Assessing knowledge about early initiation of antenatal care, and perceived pregnancy risk among women attending antenatal care at public health facilities in Mukono District, Uganda

Abstract

Background. Antenatal care (ANC) is one of the interventions aimed at reducing preventable maternal and perinatal mortality. Early initiation of ANC is vital for early risk assessment and management as well as provision of preventive measures to ensure a positive pregnancy experience and outcome for both mother and baby. However, early initiation of ANC remains low, especially in developing countries. This indicator stands low in Uganda, at 29%, according to Uganda demographic health survey (UDHS) 2016. Mukono district, a predominantly urban district in the central region of the country stands out as the worst performer by 2018/2019 at 13.7%. Knowledge about the timing, importance and benefits of early ANC is associated with initiating ANC early, and perceived risk has been associated with health seeking behaviour. Assessing the knowledge about early initiation of ANC, and risk perceptions during the first trimester in this population is therefore necessary. Objectives. This study aimed to assess; knowledge about early initiation of ANC, factors associated with being knowledgeable about early initiation of ANC, and perceived pregnancy risk attached to the first trimester among women attending ANC at public health facilities in Mukono district, Uganda. The study also explored feasible solutions to late initiation of ANC. Methods: A cross-sectional study employing mixed methods was conducted over a period of three months (June 2020 to August 2020). Knowledge and factors associated with being knowledgeable about early ANC as well as perceived pregnancy risk were assessed quantitatively using a representative sample of 427 mothers attending ANC for the first time for that pregnancy. All levels of health care were involved. Using STATA, the data was analysed, first with descriptive statistics, then logistic regression was conducted for bivariate and multivariate analysis. Qualitative methods were used to triangulate perceived pregnancy risk, as well as investigate feasible solutions to late initiation of ANC. This was done by purposively sampling women attending ANC for the first time for that pregnancy to participate in 8 FGDs, healthcare providers (irrespective of gender) to participate in 13 KIIs, and 15 partners of the women to participate in individual interviews. This data was analysed using content analysis. The data was transcribed, coded, and categorized into categories and then themes. Results: Only 9.6 percent (41 participants) were knowledgeable about early initiation of ANC. The factors that were significantly associated with being knowledgeable included; listening to the radio and/or using the internet at least once a week, as well as women being the decision makers on how to spend their earnings. Forty seven percent (47.2%) of the participants had a high perceived pregnancy risk attached to the first trimester. Conclusion: The mothers have low knowledge about early initiation of ANC. Women who listen to the radio at least once a week, use the internet at least once a week and those who make the decide on how they spend their earnings are more likely to be knowledgeable about early initiation of ANC in this population. The pregnancy risk perception was high in this population, however the decision to seek ANC is based on perceived susceptibility. There is therefore need to; create awareness about early initiation of ANC e.g. through the use of media, increase access to mass media, empower women to be able to make decisions about their health and how to spend their earnings. There is also need to provide more facilities, and improve accessibility to the facilities. In addition, the human resource should be increased, and support supervision from MOH to the facility, as well as the facility to its staff should be encouraged. Furthermore, the mothers should be educated about the potential pregnancy-related risks in the first trimester