| dc.description.abstract | Early antenatal care booking and compliance with eight antenatal care contacts improve
positive pregnancy experiences and outcomes. In 2022, Kenya adopted the World Health
Organization recommendation for eight antenatal care contacts. According to the Kenya
Demographic and Health Survey 2022, 29% of women booked early for antenatal care, but
only 4% completed all eight antenatal care contacts. Although the new model offers clear
benefits, maintaining adherence remains difficult, as both adolescent and adult women
encounter significant barriers to initiating early and completing the eight contacts. Factors
influencing the timely initiation and frequency of the eight antenatal care contacts were
investigated among adolescent and adult women at Jaramogi Oginga Odinga Teaching and
Referral Hospital, Kisumu, Kenya. A comparative cross-sectional analytical study was
conducted, and the theoretical framework was guided by Andersen and Newman’s Behavioural
Model for Health Services Utilization. The conceptual framework was constructed using
variables from the literature review and the World Health Organization’s 2016
recommendations for antenatal care. All women admitted to the maternity department were
used as the target population. Stratified random sampling was used to recruit 73 adolescent and
219 adult women in a 1:3 ratio, resulting in a sample of 292 women, calculated using a formula
for two proportions. Data was collected using a questionnaire and the antenatal booklet.
Informed consent and data confidentiality were ensured. Data analysis was conducted using
the Statistical Package for the Social Sciences version 26. Descriptive statistics were used for
predisposing, enabling, and need factors. The Mann-Whitney U test and the chi-square test
were used to compare the timing of the first antenatal care contact and the frequency of
recommended antenatal care contacts between adolescent and adult women. To identify
associated factors, multivariable logistic regression was used. The median and mean ages for
adolescent women were 18.0 and 17.82 ± 1.14 years, respectively, and for adult women, 29.0
and 27.69 ± 4.68 years, respectively. Adult women had higher rates of marriage, urban
residence, health insurance coverage, and autonomy in antenatal care decision making than
adolescent women (p<0.05). Both adult and adolescent women booked antenatal care late, with
a median of 18.00 weeks IQR 10-22 compared with 20.00 weeks IQR 12-24 (p = .02). Both
adult and adolescent women had fewer than eight antenatal care contacts, with a median of 5
(IQR 3-6.5), compared to 4 (IQR 3-5.5) (p = .04). Only 10.5% of adult women completed eight
antenatal care contacts compared with 8.2% of adolescent women. Early antenatal care booking
was influenced by receiving antenatal care information from healthcare providers (AOR = 1.96;
95% CI [ 1.06, 3.71], p = .036). Women with high-risk pregnancies (AOR = 2.33, 95% CI
[1.47, 3.91], p = .005) had more antenatal care contacts than those with low- or moderate-risk
pregnancies. This study highlights a major challenge in achieving early antenatal care booking
and completing eight antenatal contacts among adolescent and adult women. To improve
antenatal care attendance at JOOTRH, we recommend expanding access to services for
adolescent and adult women to address widespread late bookings. Building on the positive
influence of healthcare provider education and countering misinformation from informal
networks, providers should actively participate in community outreach programs. The facility
should also establish routine tracking systems and arrange follow-ups by community health
workers to sustain engagement and prevent high dropout rates. Finally, Women with low- or
moderate-risk pregnancies should be encouraged to complete all eight scheduled contacts for
preventive care, even if they have no active physical symptoms. | en_US |
