FACTORS ASSOCIATED WITH LOW ANTENATAL CARE ATTENDANCE AMONG PREGNANT WOMEN ATTENDING HEALTH CENTERS OF NEMBA DISTRICT HOSPITAL, RWANDA

Abstract

Abstract

The global target is to reduce maternal mortality to 70 deaths per 100,000 live births by 2030. Antenatal care (ANC) is critical in lowering maternal and neonatal mortality rates, regardless of a community's sociodemographic background. Recognizing the benefits of ANC for mothers and newborns, Rwanda has made attending ANC a national priority. The World Health Organization (WHO) recommends that pregnant women should attend at least four antenatal visits, with one visit occurring during the first trimester. However, despite the Rwandan government's efforts to improve healthcare infrastructure, human resources, and health insurance, barriers to ANC attendance persist. Investigating the factors contributing to low ANC attendance among pregnant women in rural areas became necessary. Consequently, this study aimed to assess the factors associated with low ANC attendance among pregnant women at the health centers of Nemba Hospital. A cross-sectional study was conducted among 270 pregnant women receiving ANC services at nine health centers. Participants were recruited using a systematic sampling method, and data were collected through pretested, structured questionnaires. Data management and analysis were conducted using SPSS version 29.0. The study was approved by Mount Kenya University and the Gakenke District office, with voluntary participation. The results revealed that 60.4% of the participants had low ANC attendance, indicating that more than half of the women did not adhere to the recommended ANC schedule. Factors associated with ANC attendance included the number of children (P < 0.001), maternal education (P = 0.01), planned pregnancies (P < 0.001), distance from home to the health center (P = 0.006), number of pregnancies (P < 0.001), history of pregnancy complications (P = 0.007), prior ANC attendance (P = 0.001), location of the health center (P < 0.001), availability of ANC services, and patient waiting times (P < 0.001). These findings underscore the significance of accessibility and service availability in ensuring adequate ANC attendance. Based on the study's results, three recommendations are proposed. First, enhancing maternal education and awareness programs about the importance of ANC, especially for women with lower education levels and multiple children, could be beneficial. Second, improving access to healthcare facilities by reducing travel time could significantly boost ANC attendance, possibly through the establishment of more health centers or reliable transportation services. Finally, ensuring the consistent availability of ANC services, including during weekends, could better accommodate women with different schedules.