Determinants of Prenatal Care Utilization in the Shai-Osu Doku District

Abstract

Background: Despite the importance of early and routine prenatal care utilization globally, most pregnant women in sub-Saharan African (SSA) initiate ANC visit in the second or third trimester of pregnancy, indicating poor and late prenatal care utilization. An estimated 810 women die from pregnancy-related complications daily with a disproportionate burden in SSA. The Shai-Osu Doku District in the Greater Accra region, Ghana, faces significant challenges regarding the effective use of antennal care (ANC) services. A significant number of expectant mothers in Shai-Osu Doku begin their ANC visits late, with some not attending at all. This study examined the factors associated with prenatal care utilization at the Shai-Osu Doku district Hospital. Aim: This study aimed to determine the factors associated with prenatal care utilization at Shai Osu Doku District Hospital. Methods: This study is a cross-sectional study among pregnant women seeking antenatal care at the Shai-Osu Doku District Hospital in November 2022. The study employed the use of questionnaires and observation checklists to collect data on prenatal care, and independent variables such as sociodemographic characteristics, knowledge and awareness about the importance of prenatal care, availability and accessibility factors, and cultural beliefs, practices and obstetric factors that may influence prenatal care utilization. The results were analyzed using descriptive statistics, ordinal logistic regression analysis, and a chi-square test of independence. Results: Of the 106 participants included in the study, adequate prenatal care utilization coverage was 68(64%). The multivariate logistic model showed reduced odds of seeking timely and effective prenatal care among women pregnant women with no formal education (aOR = 0.75, 95%, CI: 0.11-5.02), and also for expectant mothers from rural areas (aOR = 0.29, 95%, CI: 0.09 0.93). Additionally, reduced odds of seeking prenatal care were observed among pregnant women with poor knowledge of the recommended gestational age for ANC (aOR = 0.44, 95%, CI: 0.13 1.49), long distance (greater than 5km) to reach ANC centre (aOR = 0.17, 95%, CI: 0.01-0.10), and long waiting time before seeking a specialist (aOR = 0.06, 95%, CI: 0.01-1.63). Similarly, reduced odds were also observed in pregnant women from communities that perceive ANC was not necessary (aOR = 0.10, 95%, CI: 0.20-0.56), communities with taboos and fear associated with hospital visits during pregnancy had increased odds of not seeking prenatal care (aOR = 22.18, 95%, CI: 2.29-14.48). However, women with parity were observed to have increased odds of seeking prenatal care (aOR = 4.36, 95%, CI: 4.73- 6.38). Conclusion: Level of education, place of residence, parity, poor knowledge of recommended gestational age for imitating ANC, long distance to reach ANC centre, and long waiting time for seeing a specialist were statistically associated with prenatal utilization. Also, communities with taboos and fear associated with hospital visits during pregnancy as well as communities that perceive ANC as not necessary were statistically associated with prenatal care utilization. Thus, health directorates and health facilities in Greater Accra and beyond should employ strategies to address these determinants. Furthermore, special education and campaign programs about the importance of timely and effective prenatal care utilization should be incorporated into routine intervention programs in Shai-Osu Doku and the entire country as a whole.