Factors associated with antenatal clinic booking: application of the ecological model for health promotion in Mpwapwa, Dodoma – Tanzania

Abstract

Background: Antenatal clinic (ANC) is a clinic where a pregnant woman receives services during pregnancy through a series of consultations with trained health care workers such as midwives, nurses or doctors who specialize in pregnancy and birth. The ANC services are usually grouped into booking and follow-up visits. The booking visit offers the midwife/clinician the opportunity to assess the health status of the expectant mother and unborn baby. Mothers who miss antenatal clinic booking may also miss important services such as management of obstetric complications including pre-eclampsia, tetanus toxoid and identification and management of infections including human immune virus (HIV), syphilis and other sexually transmitted infections (STIs). Objective: This study describes factors associated with antenatal clinic booking among pregnant women in Mpwapwa using the ecological model for health promotion. Methodology: A cross sectional study design using a quantitative approach was employed. The study was conducted at Mpwapwa reproductive and child health (RCH) clinic which is located in Mpwapwa District Council in the Dodoma Region, Tanzania. The study population was all pregnant women attending at Mpwapwa RCH clinic during the study. A sample size of 352 participants was recruited for the study. A semi structured questionnaire consisting of open ended and closed ended questions was used to collect information about the ANC booking among pregnant women attending at Mpwapwa RCH clinic. The data were entered and analyzed using software Statistical Package for Social Sciences (SPSS) version 21 where by chi square test was used to determine the associations between late booking and independent variables. Results: A total of 352 respondents participated in the study. Majority of respondents (69.9%) registered at ANC after three months of pregnancy. This is due to the fact that most of the respondents were living in a distance of more than five kilometers to reach ANC and also majority of them were using foot as means of transport. About 227 (64.5%) of pregnant women knew that the first trimester is the best time to start ANC and 229 (65.1%) of pregnant women illustrated that required number of ANC attendance throughout the pregnancy is four times. This high knowledge of knowing best time to start ANC and required number of attending at ANC is due to the fact that most of respondents had formal education. About 231(65.6%) of respondents illustrated that it was necessary to get permission from their partner before they started ANC, and about 301 (85.5%) of respondents said that they were getting financial support from their partners. The findings of the study indicated that, the problems of depending on financial support and permission from their partners facilitated them to attend ANC late. Moreover, 140 (39.8%) of respondents reported that, they were waiting for more than an hour to get ANC services. This long waiting time was due to inadequate staffs which was observed during data collection; only one trained nurse was allocated to provide services from 40 to 50 pregnant women per day. Moreover 352 (100%) of respondents reported that they were not paying for ANC booking or clinic card. This indicated that the national exemption policy for pregnant women was adhered to. Conclusion: In conclusion, the overall proportion of late booking was high. Some of the reasons for late booking could be long walking distance to ANC, subordination of pregnant women on decision making concerning ANC booking, and dependence on partner for financial issues. Recommendation: It is important to provide community based information, education and communication on antenatal care. In addition, emphasis on the best time to start ANC is mandatory at all levels of health facilities.