KNOWLEDGE AND PERCEPTION OF LATE ANTENATAL BOOKING ON PREGNANCY OUTCOME AMONGST WOMEN ATTENDING ANTE NATALCLINICS IN SELECTED PRIMARY HEALTH CARE LAGOS STATE

Abstract

This study investigated the factors influencing late antenatal booking and its implications on pregnancy outcomes among women attending selected primary healthcare centers in Lagos State, Nigeria. A quantitative survey research design was adopted, employing a structured questionnaire to collect data from a sample of 120 respondents. The questionnaire assessed pregnant women's knowledge of antenatal care timing, their perceptions of antenatal services, and the association between late booking and pregnancy outcomes. Data analysis was conducted using SPSS27, which facilitated the presentation and analysis of collected data. Hypotheses were tested using a one-sample t-test. The findings revealed significant associations between knowledge gaps regarding antenatal care timing and late booking. Insufficient awareness among respondents contributed to delayed initiation of antenatal care services. Moreover, positive perceptions towards antenatal services were found to correlate with earlier booking for antenatal visits, suggesting that enhancing perceptions could potentially improve timely care-seeking behaviors. Furthermore, late antenatal booking demonstrated a statistically significant association with adverse pregnancy outcomes, emphasizing the critical role of early antenatal care in mitigating maternal and perinatal risks. In conclusion, this study underscores the importance of timely antenatal care in promoting maternal and child health outcomes. Recommendations include intensifying educational campaigns to increase awareness about the benefits of early booking, enhancing the quality and accessibility of antenatal services, and implementing policies to incentivize early attendance. These measures are essential for reducing the incidence of late booking and improving pregnancy outcomes among women in urban settings like Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Late antenatal booking, defined as initiation of antenatal care after 12 weeks of gestation, remains a critical issue in maternal healthcare globally. In Nigeria, including Lagos State, late booking is prevalent despite its known association with adverse pregnancy outcomes such as increased maternal and perinatal mortality and morbidity (Teshale & Tesema, 2022). This delay in seeking antenatal care can significantly impact the health of both the mother and the unborn child, leading to preventable complications and even fatalities.

Understanding the factors influencing late antenatal booking is crucial for addressing this public health challenge. Socioeconomic factors, such as low income and lack of education, have been identified as significant barriers to accessing timely antenatal care (Gudissa et al., 2021). In addition, cultural beliefs and practices often influence women's decisions regarding when to initiate antenatal care, contributing to delays (Ebonwu et al., 2018). By identifying and addressing these barriers, healthcare providers can better tailor interventions to encourage early antenatal care attendance and improve maternal and child health outcomes.

In Nigeria, the issue of late antenatal booking is exacerbated by healthcare system challenges, including inadequate healthcare facilities and limited access to quality prenatal services (Edgard-Marius et al., 2023). These systemic issues not only deter women from seeking timely care but also contribute to the overcrowding and overburdening of healthcare facilities when women eventually present for antenatal visits. Addressing these structural deficiencies is essential to ensure that pregnant women receive timely and adequate prenatal care, thereby reducing the associated risks to maternal and fetal health.

Moreover, the impact of late antenatal booking extends beyond immediate health outcomes to encompass broader socio-economic implications. For instance, delayed initiation of antenatal care is associated with increased healthcare costs due to the management of preventable complications (Grum & Brhane, 2018). This places an additional burden on already strained healthcare resources and underscores the importance of early intervention strategies aimed at promoting timely antenatal care attendance.

Efforts to mitigate the consequences of late antenatal booking must also consider regional disparities and contextual factors that influence healthcare-seeking behaviors. In rural and underserved communities, access to healthcare facilities and services may be particularly limited, further delaying the initiation of antenatal care (Tolefac et al., 2017). Targeted interventions that address these disparities and improve healthcare infrastructure are essential for reducing barriers to early antenatal care and ensuring equitable access to maternal healthcare services across diverse populations.

Furthermore, the role of healthcare policies and guidelines cannot be overstated in promoting early antenatal care initiation. Policies that emphasize the importance of early prenatal visits and provide incentives for timely attendance can encourage pregnant women to seek care sooner (Utuk et al., 2021). Similarly, integrating maternal health education into community outreach programs can empower women with knowledge about the benefits of early antenatal care and equip them to make informed decisions regarding their health and the health of their unborn children (Adere & Tilahun, 2020).

In essence, addressing the issue of late antenatal booking requires a multifaceted approach that encompasses individual, cultural, socioeconomic, and systemic factors. By understanding the determinants of late booking and their implications for maternal and child health, stakeholders can develop targeted strategies to promote early antenatal care attendance. These efforts are essential for reducing adverse pregnancy outcomes, enhancing maternal well-being, and ensuring healthier starts for infants in Nigeria and beyond (Kea et al., 2018).

1.2 Statement of Problem

Late antenatal booking, defined as the initiation of antenatal care after 12 weeks of gestation, persists as a significant concern in maternal healthcare globally, including in Nigeria and Lagos State (Teshale & Tesema, 2022). Despite extensive efforts to promote early antenatal care attendance, a substantial proportion of pregnant women continue to present late for their first prenatal visit. This delay is associated with various adverse pregnancy outcomes such as increased maternal and perinatal mortality and morbidity (Edgard-Marius et al., 2023; Grum & Brhane, 2018).

In Nigeria, particularly in urban and rural settings alike, the prevalence of late antenatal booking remains notably high (Utuk et al., 2021). This poses challenges to effective maternal healthcare delivery and compromises efforts to improve maternal and child health outcomes. The problem is exacerbated by socio-economic factors such as poverty and lack of education, which contribute to delayed healthcare-seeking behaviors among pregnant women (Gudissa et al., 2021). Additionally, cultural beliefs and traditional practices influence decision-making regarding antenatal care initiation, further delaying timely access to essential prenatal interventions (Ebonwu et al., 2018).

Moreover, structural deficiencies within the healthcare system, including inadequate healthcare facilities, understaffing, and insufficient resources, contribute to the delay in accessing prenatal care services (Tolefac et al., 2017). These systemic challenges not only hinder early antenatal care attendance but also strain healthcare resources and exacerbate disparities in maternal healthcare access and outcomes.

Therefore, addressing the issue of late antenatal booking is critical for improving maternal and child health outcomes in Nigeria. Effective strategies must be developed to identify and mitigate the barriers that prevent pregnant women from seeking timely antenatal care, thereby reducing the associated risks and enhancing overall maternal health outcomes (Adere & Tilahun, 2020; Kea et al., 2018).

1.3 Objectives of the Study

The specific objectives of this study include to:

1. Assess the knowledge of pregnant women regarding the timing and benefits of early antenatal booking.

2. Determine the perception of pregnant women towards antenatal care services in primary healthcare centers.

3. Evaluate the association between late antenatal booking and pregnancy outcomes among women attending selected primary healthcare centers in Lagos State.

1.4 Research Questions

The following research questions were examined:

1. What is the level of knowledge among pregnant women regarding the timing and benefits of early antenatal booking?

2. How do pregnant women perceive the antenatal care services provided at primary healthcare centers?

3. What is the association between late antenatal booking and pregnancy outcomes among women in Lagos State?

1.5 Research Hypotheses

The following hypotheses were tested:

1. There is no significant association between knowledge gaps regarding antenatal care timing and late antenatal booking.

2. Positive perceptions towards antenatal care services are not associated with earlier booking for antenatal visits.

3. Late antenatal booking is not significantly associated with adverse pregnancy outcomes.

1.6 Significance of the Study

This study aims to provide a thorough examination of the factors contributing to late antenatal booking in Lagos State and its significant implications for pregnancy outcomes. Despite global efforts to stress the importance of early initiation of antenatal care, a considerable number of pregnant women in Lagos State continue to delay their first prenatal visit until after 12 weeks of gestation. This research seeks to uncover the complex determinants behind this trend, which include socio-economic factors, cultural influences, and systemic challenges within the healthcare system.

By exploring these factors comprehensively, the study intends to offer valuable insights to policymakers and healthcare providers. Understanding why women in Lagos State postpone seeking antenatal care is crucial for developing targeted interventions aimed at promoting timely attendance. Such initiatives could involve community-based education programs to raise awareness about the benefits of early antenatal care, along with policy measures that incentivize prompt healthcare-seeking behaviors among expectant mothers.

Moreover, this research will contribute to the existing knowledge by highlighting the specific healthcare system challenges within Lagos State. Issues such as insufficient healthcare facilities, inadequate staffing, and resource limitations often exacerbate the problem of late antenatal booking. Addressing these systemic deficiencies is essential for ensuring equitable access to maternal healthcare services and improving overall maternal health outcomes throughout the state.

Ultimately, the findings of this study are expected to inform practical implications for healthcare practice and policy formulation in Lagos State. By guiding evidence-based strategies tailored to local contexts, policymakers can better allocate resources and implement interventions that tackle the underlying causes of late antenatal booking. This proactive approach not only supports maternal and child health but also aligns with broader public health objectives aimed at reducing preventable maternal mortality and enhancing maternal well-being.

1.7 Scope of the Study

The study focused on pregnant women attending selected primary healthcare centers in Lagos State, Nigeria, during a specified period. It examined their knowledge, perceptions, and the timing of their antenatal care initiation.

1.8 Operational Definition of Terms

Late antenatal booking: Initiating antenatal care after the first trimester (after 12 weeks of gestation).

Pregnancy outcomes: Includes maternal outcomes (maternal mortality, morbidity) and perinatal outcomes (stillbirth, low birth weight, neonatal mortality).

Knowledge: Understanding of the timing and benefits of early antenatal care.

Perception: Pregnant women's attitudes and beliefs towards antenatal care services.

Primary healthcare centers: Government-run healthcare facilities providing basic healthcare services.

Maternal mortality: Death of a woman during pregnancy, childbirth, or within 42 days of termination of pregnancy.

Perinatal mortality: Death of a fetus or neonate around the time of birth (usually within the first week).

Antenatal care: Healthcare provided to pregnant women to monitor pregnancy, promote maternal health, and prevent complications.