Determinants to late antenatal clinic start among pregnant women: The case of Saint Elizabeth general hospital, Shisong, Cameroon

  • Pan African Medical Journal, Volume 35, Year 2020

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Study Justification:
– Improving maternal health requires identifying and addressing barriers to accessing quality maternal health services.
– Factors such as distance to health facilities and inadequate health institutions can prevent women from seeking or receiving care during pregnancy and childbirth.
– This study aimed to determine factors associated with late initiation of Antenatal Care (ANC) among pregnant women in the Saint Elizabeth General Hospital, Shisong, Cameroon.
– The results of this study can help inform interventions and policies to improve access to ANC services and potentially improve pregnancy outcomes.
Study Highlights:
– The study was conducted from October 24th to November 24th, 2016.
– A total of 602 pregnant women from the ANC units of Saint Elizabeth General Hospital and its satellite institutions were included in the study.
– The outcome variable was gestational age at the start of ANC, while the independent variables included individual, community, and institutional factors.
– Factors associated with late ANC initiation (>14 weeks of pregnancy) included age, level of education, marital status, religion, parity, having a source of income, cost of services, distance to health facility, and dissatisfaction with previous ANC services.
– The study suggests that addressing issues related to the cost of ANC services and improving geographical barriers to accessing ANC services may increase the number of pregnant women starting ANC early and potentially improve pregnancy outcomes.
Recommendations for Lay Reader:
– Pregnant women should start ANC early (within the first 14 weeks of pregnancy) to improve maternal and child outcomes.
– Factors such as age, education level, marital status, religion, parity, income, cost of services, distance to health facility, and satisfaction with previous ANC services can influence the timing of ANC initiation.
– Policies and interventions should focus on reducing the cost of ANC services and improving access to ANC services, particularly for women living far from health facilities.
Recommendations for Policy Maker:
– Develop policies and interventions to reduce the cost of ANC services, making them more affordable for pregnant women.
– Improve geographical access to ANC services by increasing the number of health facilities or implementing mobile ANC clinics in remote areas.
– Strengthen the quality of ANC services to increase satisfaction among pregnant women and encourage early initiation of ANC.
– Provide education and awareness programs to promote the importance of early ANC initiation among pregnant women.
– Collaborate with relevant stakeholders, including healthcare providers, community leaders, and NGOs, to implement and monitor the effectiveness of these interventions.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing policies related to maternal health and ANC services.
– Saint Elizabeth General Hospital: Provides ANC services and can collaborate with the Ministry of Health to implement interventions.
– Healthcare providers: Responsible for delivering ANC services and educating pregnant women about the importance of early initiation.
– Community leaders: Can help raise awareness about ANC services and encourage pregnant women to seek care early.
– Non-governmental organizations (NGOs): Can provide support and resources to implement interventions and improve access to ANC services.
Cost Items for Planning Recommendations:
– Cost of reducing ANC service fees or implementing subsidies for pregnant women.
– Cost of establishing additional health facilities or mobile ANC clinics in remote areas.
– Cost of training healthcare providers on delivering quality ANC services.
– Cost of developing and implementing education and awareness programs.
– Cost of monitoring and evaluating the effectiveness of interventions.
– Cost of collaboration and coordination with key role players, including the Ministry of Health, Saint Elizabeth General Hospital, healthcare providers, community leaders, and NGOs.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is rated 7 because it provides a clear description of the study design, study population, sampling methods, and data analysis. However, it lacks information on the validity and reliability of the data collection tools, as well as the limitations of the study. To improve the evidence, the abstract could include a statement on the validity and reliability of the data collection tools used, as well as a discussion of the limitations of the study, such as potential biases or confounding factors. Additionally, providing information on the generalizability of the findings to other settings would enhance the evidence.

Introduction: to improve maternal health, barriers that limit access to quality maternal health services must be identified and addressed at all levels of the health system. The World Health Organisation (WHO) cites distance to health facility and inadequate health institutions as factors that prevent women from receiving or seeking care during pregnancy and childbirth. Specifically, we intended to determine factors associat ed with late start of late Antenatal Care (ANC) among pregnant women in the Saint Elizabeth General Hospital Shisong (SEGHS), Cameroon. Methods: this was a cross sectional study carried out from the 24th October to 24th November 2016. A total of 602 pregnant women were recruited from ANC units of SEGHS and its satellite institutions. The outcome variable was gestational age at start of ANC (estimated by counting from last menstrual period to day of first ANC consultation) while the independent variables were individual, community and institutional factors. Data was analyzed using Epi info version 7. Chi square test was used to appreciate the influence of different variables on risk of late ANC initiation (> 14 weeks of pregnancy). The level of significance was set out at (p: < 0.05). Results: out of the 602 pregnant women included in our study, 75% initiated ANC late (after 14 weeks of pregnancy). Factors associated with late ANC start were; age (p = 0.001), level of education (p = 0.002), marital status (p = 0.016), religion (p = 0.034), parity (p = 0.001), having a source of income (p=0.001), cost of services (p = 0.010), distance to health facility (p = 0.021) and dissatisfaction with previous ANC services (p = 0.014). Conclusion: Cameroon is one of the countries with a high maternal mortality ratio. WHO estimated it to be 529 per 100000 live births in 2017. Prompt and adequate ANC services can improve on maternal and child outcomes of pregnancy. The results of this study suggest tackling issues related to cost of ANC services and improving geographical (distance) barrier to accessing ANC services (in addition to addressing other identified measures) may lead to an increase in pregnant women starting ANC early and thus potentially improve pregnancy outcomes.

Study design: the study was a quantitative research. Cross-sectional analytic study was done using clinical method. Duration of study: the period of study involved then period during which data was collected, it ran for a month (24th October to 24th November 2016). Study population: the target population was all pregnant women of child bearing age from 15 years and above attending ANC in the Saint Elizabeth Catholic Hospital and its health institutions. Inclusion criteria: all women of child bearing age from 15 years and above who gave consent (those of 18 years and above) or for minors (18 years below), whose parents gave their consent; All pregnant women who had started antenatal consultation and who accepted to participate in our study. Exclusion criteria: all pregnant women who were seriously sick; all pregnant women who started their ANC in another health institution different from these two; all women of child bearing age below the age of 18 years whom parental consent was not granted. Sampling methods: the sampling method employed was non-probabilistc convenience sampling. The calculation of the sample size was done using the formula below using a prevalence of 50% in order to obtain the maximum sample size possible. Based on this, we determined our minimum sample size to be 381 and taking into account for a non-response rate of 10% the final calculated sample size was 420. However, in our study, 602 pregnant women were taking part. PΟ = Proportion of women starting ANC late (P = 50%); a = 0. 05→Za = 1.95; d is the margin of error (d = 5%). Study variables and operational definitions: for the purposes of this study, the independent variables were grouped into individual, community (social) and health systems related factors. Individual factors were: age, level of education, marital status, religion and parity. Social factors included: who was responsible for decisions, whether the spouse was employed or not, having a source of revenue, and whether there was peer influence. The health system related factors were: opinion about quality of services, cost of prenatal services, distance from health facility and satisfaction with previous ANC services. The dependent variable in our study was gestational age of pregnancy (calculated from LMP) at the time of initiating ANC. It was categorized as late if more than 14 weeks or not late if it was 14 weeks or less. Study procedure of data collection: this was a hospital-based survey where all participants who consented were interviewed using a structured questionnaire filled in the hospital. Prior to use in the study participants, a total of 20 questionnaires were pretested at the Catholic University of Central Africa among female students aged 15 years and above with the aim of revising poorly structured questions, estimate the average time required to fill the questionnaire and thus validate the use of the questionnaire in our context. It was estimated that; each questionnaire could be administered for 30-45 minutes after the pretest. A total of 602 questionnaires were administered to women greater than or equal to 15 years of age attending ANC in the Saint Elizabeth Catholic Hospital and its health institutions with objectives intended to identify and determine the determinants of late ANC initiation among pregnant women in the Saint Elizabeth General Hospital Shisong and its Health Institution, Cameroon. The questionnaire which was sub-divided into two parts was used for data collection. It consisted: (1) Socio-demographic characteristics of the pregnant women attending ANC unit of the Saint Elizabeth general hospital and its health institutions; (2) Health system determinants are related to late ANC attendance among women in the ANC unit in the Saint Elizabeth general hospital and its health institutions. Data analysis: data was entered using Microsoft Excel and analyzed using Epi Info version 7.0. Frequencies and percentages were determined for categorical variables. Means and standard deviations (mean ± SD) were calculated for continuous variables. To investigate associations between the independent variables and the outcome variable we used Chi-Square test as they were categorical variables. Fischer's exact test was used in cases were conditions for Chi-Square test were not met. Statistical significance was set at p < 0.05. Ethical consideration: ethical approval for the study was obtained from the Institutional Research Ethics Committee for Human Health (CIERSH) at the School of Health Sciences of the Catholic University of Central Africa. Administrative clearance was obtained from the Director of the saint Elizabeth Catholic General Hospital were our research took place. In this study the confidentiality of patient information and identity was respected. Written consent was obtained from all participants and confidentiality of participants was ensured by using anonymous questionnaires. Participation in the study was without any coercion and participants were free to withdraw or ask their information withdrawn at any time during the study.

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

1. Telemedicine: Implementing telemedicine services can provide remote access to prenatal care for pregnant women who live far from health facilities. This would allow them to consult with healthcare professionals through video calls, receive guidance, and monitor their pregnancy remotely.

2. Mobile clinics: Setting up mobile clinics that travel to remote areas can bring maternal health services closer to pregnant women who have limited access to healthcare facilities. These clinics can provide prenatal check-ups, vaccinations, and education on maternal health.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care and education within their communities can help bridge the gap in access to maternal health services. These workers can conduct regular check-ups, provide health education, and refer pregnant women to healthcare facilities when necessary.

4. Financial assistance programs: Implementing financial assistance programs or health insurance schemes specifically for maternal health can help reduce the financial barriers that prevent pregnant women from seeking timely care. This can include subsidies for ANC services, transportation vouchers, or coverage for emergency obstetric care.

5. Improving infrastructure: Investing in the improvement of healthcare infrastructure, particularly in rural areas, can help reduce the distance barrier to accessing maternal health services. This can involve building or upgrading health facilities, ensuring reliable transportation networks, and providing adequate medical equipment and supplies.

6. Health education campaigns: Conducting targeted health education campaigns to raise awareness about the importance of early ANC initiation and the benefits of maternal health services can help overcome cultural and social barriers. These campaigns can be conducted through various channels, such as radio, television, community meetings, and social media.

It is important to note that the specific context and needs of the Saint Elizabeth General Hospital in Shisong, Cameroon should be taken into consideration when implementing any of these innovations.
AI Innovations Description
Based on the study titled “Determinants to late antenatal clinic start among pregnant women: The case of Saint Elizabeth general hospital, Shisong, Cameroon,” the following recommendation can be developed into an innovation to improve access to maternal health:

1. Improve affordability of ANC services: Addressing the cost of prenatal services can help reduce barriers to accessing ANC. This can be done by implementing innovative financing models, such as health insurance schemes or subsidies, to make ANC services more affordable for pregnant women.

2. Enhance geographical accessibility: Distance to health facilities was identified as a barrier to accessing ANC. To overcome this, innovative solutions can be implemented, such as mobile clinics or telemedicine, to bring ANC services closer to pregnant women in remote areas. This can help overcome the geographical barrier and ensure timely initiation of ANC.

3. Strengthen community engagement: Peer influence was found to be a factor influencing ANC initiation. Implementing community-based interventions, such as community health workers or community education programs, can help raise awareness about the importance of ANC and encourage pregnant women to seek care early.

4. Improve quality of ANC services: Dissatisfaction with previous ANC services was identified as a factor associated with late ANC initiation. Innovations can be implemented to improve the quality of ANC services, such as training healthcare providers on respectful maternity care and implementing quality improvement initiatives to ensure women receive comprehensive and respectful care during their ANC visits.

By implementing these recommendations as innovative solutions, access to maternal health can be improved, leading to better pregnancy outcomes and reduced maternal mortality rates.
AI Innovations Methodology
Based on the study titled “Determinants to late antenatal clinic start among pregnant women: The case of Saint Elizabeth general hospital, Shisong, Cameroon,” here are some potential recommendations to improve access to maternal health:

1. Improve awareness and education: Implement community-based education programs to raise awareness about the importance of early antenatal care (ANC) initiation and the benefits of regular check-ups during pregnancy. This can be done through health campaigns, community health workers, and local media.

2. Reduce financial barriers: Explore options to make ANC services more affordable, such as subsidizing costs or providing financial assistance to pregnant women who cannot afford the services. This can help address the issue of cost of services identified in the study.

3. Enhance transportation services: Improve transportation infrastructure and services to reduce the distance barrier to accessing ANC. This can include providing transportation vouchers or organizing community transport systems to ensure pregnant women can easily reach healthcare facilities.

4. Strengthen healthcare facilities: Address the issue of inadequate health institutions by investing in the improvement of existing facilities and building new ones where needed. This can help ensure that pregnant women have access to quality maternal health services.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage of pregnant women initiating ANC within the first 14 weeks of pregnancy, the average distance traveled to reach a healthcare facility, or the percentage of pregnant women who report satisfaction with ANC services.

2. Collect baseline data: Gather data on the current status of the indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement the recommendations: Roll out the recommended interventions, such as awareness campaigns, financial assistance programs, transportation improvements, and healthcare facility enhancements.

4. Monitor and collect data: Continuously monitor the implementation of the recommendations and collect data on the indicators identified in step 1. This can involve regular surveys, interviews, or data collection from healthcare facilities.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on the identified indicators. Compare the post-intervention data with the baseline data to determine any changes or improvements.

6. Evaluate the results: Evaluate the results of the analysis to determine the effectiveness of the recommendations in improving access to maternal health. This can involve assessing the changes in the indicators, identifying any challenges or barriers encountered during implementation, and gathering feedback from pregnant women and healthcare providers.

7. Adjust and refine: Based on the evaluation results, make any necessary adjustments or refinements to the recommendations. This can involve scaling up successful interventions, addressing any identified shortcomings, and continuously improving the strategies to further enhance access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for future interventions.

Statistics:
Citations: 6
Authors: 9
Identifiers:
DOI: 10.11604/pamj.2020.35.112.18712
Research Areas:
Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants
Study Countries:
Cameroon
Study Design:
Cross Sectional Study, Grounded Theory
Study Approach:
Quantitative
Participants Gender:
Female
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