Concern of Pregnant Women Regarding Benefits of Utilizing Antenatal Care in Selected Maternal and Child Health Centers at Minia City

Introduction

Antenatal care (ANC) is an essential method for reducing maternal morbidity and mortality by increasing the chances of detecting high-risk pregnancies early. Globally, nearly 303,000 women died from pregnancy-related causes, with low and middle-income countries accounting for 99 % of all maternal deaths, making maternal mortality the health predictor with the largest difference between developed and developing countries (Warri & George, 2020).

Because of a lack of access to appropriate and high-quality antenatal care, millions of women in developing countries are more likely to have life-threatening or pregnancy-related complications. According to the World Health Organization (WHO), providing pregnant women with four antenatal appointments, the first of which should be arranged during the first trimester of pregnancy, is an indicator of adequate treatment (Laksono, Rukmini et al., 2020). 

Antenatal care is a set of treatments provided by coordinated health care providers to a pregnant woman, in antenatal treatment, there are several different procedures. During a pregnancy, these treatments can be delivered as 12-16 antenatal care visits. The goal of antenatal care is to help a woman approach pregnancy and birth as positive experiences by preventing, identifying, and treating conditions that may threaten the health of the fetus/newborn and/or the mother (Tsegaye & Ayalew, 2020).

Non-use of antenatal and delivery care facilities is strongly linked to maternal complications and poor perinatal outcomes. Unbooked pregnant women have worse results than booked pregnant women, ANC programmes assist pregnant women by detecting pregnancy-related conditions or illnesses that could have a negative impact on the pregnancy. Women receive a variety of therapies during antenatal appointments, including advice on safe diets, iron/folic acid supplements, and tetanus toxoid vaccination (Fagbamigbe & Idemudia, 2017).

 New technology must be introduced on a regular basis, and older services must be reconsidered. Each pregnant woman's care must be tailored to her specific needs and preferences. Antenatal care begins with pregnancy planning and continues through the neonatal and postpartum periods, it is widely accepted by health providers that it starts with a pregnant woman's first appointment for antenatal treatment and lasts until she gives birth(Tekelab, Chojenta et al., 2019).

The antenatal care for pregnant woman include (12-16) visits to health-care facilities, as well as provider visits to her home. The first visit usually consists of a thorough social, family, medical, and obstetric background, a thorough physical examination, and a risk assessment, which may include a variety of laboratory tests. Easier exams are performed on subsequent visits, but some examinations are still performed on any visit. Exams later in pregnancy are focused on the developing fetus's health and the planning for a healthy delivery (John, Binu et al., 2019).

The recommendations for routine ANC treatment are established by (WHO, 2016), guidelines for handling of pregnancy-related risks. Good clinical practices, according to the WHO, include routine screening for hypertensive diseases in pregnancy by daily blood pressure measurement, testing for foetal heart rhythms, and advice on birth preparation and postpartum family planning (Ali, Sultana et al., 2018).

 The safe motherhood initiative strongly emphasized ensuring the accessibility and use of antenatal services as most of the deaths occurring from obstetric complications are preventable. Though antenatal care service utilization is very essential for improvement of maternal and child health, the use of the service is still very limited in developing world. World Health Organization (WHO) recommends a four-visit ANC schedule for low risk pregnancies. During these visits, the components of antenatal care include iron supplementation, blood and urine tests, at least two Tetanus Toxoid (TT) injections, blood pressure measurement, intestinal parasite drugs, and health education related to pregnancy and detection of the problems that make the pregnancy high risk one (WHO, 2016).

Community health nurse (CHN) is capable of providing a wide range of programmers and events, including basic health care, health education, and encouraging the use of facility-based healthcare services. By offering a range of interventions, such as home-based malaria care, food safety education, and promotion of exclusive breastfeeding, CHN programmes can be effective in reducing maternal and child mortality in low-income settings (Yeneneh, Alemu et al., 2018).

Significance of the study:

In Egypt, the maternal mortality rate has been reduced to <50/100,000 live births in 2015 but still stationary over 10 years (El-Agwany, 2021)‏.  According to Millennium Development Goals, 2015, some Egyptian Governorates have high rates of MMR, that is 60–65 deaths per 100 000 live births in Assiut, Gharbia, Beni Suef, Qena, and Sohag, whereas others have low rates of MMR „24–37 deaths per 100 000 live births‟ in New Valley, Ismailia, Suez, and Port Said (Mahmoud & Omar, 2018).

Also El-Agwany, (2021)‏, who studied ''Severe maternal outcomes: World health organization maternal near-miss and maternal mortality criteria in University Tertiary Hospital Egypt'' reported thatDuring the 24-month study period, there were 28,877 deliveries, 185 women suffered maternal complication: 171 maternal near-miss and 14 deaths. severe maternal outcome ratio is 6.5/1000 live birth, maternal near-miss incidence ratio of 5.9/1000 live births, maternal death incidence ratio 0.5/1000 live birth, maternal mortality ratio of 48.48/100,000 live births, maternal near-miss mortality ratio is 12:1, and a mortality index of 7.5%.

Aim of the study

The aim of the current study was to assess concern of pregnant women regarding benefits of utilizing antenatal care in selected Maternal& Child Health Centers at Minia City.

Research Questions:

The study will answer the following questions:

1-       What pregnant women's level of knowledge regarding the benefits of utilizing antenatal?

2-       What pregnant women's attitude towards the use of antenatal care utilization?

3-       What pregnant women's practices towards the use of antenatal care utilization?

4-       Are there a relation between socio demographic data of women& their level of knowledge, attitude and practices regarding benefits of utilizing antenatal care?

Subjects and methods

Research design:

A descriptive cross-sectional research design used in this study.

Setting

The research was carried out in four MCH centers at Minia city (Minia Eastern Health Center, Minia Western Health Center, Minia first and second Health Care Center). These centers were selected randomly. These centers provide a variety of programs, including mandatory vaccinations, family planning, antenatal and postnatal care, and antenatal and postnatal care for women who visit MCH centers for family planning and antenatal care. 

Sample: Purposive sample was used (Every health center was chosen based on the estimated number of women seen during the data gathering). All pregnant women attended for antenatal care in selected health centers. Sample size was determined as number of all pregnant women visiting maternal and child health at selected centers (No. of pregnant women visited each MCH center during six (6) months. The total number of the women was 285 who had included in the study for each center as follow:-

Inclusion criteria:

All Pregnant women (primi gravida, multigravida) who had at least one previous ANC visit during their current pregnancy in 3rd trimester.

Exclusion Criteria:

-          pregnant women with complication as (gestational diabetes, preeclampsia, preterm labor, miscarriage, anemia, infections)

Tools:

Tool I: interviewing Questionnaire:-

Tools for data collection was consisted of four tools:

The first tool: Structured interview questionnaire was developed by the investigator to collect data related to;

-          Part (1):- Included eight (8) questions, it was involved with the socio-demographic features of the women who were being examined and encompass item such as (age, education, occupation residence, income, living condition and type of family), with response multiple choice.

-          Part (2): It included eleven (11) questions, to assess the present and past obstetric history of the studied women and women's health care service utilization, such as: (How many times have you been pregnant, how many children do you have ……...etc.

The second tool: To assess knowledge on antenatal care among women which is composed of twenty five (25) open-ended questions related to: (Do pregnant women need to go for an antenatal check-up? If yes is it required to go for antenatal care even if there is no complication during pregnancy?…………etc.). With response (Yes, No).

Scoring system:-

The total optimal score = thirty one (25) points, this score ranged between zero (0) for incorrect responses, one (1) for correct responses and represent 100% for all items for every question which categorized into two levels as unsatisfactory level

( less than 60%)  and satisfactory level 60-100%.

Third tool: To determine attitudes towards antenatal care among women who attend ANC services at a specific health centers it includes thirteen (13) questions, with response strongly agree, agree and Disagree are three option by using  a Likert scale (Fantanesh and Desalegn ,2015).

Scoring system:-

The total score are equal 26 point, which distributed as following strongly agree scored as (2 mark), agree equal (1mark)  while disagreeing response equal as (Zero mark). -Scores > (14) (60%) was classified as positive attitude Scores ≤ (14) (60%) was classified as negative attitude.

Fourth tool: it includes sixteen (16) questions, to assess Practices towards antenatal care among women, such as: (registration, Examination, Fetal examination …...etc.) With response done or not done.

Scoring system:-

The total optimal score= sixteen (16) this score ranged between zero (0) for not done, one (1) for done practices and represent 100% for all items for every question which categorized into two levels as poor practices level for 0- 60%, and good practices level 60-100%.

The Validity of the Tool:

The tool was submitted to a jury of five experts in the field of community health from the faculty of nursing at Minia Universities. Tool content validity was done to identify the degree to which tools are supposed to be measured. The tools were examined for content coverage, the sequence of items, clarity, relevance, applicability, wording, length, format, and overall appearance. Some modifications were done.

Reliability of the Tool:

The Reliability of the tool was performed to confirm the consistency of the tool. The internal consistency measured to identify the extent to which the items of the tool measured what it was intended to measure. The internal consistency of the tool was assessed with the Cronbach's alpha coefficient. Cronbach's alpha coefficient of 0.00 indicates no reliability and a coefficient of 1.00 indicates perfect reliability.

Pilot Study:-

Before starting to collect the data, a pilot study was carried out on (10%) of sample to test the applicability of the questionnaire and excluded from the study, and to identify the most suitable time to collect data. The results of the pilot study were not included in the study results because some changes were applied to the questionnaire to clarify some questions.

Data Collection Procedure:-

• Before beginning data collection, the Dean of the Faculty of Nursing at Minia University sent an official letter to the head manager of MCH Centers in Minia, requesting permission to gather information.
• Objectives, aim of the research were clarified to the MCH centers managers to gain their cooperation and to allow meeting with women.
• The investigator attended to the MCH center and give sessions to explain the aim and nature of study and how to fulfill this questionnaire briefly through direct personal communication, verbal agreement was obtained from respondents before they were allowed to take part in the research.
• Investigator was visited the MCH centers four days/week (Saturday, Sunday, Tuesday, Thursday,) at the official time from 8 Am: 12 Pm, and she filled out a number of five to six questionnaires per day.  The questionnaires were filled by the women who are able to read and write and the investigator help them, and the investigator fills the questionnaire for women who were unable to read and write.   
• The questionnaire had taken time from 25 to 30 minutes according to women's tolerance and every woman was allowed to ask any question to clear any misunderstanding. The investigator stayed with women's during fulfilling the questionnaires and remind with women to answer all questions that present in questionnaires.
• The data was gathered over a six-month period, starting in in the first of August 2020 and ending in January 2021.

Ethical Consideration:

The women were informed that their participation in the study was completely voluntary and there was no harm if they not participated in the study. Oral consent was taken to be included in the study subject, explanation about the study was done to the women included the aim of the study and the potential benefits. The participant was informed about the withdrawal procedures if they decided to leave the study at any time before and during the completion of data collection. Confidentiality of data, privacy, identity, voluntary participation, and the right to refuse to participate in the study was emphasized to subjects.

Statistical Analysis

Data were analyzed using the statistical package for social science (SPSS) version 20. Numerical data were expressed as mean and SD. Quantitative data were expressed as frequency and percentage. Relations between different numerical variables were tested using the using chi square test. Person's correlation was used. A statistically significant level was considered when the p-value was less than 0.05.

Results

Table (1); Distribution of Study Sample Regarding their Socio Demographic Characteristics (n=285)

Table (1) shows that, 51.5% of the study sample their age ranged from 20-30 years, 14.9% their age more than 30 years old with a mean age Mean ± SD = 19.8 ± 12.4. Regarding their education 33% of secondary school, 22.5% are able to read and write, and 3.6% of primary school.  In addition 83.5% are house wives, 15.8% are employees and 0.7% is students. Also 96.5 of study sample are from urban, 3.5% from rural, 58.9% their income are enough but 41.1% their income is not enough. Regarding their living condition 80% of sample have nuclear family, 3.6% lived in extended family and 65.6% of study sample hear  about importance of attending antenatal care at health facility.in addition 74.7% of sample receive support from husband in attending antenatal care.

Table (2): Distribution of Study Sample Regarding Their Obstetric Information (n=285)

Table (2) shows that, 48.4% of study subject's hade first pregnancy, 35.8% hade second pregnancies and 4.2% hade more than three pregnancies. Regarding their Number of children 67.1% have one child, 23.5% have two children and 4.7% have three children. Regarding average years between deliveries 72.3% of study sample have ≤ 2 years and 27.7% have > 2years. Regarding age at the first delivery 79% of study sample has 18-24 years, 18.9% have 25-30years old and 62.8% first visit within12 weeks but 30.9% the first visit within 24 week.    

Table (3); Distribution of Study Sample Regarding Their Information Given During Antenatal Visit (n=285)

Table (3) shows that, 84.2%, 86.3%, 53.3%, 83.9 and90.2 respectively of study subjects during antenatal visits  the health professional informed them about  the following points -Importance of antenatal check-up for pregnant women, when to start antenatal check-up,  the  importance of  HIV test, the  danger signs of pregnancy and  exclusive of breast feeding babies. Regarding place of last delivery 35.8% of study subjects delivered at home, 44.6% delivered at hospital, and 1.4% delivered at health centers. 

Table (4): Distribution of Study Sample Regarding Their Total Knowledge Score About Antenatal Care Services (n=285).

Table (4): illustrates that 92.7% of study subjects have satisfactory knowledge score but 7.3% of study subjects have unsatisfactory knowledge scores about antenatal care services.

Table (5): Distribution Of Study Sample Regarding Their Total Attitudes Score About Antenatal Care Services (n=285).

Table (5): illustrates that 91.5% of study subjects have positive attitudes but 8.5% of study subjects have negative attitudes about antenatal care services.

Figure (1): Distribution of Study Sample regarding their total Practices score about Antenatal Care services (n=285).

Figure (1): illustrates that 90.1% of study subjects have good practices scores but 9.8% of study subjects have poor practices scores about antenatal care services.

Table (6): Relation between Total Knowledge level of Study Sample and Their Selected Socio- Demographic Variables (n=285).

Significant at (p-value <0.01)

Table (6): points statistically significant relationship between knowledge score and age and education p value 0.002 and 0.001 respectively.

Table (7): Relation between Practices of Study Sample and Their Selected Socio- Demographic Variables (n=285).

     significant at (p-value <0.01)

Table (7): points statistically significant relationship between practices score and age and education p value 0.004 and 0.001 respectively.

Table (8): Relation between Attitudes Of Study Sample And Their Selected Socio- Demographic Variables (n=285).

     significant at (p-value <0.01)

Table (8): points statistically significant relationship between attitudes score and age and education p value 0.001 and 0.001 respectively.

Table (9) Correlations between knowledge, attitudes and practices of study sample About Antenatal Care Services (n=285).

Table (9) shows that correlations between knowledge, attitudes and practices of study sample, have highly statistically significant correlation.