Multiple Antenatal Care Bookings among Pregnant Women in Urban and Rural Communities of Ebonyi State, Nigeria: A Mixed Method Study

Aims: To determine the factors influencing multiple antenatal care bookings among pregnant women in urban and rural communities of Ebonyi state, Nigeria.

Study Design: This was a community based cross-sectional comparative study design using a sequential mixed method exploratory approach.

Place and Duration of Study: The study was conducted in urban and rural communities of Ebonyi State, Nigeria between September and October 2017.

Methodology: A two stage sampling method was used to select 660 women who have been delivered of babies within one year preceding the study irrespective of place of antenatal care. Also the respondents were permanent residents of the selected communities for one year. Eight focus group discussions were conducted among women who delivered within one year preceding the study and those pregnant during the period of study. Twelve key informant interviews were also conducted among providers of antenatal care in health facilities in the selected communities. Chi square test of statistical significance and multivariate analysis using binary logistic regression were used in the analysis and level of statistical significance was determined by a p value of <0.05. QDA Miner Lite v2.0.6 was used in the analysis of qualitative data.

Results: The mean age of respondents were 29.6±6.2 and 28.6±5.1years in urban and rural communities respectively. A significantly higher proportion of respondents in urban area, 34.5% registered for antenatal care in more than one health facility when compared to those in rural, 25.8%. (p=0.014). The major reason for multiple antenatal care bookings in the urban was because of strike actions by health workers in the public health sector while in the rural, it was because of emergency which may occur during the period of pregnancy or labour. Predictor of multiple antenatal bookings among the respondents was the attainment of tertiary education. (A0R=1.7; 95%C1: 1.1-2.6).

Conclusion: More than a third of the respondents registered for antenatal care in more than one health facility. The reasons for this practice are a manifestation of the weaknesses of the health system and at a high cost to the women and the country especially as Nigeria bears the highest burden of maternal deaths globally. The Government of Nigeria should bring to an end the frequent industrial actions in the public health sector. There is also the need to train the health workers and enlighten the populace on referral system. These may serve as initial steps towards embracing quality maternal health services in Nigeria.