Early initiations of first antenatal care visit and associated factor among mothers who gave birth in the last six months preceding birth in Bahir Dar Zuria Woreda North West Ethiopia

Antenatal care is the care which provided for the mother during pregnancy to improve the health of the mother and unborn baby. World health organization is recommended for booking the services before the first trimester or 12 weeks of gestation. However, according to our country Ethiopia ministry health, it’s acceptable until 16 weeks of gestation. This study was trying to answer the level and associated factors through structured interview questionnaires.

The participants were asked their socio-demographic characteristics, reproductive characteristics, about antenatal care service utilization, and the challenges they face during antenatal care service utilization.

Of 400 participants 187 of the participants were initiated the follow-up before 16 weeks of gestation. This study reveals that the average month mothers were starting antenatal care visit at 16 weeks and 5 days. Short distances from the facilities, knowledge on the timing of ANC, not having under-five children, having one under-five child, and wanted or planned pregnancy was the main factor that affects the early timing of antenatal care visit.

In conclusion, the prevalence of early timing of ANC visit in the study area was high in comparison to the national figure. Factors that responsible for early initiation of ANC services were the accessibility of the services, knowledge about the timing of ANC, a desire of pregnancy, and under-five children. Policy action will be required to farther improve the timely booking of ANC.

Pregnancy is one of the most important periods in the life of a woman, a family, and a society [1]. While, because of these physiological changes that occur during pregnancy, mother and her baby were facing life treating problems. To avert the problem, there are different maternal health care services were provided for minimizing the problem. One of the services is Antenatal care (ANC) [2]. The aim of ANC service is to prevent health problems that affect both the fetus and mother and to ensure that each newborn child has a good start [3].

Nevertheless, true progress has been made globally in terms of increasing access and use, there are high numbers of maternal deaths and stillbirths were occurred [4]. Globally around 2.6 million stillbirths annually and 830 maternal deaths every day occur due to the pregnancy-related cause. Among all deaths, 99% occurred in the developing countries as compared as 1% in developed countries [5]. Many maternal and prenatal deaths occur in women who have not received timely, inadequate and no utilization of ANC [6]. Early antenatal care attendance during the first three months of gestation plays a major role in detecting and treating complications that occur during pregnancy [2].

The timing of Antenatal care booking is one of the basic components of ANC services. It helps to early detection, managing, and prevent problems that occur during the pregnancy time. According to WHO Focus antenatal care model recommendation, all pregnant mothers are better to start ANC booking within the first trimester of pregnancy (within 12 weeks) [3]. In addition, now a time World Health Organization adopt a new ANC model that recommend to increase the numbers of contact from four visits to eight contacts for the aim of reducing prenatal mortality and to improve women experiences of care [3, 7]. Actually, this new Antenatal care model still is not practicable in Ethiopia. However, according to the Federal Democratic Republic of Ethiopia Ministry of Health recommendation, the timing of ANC booking is acceptable until 16 weeks of gestation [8].

Existing evidence in the global shows that the prevalence of early timing of antenatal care visits were around 43%. According to the report, there is a high discrepancy between developed and developing regions [9]. The report showed that 85% of mothers in the developed region start their ANC follow up earlier but it was below 45% and less than 25% in the developing countries and sub-Sahara region respectively [10]. According to different demographic health survey report in sub-Sahara countries shows that the prevalence of early timing of ANC visit ranges from 17.6 to 20% [8, 11, 12].

According to Ethiopian demographic health survey, 2016 report indicates that 20% of pregnant mothers started their Antenatal care visit at the first trimester of pregnancy from that 44% of the mothers live in the urban, start ANC visit at the first trimester of pregnancy compared to 17% in the rural community [8]. Different literature conducted in Ethiopia also shows that the prevalence of early timing of ANC visit ranges from 17 to 41% [13‐15].

Studies conducted in developing countries showed that residence, educational status of the mother, husband occupation, parity and planned or wanted pregnancy was factors for late ANC booking [16, 17]. Studies conducted in the urban Ethiopia shows that age of the mother, educational status of the mother, previous history of ANC, perceive adequacy of ANC, low monthly income, receiving advice on when to start ANC visits, household food insecurity, parity, urine test as a means of pregnancy recognition, and unplanned pregnancy was a determinant of the early timing of ANC visits [13, 14, 18‐22].

Studies conducted in rural Ethiopia showed that age of the mother, parity, planned pregnancy, media access, knowledge about the time of ANC booking, and advised to book within 12 weeks was affected the timing of antenatal care visit [23, 24]. There are limited finding on the prevalence and factors associated with the early timing of ANC booking in the study area as well as in the country. For this situation, a cross-sectional study is important to address the gap. Therefore assessing the prevalence and factors that associated with early timings of antenatal care visit are important for setting intervention that helps to improve the utilization of ANC services.

Out of 410 mothers who have a history of Antenatal care follow up in Bahir Dar Zuria District, 400 complete the interview administer questionnaires. Therefore the data analysis was made based on 400 respondents that have been completed the interview. The response rate was 97.56%.

The prevalence of early timing of ANC visits was 46.8%. The factors that directly affect the early timing of ANC visits were distances, knowledge of the mother on the timing of ANC, numbers of under-five children, and desire of pregnancy.

This finding shows that the prevalence of early first time antenatal care visits was 46.8 with 95% CI [40.5, 51.8] which is in line with the prior study conduct in Gonder Ethiopia 47.4% [18], and central Tigray Ethiopia 41% [14]. However the finding of this study was lower than study conduct in Addis Ababa Ethiopia 58% [27], and Nepal 70% [17]. The difference might be due to the study area in Addis Ababa there are accessible and available services and more aware of the existing services than the study area.

The finding of this study was higher than study conduct in Gedeo Zone Ethiopia 35.4% [20], Ethiopian DHS 20% [8], and in the Global estimate 24% [10]. This inconsistency could be attributed to the scope of the study, the fact that EDHS covered more remote. It is also significant to note down the time gap between the EDHS and this study.

This study also shows that mothers who live within short distances from the health facility were more likely early initiate ANC visit than those who travel more than one hour. This finding was in line with the finding of previous study conduct in Cameron [28]. This might be due to women live in a developing country spent more times for activities like drawing water, household chores, rearing children and for agricultural activities rather than their health. As a result, they didn’t think to attain the health facility for receiving ANC services because they have no time to go there. In addition to this, it may impose them for extra costs for transportation as well as loss from agricultural production.

This study also explains that mothers who have had knowledgeable on the timing of ANC were more likely to early initiate the ANC services than those not knowledgeable. This finding was consistent in meta-analysis study conduct in Ethiopia [29], and Southern Ethiopia [30, 31] this might be due to knowledge is important to realize the existing services and the timing of initiating ANC visits. In addition to this, high illiteracy level in the community may cause poor knowledge in the community.

Mothers who want her pregnancy were more likely to start the follow up early than the counterpart. This finding was in line with previous study conduct in Debre Markos Ethiopia [32], Sothern Ethiopia [33], Ethiopia [29], Tigray Ethiopia [34], South Africa [35], and Nepal [17]. This might be due to when the mother prefers the pregnancy she is eager to keep the health of the baby. Due to that, they are excited to attain the follow up earlier.

In addition in this study the odds of early initiations of ANC visit among women who have no under-five children 2.7 and one under-five children 2.2 times higher than those who had two under-five children [AOR 2.7; 95% CI; 1.3,5.8], [AOR 2.2; 95% CI; 1.1,4.5] respectively. There are limited finding with regard to the relation between timing of initiation and numbers of under-five children in the previous study but in this study numbers of under-five children was one of the determinant factors for the timing of initiation of ANC. This might be due to women may responsible for caring for their baby.

The prevalence of early initiation of ANC in the study area was high in comparison to the national prevalence of the country. The factor that responsible for early initiation of ANC services were distance, knowledge on the timing of ANC, a desire of pregnancy, and less and family size.

For federal and regional health bureau to increase the awareness of timings of antenatal care utilization and increase access and availability of family planning method for preventing unintended pregnancy.