Menu
Menu
Menu
Menu
Background: Delayed first antenatal care contact refers to first antenatal care contact occurring above twelfth weeks of gestation. Studies in Nigeria and in other countries have examined the prevalence and predictors of delayed first antenatal care contact. Nevertheless, existing studies have rarely examined the predictors among primiparous women. In addition, the evidence of higher health risks associated with primigravida emphasizes the need to focus on primiparous women. This study, therefore, examined the predictors of delayed first antenatal care contact among primiparous women in Nigeria. Methods: The study was a descriptive cross-sectional design that analyzed data extracted from the 2018 Nigeria Demographic and Health Survey. The study analyzed a weighted sample of 3,523 primiparous women. The outcome variable was delayed first antenatal care contact. explanatory variables were grouped into predisposing, enabling, and need factors. The predisposing factors were maternal age, education, media exposure, religion, household size, The knowledge of the fertile period, and women’s autonomy. The enabling factors were household wealth, employment status, health insurance, partner’s education, financial inclusion, and barriers to accessing healthcare. The need factors were pregnancy wantedness and spousal violence during pregnancy. Data were analyzed using Stata 14. Two multivariable logistic regression models were fitted. Statistical significance was set at p < 0.05. Results: Nearly two-thirds (65.0%) of primiparous women delayed first antenatal care contact. Maternal age, maternal education, media exposure, religion, household membership, and knowledge of the fertile period were predisposing factors that significantly influenced the likelihood of delayed first antenatal care contact. Also, household wealth, employment status, health insurance, partner’s education, perception of distance to the health facility, and financial inclusion were enabling factors that had significant effects on delayed first antenatal care contact. Pregnancy wantedness was the only need factor that significantly influenced the likelihood of delayed first antenatal care contact. Conclusion: The majority of primiparous women in Nigeria delayed first antenatal care contact and the delay was predicted by varied predisposing, enabling, and need factors. Therefore, a public health education program that targets women of reproductive age especially primiparous women is needed to enhance early antenatal care contact in the country.
The study was descriptive cross-sectional research that entails the analysis of quantitative secondary data extracted from the women’s data of 2018 Nigeria Demographic and Health Survey (NDHS). The choice of the 2018 NDHS stems from the high quality of the data, as well as the availability of the datasets in the public domain, which encourages replication of the study elsewhere, as well as the international comparability of the study findings. The study represents a further analysis of the 2018 NDHS, which is conducted under the auspices of the Demographic and Health Survey (DHS) program. The DHS program is being implemented in several developing countries by the Inner-City Fund (ICF) to build capacity for the collection and provision of reliable national estimates of demographic and health characteristics in developing countries [42]. The 2018 NDHS was conducted by the National Population Commission (NPC) with the technical, and financial support of many development partners [4]. The methodology adopted for the conduct of the 2018 NDHS is similar to the methodology usually adopted in the DHS program [43]. Details of the methodology are widely available to all interested researchers via https://dhsprogram.com/pubs/pdf/FR359/FR359.pdf. The study targets reproductive-age women who are first-time mothers in Nigeria. In the 2018 NDHS, this group of childbearing women was 11,363 (27.2%) out of the 41,821 women covered in the survey but only 3,488 of the women were included in the domestic violence module. The study sample was derived upon execution of the inclusion/exclusion criteria. Three sets of women were excluded. One, all women who were not first-time mothers were not included. This was necessary to maintain study focus on only primiparous women. This criterion excluded 30,458 women covered in the survey. Two, all women not included in the domestic violence module were excluded. This was necessary because only women included in the module were asked questions on spousal violence, which is one of the explanatory variables examined in the study. This criterion excluded 7,875 women covered in the survey. Three, 24 women who reported traditional or other religions besides Islam and Christianity were excluded due to their insignificant proportion which may distort the statistical analysis. The analyzed sample in the study was therefore 3,523 women. The DHS weighting factor was applied. The outcome variable in the study was delayed first antenatal care contact. This was derived from response to the timing of the first antenatal care contact. All first antenatal contact occurring after 12 weeks of gestation were grouped as ‘yes’ and coded ‘1’ while contact within the first trimester was grouped as ‘no’ and coded ‘0’. This measure is in line with the recommendation of the current global model of standard antenatal care [1] and has been adopted in existing studies on delayed first antenatal care contact [18, 23, 24, 26, 27]. Findings in existing empirical studies, as well as the Andersen model, guided the selection of the explanatory variables. Four sets of variables were selected. One, seven predisposing factors were selected. These were maternal age (15–24, 25–34, or 35–49 years), education (no formal education, primary, secondary, or higher), media exposure (low, moderate, or high), religion (Islam or Christianity), household size (small or large, with small size indicating six people, and large size indicating seven or more people in the household), knowledge of fertile period (correct or incorrect, with correct knowledge indicating midway between two menstrual cycles) and women’s autonomy (low or high, with low indicating women’s lack of involvement in the household decision, and high indicating sole or joint involvement with a partner). Media exposure was derived by combining responses to the frequency of reading newspaper, listening to radio, and watching television per week. Responses to each media outlets were assigned score of ‘1’ for ‘not at all’ ‘2’ for ‘less than once a week’ ‘3’ for ‘at least once a week’. This gives a total score of nine (9) which was divided into three equal parts with scores of ‘1–3’ representing ‘low exposure’, scores of ‘4–6’ representing ‘moderate exposure’, and scores of ‘7–9’ representing ‘high exposure’. Household size was divided into ‘small or large’ based on the recommendation of the 1988 national policy on population for development, unity, progress, and self-reliance [44] which suggests four children per woman. A large household size connotes that the household consists of more than four other people in addition to the couple. The knowledge of the fertile period was included because late awareness that pregnancy has occurred contributes to delayed first antenatal care [13]. Women’s autonomy was derived by combining participation in the three-household decision-making. Women who had the final say either solely or jointly with their partner in all the decisions were deemed to have ‘high autonomy’ while other women belong to the ‘low autonomy’ category. These variables have been found to be important correlates of delayed first antenatal care in existing studies [18, 25, 28, 45]. Two, six enabling factors were selected. These were household wealth (poorest, poorer, middle, richer, richest), employment status (employed or unemployed), health insurance (enrolled or not enrolled), partners’ education (none, primary, secondary, higher), financial inclusion (yes or no, with yes indicating ownership of a bank account and no indicating otherwise), and perception of money for medical treatment and perception of distance to health facility (big problem or not a big problem). Bank ownership was used to measure women’s financial inclusion because it is one of the key means that ensures access to formal financial information, assistance, and services such as credit and insurance. This measure is widely accepted and used to proxy financial inclusion [46, 47]. With the exclusion of financial inclusion, these variables have been confirmed to be significant predictors of delayed first antenatal care contact [18, 23, 24, 45, 48, 49]. Three, two need factors were selected. These were pregnancy wantedness (planned, when pregnancy was wanted at the time of occurrence or unplanned when pregnancy was not wanted at all or not wanted at the time of occurrence) and spousal violence during pregnancy (experienced or not experienced). The two variables have been identified as having significant predictive power on antenatal care utilization [49–52]. Two external environmental factors, namely, place of residence and geo-political zone were included for statistical control. Studies have shown that these two variables are strong correlates of delayed first antenatal care contact [26, 53]. Data were analyzed at three levels using Stata 14 [54]. Firstly, the prevalence of delayed first antenatal care contact and the socio-demographic characteristics of respondents were described using frequency distribution and percentages. Secondly, the research variables were cross-tabulated for the purpose of assessing how delayed the first antenatal care contact varies in response to changes in the explanatory variables. The Unadjusted Odds Ratio (UOR) was used to examine the relationship between the outcome and explanatory variables. Any variable with no statistical significance at this level was not included in subsequent analysis. Thirdly, two multivariable logistic regression models were fitted to examine the predictors of delayed first antenatal care contact using Adjusted Odds Ratio (AOR). Model 1 included the predisposing, enabling, and need factors, while Model 2 controlled for the external environmental factors. Model 2 is the full model on which the discussion of findings was anchored. Statistical significance was set at p < 0.05.
N/A
