Table of Contents
APPROVAL ............................................................................................................................. iii
DEDICATION.......................................................................................................................... iv
ACKNOWLEDGEMENT...........................................................................................................v
ABSTRACT…………………………………………………………………………………..….Vi
LIST OF ABBREVIATIONS/ACRONYMS ........................................................................................... x
CHAPTER ONE..................................................................................................................................1
INTRODUCTION...............................................................................................................................1
1.1 Background ...................................................................................................................................1
1.2 Problem statement .........................................................................................................................3
1.3 Purpose of the study.......................................................................................................................3
1.4 Specific objectives.........................................................................................................................3
1.5 Research questions.........................................................................................................................4
1.6 Significance of the study................................................................................................................4
1.7 Conceptual framework...................................................................................................................5
1.8 Scope of the study..........................................................................................................................6
CHAPTER TWO.................................................................................................................................7
LITERATURE REVIEW ....................................................................................................................7
2.1 Introduction ...................................................................................................................................7
2.2 Maternal Education........................................................................................................................7
2.3 Family size ....................................................................................................................................7
2.4 Religion.........................................................................................................................................7
2.5 Socio-economic conditions ............................................................................................................8
2.6 Attitude of health workers..............................................................................................................8
2.7 Cultural beliefs ..............................................................................................................................8
2.8 Accessibility of antenatal care services...........................................................................................8
2.9 Inadequate knowledge....................................................................................................................8
2.1.0 Social and Cultural support .........................................................................................................9
2.1.2 Age.............................................................................................................................................9
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2.1.3 Intention to get pregnant .............................................................................................................9
2.1.4 Husbands level of education........................................................................................................9
CHAPTER THREE........................................................................................................................... 11
METHODOLOGY............................................................................................................................ 11
3.1 Study design ................................................................................................................................ 11
3.2 Study population.......................................................................................................................... 11
3.3 Study site..................................................................................................................................... 11
3.4 Sample size determination ........................................................................................................... 11
3.5 Inclusion and exclusion criteria. ................................................................................................... 12
3.6 Inclusion criteria .......................................................................................................................... 12
3.7 Exclusion criteria ......................................................................................................................... 12
3.8 Data collection tools .................................................................................................................... 12
3.9 collection method......................................................................................................................... 12
3.10 Data presentation and analysis.................................................................................................... 12
3.12 Study limitations........................................................................................................................ 12
3.13 Ethical consideration.................................................................................................................. 12
CHAPTER FOUR ............................................................................................................................. 13
4.0 Results......................................................................................................................................... 13
4.1 Social demographic characteristics of the respondents.................................................................. 13
Table .1: Socio-Demographic Characteristics of ANC respondents .................................................... 13
4.2. Characteristics of ANC providers................................................................................................ 16
Table 2: Social –demographic characteristics of ANC providers ........................................................ 16
4.3. Factors influencing late Antenatal care attendance....................................................................... 17
Table 3 (a) responses from early starters............................................................................................ 17
1. Red graph shows response from the ANC providers................................................................... 18
Table 3(b) responses from the late starters ......................................................................................... 18
Table 4: Reasons for late attendance .................................................................................................. 19
4.3.1 Poor Quality of Care ................................................................................................................. 19
4.3.2 Myths and misconceptions........................................................................................................ 20
4.3.3 Traditional Beliefs and Practices............................................................................................... 21
4.3.4 Financial Difficulties................................................................................................................. 22
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4.3.5. Alternatives to ANC................................................................................................................. 23
4.3.6. Ignorance................................................................................................................................. 23
4.3.7 Age........................................................................................................................................... 24
4.4. Knowledge of mothers about benefits of attending ANC early..................................................... 24
4.5. Traditional Birth Attendants........................................................................................................ 24
4.6. Distances to ANC health facilities. .............................................................................................. 25
4.7. The mode and means of transport used by ANC attendees........................................................... 25
CHAPTER FIVE............................................................................................................................... 27
DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS...................................................... 27
5.1 DISCUSSION ............................................................................................................................. 27
5.1.1 Alternatives to ANC at KIU- teaching hospital.......................................................................... 27
5.1.2 Antenatal Care late attendance .................................................................................................. 27
5.1.3 Respondents recommendations on how to improve ANC utilization at KIU-teaching hospital. .. 30
5.2 Conclusions................................................................................................................................. 31
5.3 Recommendations........................................................................................................................ 32
References......................................................................................................................................... 34
APPENDICES ..................................................................................................................................... 39
APPENDIX 1: Consent form .............................................................................................................. 39
APENDIX II: Questionnaire ........................................................................................................... 40
ABSTRACT BACKGROUND. Early initiation of antenatal care visits is an essential component of services to improving maternal and new born health. The Uganda Demographic and Health Survey (UBOS, 2007, UDHS, 2006) conducted in 2006 and Uganda Bureau of Statistics conducted in 2007 indicated that 94% of women in rural areas being twice less likely to attend ANC than the urban women, only 8% of rural women in Uganda received ANC from a doctor. However, detailed study to identify factors associated with late initiation of care has not been conducted in KIU-teaching hospital. The aim of this study is to assess the factors associated with late ANC care attendance and to determine the proportion of women who attend late to ANC in KIU-teaching hospital. Methods: The study design will be cross-sectional, the study Participants will be pregnant women, nurses, administrators doctors; it will be conducted at Kampala international teaching hospital for a period of one month. Data was collected using pre-tested questionnaire and interview method. Logistic regression analysis was done to identify factors associated with late first ANC with the level of significance set at 0.056. Results: A total of 156 women participated in the study; 100 (64.1%) of them came for their first ANC visit late, after 12 weeks of gestation. Most common reasons for coming late for first ANC were financial constraints (38.5%, 60) and long distance to the hospital (34.5%, 45). Factors associated with late start of first ANC, Traditional beliefs (25, 22.9%), Myths and misconceptions (05, 14.3%), Ignorance (02, 11.4%), Age (04, (17.1%), Conclusion: About half of pregnant women do not start ANC early in the first trimester largely due to large family size, low monthly income and long distance to the hospital, age, alternatives, poor quality of services, harassments from health workers.