Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda

DOI: 10.4236/ojpm.2015.53016   PDF   HTML   XML   5,068 Downloads   6,762 Views   Citations


Introduction: Globally every year 529,000 maternal deaths occur, 99% of this in developing coun-tries. Uganda has high maternal and neonatal morbidity and mortality ratios, typical of many countries in sub-Saharan Africa. Recent findings reveal maternal mortality ratio of 435:100,000 live births and neonatal mortality rate of 29 deaths per 1000 live births in Uganda; these still remain a challenge. Women in rural areas of Uganda are two times less likely to attend ANC than the urban women. Most women in Uganda have registered late ANC attendance, averagely at 5.5 months of pregnancy and do not complete the required four visits. The inadequate utilization of ANC is greatly contributing to persisting high rates of maternal and neonatal mortality in Uganda. This study was set to identify the factors associated with late booking and inadequate utilization of Antenatal Care services in upcountry areas of Uganda. Method: Cross-sectional study design with mixed methods of interviewer administered questionnaires, focus group discussions and key informant interviews. Data was entered using Epidata and analyzed using Stata into frequency tables using actual tallies and percentages. Ethical approval was sought from SOM-REC MakCHS under approval number “#REC REF 2012-117” before conducting the study. Results: A total of four hundred one were enrolled with the majority being in the age group 20 - 24 years (mean age, 25.87 ± 6.26). Health workers played a great role (72.04%), followed by the media (15.46%) and friends (12.50%) in creating awareness about ANC. A significant number of respondents went to TBAs with reasons such as “near and accessible”, “my husband decided”, and “they are the only people I know”. 37.63% of the respondents considered getting an antenatal Card as an importance of ANC. 71 (19.67%) respondents gave a wrong opinion (late) on booking time with reasons like demands at work, no problems during pregnancy, advised by friends, just to get a card, long distance and others didn’t know. Almost half of the respondents never knew the recommended number of visits. Religion, occupation, level of education, and parity were found to influence place of ANC attendance, number of ANC visits and booking time. Husbands were necessary to provide financial support, accompany their wives ANC clinic, and ensure that they complete the visits. But their response was poor due to: fear of routine investigations and constrained economically. Conclusion: The study findings show the actual rural setting of ANC services attendance and utilization. Much sensitization has to be done specifically in these rural areas to empower pregnant women and their husbands as to improve ANC attendance and utilization.

Share and Cite:

Kawungezi, P. , AkiiBua, D. , Aleni, C. , Chitayi, M. , Niwaha, A. , Kazibwe, A. , Sunya, E. , Mumbere, E. , Mutesi, C. , Tukei, C. , Kasangaki, A. and Nakubulwa, S. (2015) Attendance and Utilization of Antenatal Care (ANC) Services: Multi-Center Study in Upcountry Areas of Uganda. Open Journal of Preventive Medicine, 5, 132-142. doi: 10.4236/ojpm.2015.53016.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] (2008) Alarm International. 4th Edition Manual.
[2] Uganda Bureau of Statistics (UBOS) and Macro International Inc. (2007) Uganda Demographic and Health Survey 2006. UBOS and Macro International Inc., Calverton.
[3] Villar, J., Bakketeig, L., Donner, A., et al. (2002) The WHO Antenatal Care Randomized Controlled Trial: Manual for Implementation of New Model. 6-28.
[4] Zeine, A., Mirkuzie, W. and Shimeles, O. (2010) Factors Influencing Antenatal Care Service Utilization in Hadiya Zone. Ethiopian Journal of Health Sciences, 20, 75-82.
[5] Karl, P. and Ajegbomogun, B. (2005) Utilisation of Antenatal Care in a Nigerian Teaching Hospital. African Journal of Reproductive Health, 9, 159-161.
[6] Mesganaw, F., Olwit, G. and Shamebo, D. (1990) Determinants of ANC Attendance and Preference of Site or Delivery in Addis Ababa. Ethiopia Journal of Health Development, 6, 17-21.
[7] World Bank (1994) World Development Report: Infrastructure for Development. Oxford University Press, New York.
[8] Simkhada, B., Teijlingen, E.R., Porter, M. and Simkhada, P. (2008) Factors Affecting the Utilization of Antenatal Care in Developing Countries: Systematic Review of the Literature. Journal of Advanced Nursing, 61, 244-260.
[9] Dairo, M.D. and Owoyokun, K.E. (2010) Factors Affecting the Utilization of Antenatal Care Services in Ibadan, Nigeria. Benin Journal of Postgraduate Medicine, 12, 5-7.
[10] Nguyen, H.T.H., Hatt, L., Islam, M., Sloan, N.L., Chowdhury, J., Schmidt, J.-O., Hossain, A. and Wang, H. (2012) Encouraging Maternal Health Service Utilization: An Evaluation of the Bangladesh Voucher Program. Social Science & Medicine, 78, 989-996.
[11] Ebuehi, O.M. and Akintujoye, I.A. (2012) Perception and Utilization of Traditional Birth Attendants by Pregnant Women Attending Primary Health Care Clinics in a Rural Local Government Area in Ogun State, Nigeria. International Journal of Women’s Health, 4, 25-34.
[12] Belsey, M.A. (1985) Traditional Birth Attendants: A Resource for the Health of Women. International Journal of Gynecology Obstetrics, 23, 247-248.
[13] Bang, A.T., Bang, R.A. and Sontakke, P.G. (1994) Management of Childhood Pneumonia by Traditional Birth Attendants. Bulletin of the World Health Organization, 72, 897-905.
[14] Allotey, P.K. (1999) Where There’s No Tradition of Traditional Birth Attendants: Kassena Nankana District, Northern Ghana. In: Berer, M. and Ravindran, S., Eds., Safe Motherhood Initiatives: Critical Issues, Blackwell Science, Oxford, 147-154.
[15] Alisjahbana, A., Williams, C., Dharmayanti, R., Hermawan, D., Kwast, B.E. and Koblinsky, M. (1995) An Integrated Village Maternity Service to Improve Referral Patterns in a Rural Area in West-Java. International Journal of Gynecology Obstetrics, 48, S83-S94.
[16] Amin, R. and Khan, A.H. (1989) Characteristics of Traditional Midwives and Their Beliefs and Practices in Rural Bangladesh. International Journal of Gynecology Obstetrics, 28, 119-125.
[17] Akpala, C.O. (1994) An Evaluation of Knowledge and Practices of Trained Traditional Birth Attendants in Bodinga, Sokoto State, Nigeria. Journal of Tropical Medicine and Hygiene, 97, 46-50.
[18] Ndyomugyenyi, R., Neema, S. and Magnussen, P. (1998) The Use of Formal and Informal Services for Antenatal Care and Malaria Treatment in Rural Uganda. Health Policy Plan, 13, 94-102.
[19] Ghosh, R. (2012) Child Mortality in India: A Complex Situation. World Journal of Pediatrics, 8, 11-18.
[20] Ssengooba, F., Neema, S., et al. (2010) Health Systems Development Programme. Maternal Health Review Uganda. Makerere University Institute of Public Health, Kampala.
[21] Mugisha, C., Odit, A., Luzze, H., et al. (2010) Uganda Clinical Guidelines: National Guidelines on Management of Common Conditions. Ministry of Health, Uganda, 325-378.
[22] FAO (1990) Conducting Small-Scale Nutrition Surveys: A Field Manual. Rome.
[23] Magnani, R. (1997) Sampling Guide. IMPACT Food Security and Nutrition Monitoring Project, Arlington, VA.
[24] UNICEF (1995) Monitoring Progress toward the Goals of the World Food Summit for Children: A Practical Handbook for Multiple Indicator Surveys. New York.
[25] Kabir, M., Iliyasu, Z., Abubakar, I.S. and Sani, A. (2005) Determinants of Utilization of Ante-Natal Care Services in Kumbotso Village, Northern Nigeria. Tropical Doctor, 35, 110-111.
[26] Manju, R., Sekhar, B. and Harvey, S. (2008) Differentials in the Quality of Ante-Natal Care in India. International Journal for Quality in Health Care, 20, 62-71.
[27] Lawn, J. and Kerber, K., Eds. (2006) Opportunities for Africa’s Newborn: Practical Data, Policy and Programmatic Support for New Born Care in Africa. PMNCH, Cape Town.
[28] Ram, F. and Sigh, A. (2006) Is Ante-Natal Care Effective in Improving Maternal Health in Rural Uttar Pradesh? Evidence from a District Level Household Survey. Journal of Biological Sciences, 38, 433-434.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.