FACTORS ASSOCIATED WITH UTILIZATION OF ANTENATAL CARE SERVICES AMONG WOMEN IN KYANGWALI REFUGEE SETTLEMENT, HOIMA DISTRICT
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Introduction: Uganda is the third largest refugee hosting nation in the world and this creates a significant public health concern especially around maternal health. Though the country has achieved a decline in the maternal mortality ratio, the influx of refugees could impede these gains. Utilizing Antenatal Care services among refugees is equally important to achieve significant maternal health outcomes in order to prevent maternal mortality. Objective: The objective of this study was to assess factors associated with utilization of Antenatal Care (ANC) services among women refugees in Kyangwali Refugee Settlement. Methods: This was a cross-sectional study carried out in Kyangwali refugee settlement among women aged 15-49 years and who had delivered within the past one year. Data was collected using a structured questionnaire, the assessment was based on a sample of 362 women randomly selected. Analysis was done using frequency distribution, Chi-square statistics and binary logistic regression. Results: Approximately 7 in 10 (70.7%) refugee women utilized ANC services. Marital status, partner’s education level, delay in accessing ANC services at the health facility and distance to the nearest health facility had a statistically significant association (p<0.05) with utilization of ANC services. The odds of utilizing antenatal care services among women refugees in Kyangwali Refugee Settlement decreased among unmarried women (AOR=0.054; 95% CI = 0.009 - 0.315) and married women (AOR=0.082; 95% CI = 0.015, 0.452) compared to divorced/separated/widowed women. Women who experienced a delay in accessing ANC services at the health facility were less likely to utilize ANC services compared to women who did not experience delay in accessing ANC services at the healthy facility (AOR=0.348; 95% CI = 0.149, 0.812). Women who walked a distance of more than 5 kilometers were less likely to utilize ANC services than women who walked a distance of 0 - 2 kilometers to the health facility (AOR=0.534; 95% CI = 0.289 – 0.988). On the other hand, the odds of utilizing antenatal care services among women refugees in Kyangwali Refugee Settlement increased with women whose partners had secondary/post-secondary education (AOR=3.023; 95% CI = 1.294 – 7.060). Conclusion: The factor associated with increased utilization of ANC services among women refugees of reproductive age in Kyangwali Refugee Settlement was having a partner with Secondary/postsecondary education while the factors associated with decreased utilization of ANC services were; being both unmarried and married compared to those who are divorced or separated or widowed; experiencing delay in accessing services at the health facility and traveling a distance of more than 5km to the health facility Recommendations: There is need to increase awareness and sensitization on the importance of Antenatal Care services among men, especially men with lower education levels. In light of the findings, there is need to encourage women to utilize ANC services in health facilities during their first trimester. Awareness campaigns and programs on ANC utilization should be intensified at community level particularly by traditional chiefs and at district level. Future researchers should conduct a qualitative research using Focus Group Discussion (FGD) and Key Informants (KI) interviews to explore more on low utilization of ANC among single and married women. Another study focusing on the impact of male involvement in antenatal care uptake would also be of great significance to see whether this can improve antenatal care service utilization among mothers.