considered as having a favorable attitude [33,41,42]. Husband involvement: Husband involvement in maternal and child health-related activities was measured using 9 questions: 1) did your husband go with you for ANC follow-up at least once in your most recent pregnancy? 2) Did your husband provide transport/gave money for transport during your recent pregnancy or delivery? 3) Did your husband accompany you to the hospital during labor for your recent delivery? 4) Did your husband discuss with health care providers during your recent pregnancy or delivery? 5) Did your husband look after the child at home/stay with the babies while you are outside the home? 6) Did your husband bathe a newborn/infant while you are busy? 7) Did your husband buy clothes/other things for infants/neonates? 8) Did your husband go with you for immunization services? 9) Did your husband assist you while you breastfeed the newborn/infant? Each question was coded as 0 for “no” and 1 for “yes”. The total score ranged from 0–9 and a score of above the mean was considered as husband involved Based on the summative score of variables designed to assess husband involvement a score above the mean was considered as involved [43,44]. Household decision-making power: Women’s decision-making power was assessed using 9 questions: 1) who decides about health care for you? 2) Who decides on the large household purchase or sell? 3) Who decides on intra-household resource allocation/ daily household purchases? 4) Who decides on where and when to seek medical care for sick newborns/children? 5) Who decides on visits of family, friends, or relatives? 6) Who decides when to have an additional child? 7) Who usually decides how your partner’s/husband earnings will be used? 8) Who decides to go for an ANC visit, postnatal (PNC) visit, where to deliver, and infant immunization? 9) Who usually decides what foods to be cooked each day? The possible answers were me alone which was coded as 2, both of us which was coded as 1, and the husband alone or others which was coded as 0. The score ranged from 0 to 18 and a woman who scored above the mean was considered as having higher household decision-making power [45]. Media exposure: Those women who responded at least once a week to one of the media are considered to be regularly exposed to that form of media (i.e. TV, radio, or magazine) [19]. Experienced danger signs: Women who have experienced one or more of the danger signs during their last pregnancy or childbirth were considered as experienced danger signs. History of neonatal death: Women who have experienced the death of a neonate within the first 28 completed days of life [46]. History of abortion: Women who have experienced termination of pregnancy before 28 weeks gestation in the Ethiopian context [47]. The data collection tool was developed by reviewing the literature [4,5,28,33,41,42]. The data were collected using a semi-structured interviewer-administered questionnaire through face-to-face interviews. Initially, the questionnaire was prepared in English and translated to the Amharic language, and back to English to ensure consistency. The questionnaire contains socio-demographic characteristics, reproductive and maternity healthcare characteristics, husband involvement in maternal and child health-related activities, household decision-making power, and questions assessing women’s comprehensive knowledge of ANC, and attitude towards its uptake. The questionnaire was assessed by a group of researchers (three in the field of maternal and child health, one in the field of public health, and two midwives in the hospital) to evaluate and enhance the items in the question. Before the actual data collection, we did a pretest on 34 women at Ziquala Woreda which has similar socio-cultural and living standards as the study population. Eight female HEWs and four male Diploma in midwifery holders were recruited for data collection and supervision, respectively. Two days of training were given regarding the overall data collection process. During the data collection, the questionnaire was checked for completeness daily by the supervisors. Data were checked, coded, and entered into EPI INFO version 7.1.2, and were exported to SPSS version 25 for further cleaning and analysis. Before analysis, re-coding, transforming, computing, and categorizing of variables were done. Descriptive statistics were used to show participants’ characteristics, comprehensive knowledge of ANC, and attitude towards its uptake. Binary logistic regression analysis was fitted to identify statistically significant independent variables, and variables having a p-value of < 0.25 were included in the multivariable logistic regression for controlling confounders. The multicollinearity assumption was checked using the variance inflation factor (VIF), where VIF <10 was acceptable. In the multivariable logistic regression (Backward Likelihood Ratio approach), a p-value of < 0.05 with a 95% CI for the adjusted odds ratio was employed to ascertain the significant association. We conducted the study under the declaration of Helsinki. Ethical approval was obtained from the Institutional Ethical Review Board of Debre Berhan University (protocol number; P005/20). A formal letter of administrative support was gained from the Sehala Seyemit Woreda health office. Both oral and written informed consent was collected from each of the study members after a clear explanation of the aim of the study and their right to withdraw from the study at any time. For those women who cannot read and write, a thumbprint was taken (i.e. it is a common practice in Ethiopia including banking services and other large issues that need a signature). The study participants were assured that the collected information is anonymous and kept confidential for the study purpose only.

AI Digest

Study Justification:

– Maternal and neonatal mortality rates in Ethiopia are still high, despite efforts to achieve the sustainable development goal of reducing these rates.
– Knowledge about antenatal care (ANC) and a positive attitude towards its uptake are crucial for improving maternal and neonatal health outcomes.
– There is a lack of evidence regarding the knowledge and attitude of women towards ANC uptake in rural communities in Ethiopia.
– This study aimed to assess the factors associated with comprehensive knowledge of ANC and attitude towards its uptake among women who delivered at home in rural Sehala Seyemit district, northern Ethiopia.

Study Highlights:

– The study was conducted from September 1st to October 15th, 2020, in rural Sehala Seyemit district, Waghimra zone, Amhara regional state, Northern Ethiopia.
– A total of 653 women who delivered at home in the selected “kebeles” (administrative units) were included in the study.
– The data were collected using a semi-structured interview guide and analyzed using statistical software.
– The study found that 56.5% of women had comprehensive knowledge of ANC, while 75.2% had a favorable attitude towards its uptake.
– Factors significantly associated with knowledge of ANC included older age, media exposure, history of abortion, time to reach health facility, and history of obstetric danger signs.
– Factors predicting a favorable attitude towards ANC utilization included higher decision-making power, adequate knowledge of ANC, delivery attended by health extension workers, and media exposure.

Study Recommendations:

– Strengthen access to transportation to improve women’s ability to reach health facilities for ANC.
– Increase media exposure to disseminate information about ANC and its importance.
– Promote husband involvement in maternal and child health-related activities.
– Enhance women’s decision-making power within households.
– Encourage women to deliver at health facilities with skilled providers.

Key Role Players:

– Health extension workers: They can provide ANC services and educate women about the importance of ANC.
– Media organizations: They can disseminate information about ANC through various channels, such as radio, television, and magazines.
– Community leaders: They can advocate for ANC and encourage community members to prioritize maternal healthcare.
– Transportation providers: They can ensure reliable transportation options for women to reach health facilities.

Cost Items for Planning Recommendations:

– Transportation infrastructure: Budget for improving road conditions and transportation services in rural areas.
– Media campaigns: Allocate funds for creating and broadcasting ANC-related messages through various media channels.
– Training programs: Provide resources for training health extension workers and community leaders on ANC education and advocacy.
– Community engagement activities: Allocate funds for community mobilization and awareness-raising activities to promote ANC uptake.
Please note that the cost items provided are general suggestions and may vary based on the specific context and resources available in the study area.

Strength of Evidence

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong because it provides a clear description of the study design, sample size calculation, data collection methods, and statistical analysis. The study conducted a community-based cross-sectional study in a specific rural district in northern Ethiopia, which enhances the generalizability of the findings. The study used a multi-stage sampling technique and collected data through face-to-face interviews using a semi-structured questionnaire. Both bivariable and multivariable logistic regression analyses were conducted to identify factors associated with women’s knowledge of antenatal care and attitude towards its uptake. The study also provides specific results, including the percentage of women with adequate knowledge and a favorable attitude. The conclusion suggests actionable steps to improve women’s knowledge and attitude towards antenatal care uptake. To further strengthen the evidence, the abstract could include information on the response rate and potential limitations of the study, such as non-response bias or recall bias.

Abstract

A community-based cross-sectional study was conducted from September 1st to October 15th, 2020. This study was conducted in rural Sehala Seyemit district, Waghimra zone, Amhara regional state, Northern Ethiopia. Sehala Seyemit district is located 285 km northeast of Bahir Dar (the capital city of Amhara regional state) and about 799 km north of Addis Ababa (the capital city of Ethiopia). Accessing health services in the district is difficult because of the lack of transportation to each “kebeles” (which is the smallest administrative unit in Ethiopia). Maternal health services such as ANC, childbirth, and postnatal care are given for free in Ethiopia, including the study area. The district has 13 “kebeles”; 12 rural and 1 urban “kebeles”. Currently, the district has a population of 39,435. Over 90% of the population are farmers. Moreover, there are 3 health centers and 13 health posts serving the community. Furthermore, there were a total of 923 women who gave birth at home in the last 2 years (Sehala Seyemit Woreda report, unpublished data). All women who gave birth in the last two years in the selected “kebeles” during the data collection period were selected to be part of the study. All critically ill women throughout the data collection period were excluded. The sample size for this study was determined by using a single population proportion formula by considering the following assumptions: women’s attitude towards ANC in Mizan, Ethiopia-70.6% [4], 95% level of confidence, and 5% margin of error. Thus, n=(Zα/2)2p(1−p)d2=n=(1.96)2*0.706(1−0.706)(0.05)2 = 319. Where, n = required sample size, α = level of significant, z = standard normal distribution curve value for 95% confidence level = 1.96, p = women’s attitude towards ANC, and d = margin of error. By considering a design effect of 2 (since multistage sampling) and a 5% non-response rate, the minimum adequate sample size was 670. A multistage sampling technique was employed to select the study participants. In the first stage, eight kebeles were selected randomly among the 12 rural “kebeles”. In addition, the lists of home-delivered women from the selected kebeles were obtained from health extension workers (HEWs) and local administrators. Thereafter, the sampling frame was designed by numbering the list of women. Then, the total sample size was distributed to each selected “kebeles” proportionally. In the second stage, the women were selected by a simple random sampling technique using a table of random generation. Women’s knowledge of ANC (adequate/inadequate) and women’s attitude towards ANC uptake (favorable/unfavorable) were the outcome variables. Whereas age of the women, marital status, women’s educational status, women’s occupation, husband educational status, husband occupation, family size, exposure to mass media, time to reach the nearby health facility, parity, history of ANC, number of ANC, birth assistant, husband involvement in maternal and children’s health, household decision-making power, history of abortion, history of neonatal death, history of obstetric danger signs during pregnancy, and status of the pregnancy were the explanatory variables. Home delivery: Is defined as a birth that has taken place at the laboring woman’s own home, or her relative, or her neighbor rather than a birthing center without a skilled birth attendant [39]. Traditional birth attendant: Is a person who is traditionally experienced in attending labor to assist women in childbirth and give care during pregnancy and childbirth [38]. Comprehensive knowledge of ANC: Includes knowledge of ANC and pregnancy, knowledge of obstetric danger signs, knowledge of birth preparedness and complication readiness, knowledge of malaria prevention, knowledge of anemia prevention, knowledge of helminthic infection prevention, and knowledge of tetanus prevention during pregnancy. A total of 20 open and close-ended questions were designed to assess the comprehensive knowledge of ANC. Correct and/or “Yes” answers were coded as 1, whereas incorrect and/or “No”/don’t know answers were coded as 0. The minimum and maximum scores were 0 and 20, respectively. Thus, based on the summative score of variables designed to assess knowledge, a score above the mean was considered knowledgeable [4,5,40] (S1 File). Women’s attitude: Women’s attitude towards ANC was measured using 9 questions: 1) Want to have ANC follow up for next time 2) Intention to deliver in a health facility for the next pregnancy 3) Health care professionals providing antenatal care is good 4) All pregnant women should have ANC follow up 5) Timely ANC follow up will be safer for both mother and baby 6) Want to pay for ANC if it is with fee 7) Husbands should be present during ANC follow-up 8) Advice regarding proper health during pregnancy can be gotten outside the hospital 9) Follow up during pregnancy may decrease antenatal and postnatal complications. Each question has a five-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, 5 = strongly agree). The total score was 9–45 and women who scored above the mean value were considered as having a favorable attitude [33,41,42]. Husband involvement: Husband involvement in maternal and child health-related activities was measured using 9 questions: 1) did your husband go with you for ANC follow-up at least once in your most recent pregnancy? 2) Did your husband provide transport/gave money for transport during your recent pregnancy or delivery? 3) Did your husband accompany you to the hospital during labor for your recent delivery? 4) Did your husband discuss with health care providers during your recent pregnancy or delivery? 5) Did your husband look after the child at home/stay with the babies while you are outside the home? 6) Did your husband bathe a newborn/infant while you are busy? 7) Did your husband buy clothes/other things for infants/neonates? 8) Did your husband go with you for immunization services? 9) Did your husband assist you while you breastfeed the newborn/infant? Each question was coded as 0 for “no” and 1 for “yes”. The total score ranged from 0–9 and a score of above the mean was considered as husband involved Based on the summative score of variables designed to assess husband involvement a score above the mean was considered as involved [43,44]. Household decision-making power: Women’s decision-making power was assessed using 9 questions: 1) who decides about health care for you? 2) Who decides on the large household purchase or sell? 3) Who decides on intra-household resource allocation/ daily household purchases? 4) Who decides on where and when to seek medical care for sick newborns/children? 5) Who decides on visits of family, friends, or relatives? 6) Who decides when to have an additional child? 7) Who usually decides how your partner’s/husband earnings will be used? 8) Who decides to go for an ANC visit, postnatal (PNC) visit, where to deliver, and infant immunization? 9) Who usually decides what foods to be cooked each day? The possible answers were me alone which was coded as 2, both of us which was coded as 1, and the husband alone or others which was coded as 0. The score ranged from 0 to 18 and a woman who scored above the mean was considered as having higher household decision-making power [45]. Media exposure: Those women who responded at least once a week to one of the media are considered to be regularly exposed to that form of media (i.e. TV, radio, or magazine) [19]. Experienced danger signs: Women who have experienced one or more of the danger signs during their last pregnancy or childbirth were considered as experienced danger signs. History of neonatal death: Women who have experienced the death of a neonate within the first 28 completed days of life [46]. History of abortion: Women who have experienced termination of pregnancy before 28 weeks gestation in the Ethiopian context [47]. The data collection tool was developed by reviewing the literature [4,5,28,33,41,42]. The data were collected using a semi-structured interviewer-administered questionnaire through face-to-face interviews. Initially, the questionnaire was prepared in English and translated to the Amharic language, and back to English to ensure consistency. The questionnaire contains socio-demographic characteristics, reproductive and maternity healthcare characteristics, husband involvement in maternal and child health-related activities, household decision-making power, and questions assessing women’s comprehensive knowledge of ANC, and attitude towards its uptake. The questionnaire was assessed by a group of researchers (three in the field of maternal and child health, one in the field of public health, and two midwives in the hospital) to evaluate and enhance the items in the question. Before the actual data collection, we did a pretest on 34 women at Ziquala Woreda which has similar socio-cultural and living standards as the study population. Eight female HEWs and four male Diploma in midwifery holders were recruited for data collection and supervision, respectively. Two days of training were given regarding the overall data collection process. During the data collection, the questionnaire was checked for completeness daily by the supervisors. Data were checked, coded, and entered into EPI INFO version 7.1.2, and were exported to SPSS version 25 for further cleaning and analysis. Before analysis, re-coding, transforming, computing, and categorizing of variables were done. Descriptive statistics were used to show participants’ characteristics, comprehensive knowledge of ANC, and attitude towards its uptake. Binary logistic regression analysis was fitted to identify statistically significant independent variables, and variables having a p-value of < 0.25 were included in the multivariable logistic regression for controlling confounders. The multicollinearity assumption was checked using the variance inflation factor (VIF), where VIF <10 was acceptable. In the multivariable logistic regression (Backward Likelihood Ratio approach), a p-value of < 0.05 with a 95% CI for the adjusted odds ratio was employed to ascertain the significant association. We conducted the study under the declaration of Helsinki. Ethical approval was obtained from the Institutional Ethical Review Board of Debre Berhan University (protocol number; P005/20). A formal letter of administrative support was gained from the Sehala Seyemit Woreda health office. Both oral and written informed consent was collected from each of the study members after a clear explanation of the aim of the study and their right to withdraw from the study at any time. For those women who cannot read and write, a thumbprint was taken (i.e. it is a common practice in Ethiopia including banking services and other large issues that need a signature). The study participants were assured that the collected information is anonymous and kept confidential for the study purpose only.

Materials

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Strengthening transportation: Improve access to health facilities by addressing the lack of transportation in rural areas. This can be done by providing reliable transportation services, such as ambulances or mobile clinics, to ensure that pregnant women can easily reach healthcare facilities for antenatal care, childbirth, and postnatal care.

2. Mass media campaigns: Increase awareness and knowledge about maternal health by implementing mass media campaigns. This can involve using various forms of media, such as radio, television, and magazines, to disseminate information about the importance of antenatal care, birth preparedness, and the availability of free maternal health services.

3. Involvement in household decision-making: Empower women by promoting their involvement in household decision-making processes. This can be achieved through community-based programs that educate both women and men about the benefits of shared decision-making in maternal and child health. Encouraging husbands to support their wives in seeking antenatal care and making healthcare decisions can improve access to maternal health services.

4. Skilled birth attendants: Encourage women to deliver at a health facility with the assistance of skilled birth attendants. This can be achieved by raising awareness about the risks associated with home deliveries and promoting the benefits of delivering in a healthcare facility. Training and deploying more skilled birth attendants, such as midwives, in rural areas can also improve access to safe deliveries.

By implementing these innovations, it is expected that access to maternal health services will be improved, leading to better maternal and neonatal health outcomes in rural areas of Sehala Seyemit district, northern Ethiopia.

AI Innovations Description

The study conducted in rural Sehala Seyemit district, northern Ethiopia aimed to assess factors affecting comprehensive knowledge of antenatal care (ANC) and attitude towards its uptake among women who delivered at home. The study found that women’s knowledge of ANC was inadequate, with only 56.5% having comprehensive knowledge. However, 75.2% of women had a favorable attitude towards ANC utilization.

Several factors were identified as significantly associated with women’s knowledge of ANC. These factors included older age, media exposure, history of abortion, time to reach a health facility, and history of obstetric danger signs. On the other hand, higher decision-making power, adequate knowledge of ANC, delivery attended by health extension workers, and media exposure were predictors of a favorable attitude towards ANC utilization.

Based on these findings, the study recommended several strategies to improve access to maternal health services, particularly ANC. These recommendations include:

1. Strengthening access to transportation: Given the difficulty in accessing health services in the district due to the lack of transportation, improving transportation infrastructure and availability can help women reach health facilities for ANC services.

2. Mass media campaigns: Increasing media exposure can improve women’s knowledge of ANC. Implementing mass media campaigns that provide accurate and comprehensive information about ANC can help raise awareness and knowledge among women in the community.

3. Involvement in household decision-making: Empowering women to participate in household decision-making can positively influence their attitude towards ANC utilization. Encouraging women’s involvement in decision-making processes related to maternal and child health can help promote ANC uptake.

4. Encouraging delivery at a health facility by a skilled provider: Women who delivered with the assistance of health extension workers had a more favorable attitude towards ANC utilization. Promoting the importance of delivering at a health facility with skilled providers can help improve maternal healthcare service uptake.

By implementing these recommendations, it is expected that women’s knowledge and attitude towards ANC will improve, leading to increased utilization of maternal health services and ultimately contributing to the reduction of maternal and neonatal mortality in the community.

AI Innovations Methodology

Based on the provided description, the study aimed to assess factors affecting comprehensive knowledge of antenatal care (ANC) and attitude towards its uptake among women delivered at home in rural Sehala Seyemit district, northern Ethiopia. The study used a community-based cross-sectional design and collected data from 653 women using a semi-structured interview guide. The data were analyzed using both bivariable and multivariable logistic regression analyses to identify factors associated with women’s knowledge of ANC and attitude towards its uptake.

The study found that 56.5% of women had knowledge of ANC, while 75.2% had a positive attitude towards its uptake. Factors significantly associated with knowledge of ANC included older age, media exposure, history of abortion, time to reach health facility, and history of obstetric danger signs. Factors associated with a favorable attitude towards ANC utilization included higher decision-making power, adequate knowledge of ANC, delivery attended by health extension workers, and media exposure.

To improve access to maternal health, the study recommends strengthening access to transportation, mass media, involvement in household decision-making, and encouraging women to deliver at a health facility with a skilled provider. These recommendations aim to increase women’s knowledge and attitude towards ANC uptake, thereby improving maternal healthcare service utilization.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could involve conducting a pre- and post-intervention study. The study could select a sample of women from the same rural Sehala Seyemit district and collect data on their knowledge of ANC and attitude towards its uptake before implementing the recommended interventions. After implementing the interventions, data could be collected again from a similar sample of women. The pre- and post-intervention data could then be compared to assess the impact of the interventions on improving access to maternal health.

The impact could be measured by comparing the proportion of women with adequate knowledge of ANC and a favorable attitude towards its uptake before and after the interventions. Additionally, other indicators such as the proportion of women delivering at a health facility with a skilled provider could be measured. Statistical tests, such as chi-square tests or t-tests, could be used to determine if there are significant differences between the pre- and post-intervention data.

Overall, the study provides valuable insights into factors affecting access to maternal health in rural Ethiopia and offers recommendations for improving access. The suggested methodology for simulating the impact of these recommendations can help evaluate the effectiveness of interventions in improving access to maternal health services.

Author

Dima Health

Statistics:

Citations: 1

Identifiers:

DOI: 10.1371/journal.pone.0276125

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants, Workforce

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male & Female