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 examined the factors that influence late antenatal booking and the effects of such delays on pregnancy outcomes among women receiving care at selected primary healthcare centers in Lagos State, Nigeria. The research employed a quantitative survey design and utilized a structured questionnaire to gather data from 120 respondents. The questionnaire evaluated pregnant women’s knowledge of the appropriate timing for antenatal care, their perceptions of antenatal services, and the relationship between late booking and pregnancy outcomes. Data were analyzed using SPSS version 27, enabling effective presentation and statistical examination of the results. Hypotheses were tested with the one-sample t-test. The results indicated significant links between gaps in knowledge about antenatal care timing and the occurrence of late booking. Limited awareness among the participants was a key contributor to the delayed start of antenatal care. Additionally, favorable perceptions of antenatal services were associated with earlier initiation of antenatal visits, indicating that improving perceptions may help promote timely care-seeking. Late antenatal booking also showed a statistically significant connection with unfavorable pregnancy outcomes, highlighting the vital importance of early antenatal care in reducing maternal and perinatal risks. In conclusion, the study emphasizes the critical need for timely antenatal care to enhance maternal and child health results. Recommendations involve strengthening educational campaigns to boost awareness of the advantages of early booking, improving the quality and accessibility of antenatal services, and introducing policies that encourage early attendance. These steps are vital for lowering the rate of late booking and enhancing pregnancy outcomes for women in urban areas such as Lagos State.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Late antenatal booking, which is defined as beginning antenatal care after 12 weeks of gestation, continues to be a major challenge in maternal healthcare worldwide. In Nigeria, particularly in Lagos State, late booking is common even though it is well known to be linked with negative pregnancy outcomes, including higher rates of maternal and perinatal mortality and morbidity (Teshale & Tesema, 2022). Such delays in accessing antenatal care can have substantial effects on the well-being of both the mother and the fetus, resulting in avoidable complications and, in some cases, death.

Gaining insight into the factors that lead to late antenatal booking is essential for tackling this public health problem. Socioeconomic elements, including low income levels and limited education, have been recognized as major obstacles to obtaining timely antenatal care (Gudissa et al., 2021). Cultural beliefs and practices also play a significant role in shaping women’s choices about when to start antenatal care, often causing further postponements (Ebonwu et al., 2018). Identifying and tackling these obstacles can enable healthcare providers to design more effective interventions that promote early antenatal care attendance and lead to better maternal and child health results.

In Nigeria, the problem of late antenatal booking is worsened by difficulties within the healthcare system, such as insufficient facilities and restricted access to high-quality prenatal services (Edgard-Marius et al., 2023). These systemic shortcomings not only discourage women from seeking prompt care but also lead to overcrowding and excessive strain on healthcare facilities once women finally arrive for antenatal visits. Resolving these structural problems is necessary to guarantee that pregnant women obtain timely and sufficient prenatal care, thereby minimizing risks to maternal and fetal health.

The consequences of late antenatal booking go beyond immediate health effects and include wider socioeconomic impacts. For example, postponing the start of antenatal care is connected to higher healthcare expenses resulting from the treatment of complications that could have been prevented (Grum & Brhane, 2018). This adds further pressure to already limited healthcare resources and stresses the value of early intervention approaches designed to encourage prompt antenatal care attendance.

Initiatives to reduce the effects of late antenatal booking should also take into account regional differences and specific contextual elements that affect healthcare-seeking patterns. In rural and underserved areas, access to healthcare facilities and services is often especially restricted, which contributes to even greater delays in starting antenatal care (Tolefac et al., 2017). Focused interventions that tackle these inequalities and strengthen healthcare infrastructure are crucial for removing barriers to early antenatal care and providing fair access to maternal healthcare services for various population groups.

Additionally, the influence of healthcare policies and guidelines is extremely important for encouraging the early start of antenatal care. Policies that highlight the value of early prenatal visits and offer incentives for timely attendance can motivate pregnant women to seek care earlier (Utuk et al., 2021). Likewise, incorporating maternal health education into community outreach initiatives can give women the knowledge they need about the advantages of early antenatal care and help them make well-informed choices about their own health and the health of their unborn children (Adere & Tilahun, 2020).

In summary, dealing with late antenatal booking demands a comprehensive strategy that addresses individual, cultural, socioeconomic, and systemic influences. Through a clear understanding of the causes of late booking and their consequences for maternal and child health, stakeholders can create specific strategies to encourage early antenatal care attendance. These actions are fundamental for decreasing adverse pregnancy outcomes, improving maternal well-being, and giving infants healthier beginnings in Nigeria and other regions (Kea et al., 2018).

1.2 Statement of Problem

Late antenatal booking defined as starting antenatal care after 12 weeks of gestation remains a serious issue in maternal healthcare around the world, including in Nigeria and Lagos State (Teshale & Tesema, 2022). Even with widespread initiatives to encourage early antenatal care attendance, a large number of pregnant women still arrive late for their initial prenatal visit. This delay is linked to multiple adverse pregnancy outcomes, such as elevated maternal and perinatal mortality and morbidity (Edgard-Marius et al., 2023; Grum & Brhane, 2018).

In Nigeria, the rate of late antenatal booking stays notably high in both urban and rural environments (Utuk et al., 2021). This situation creates difficulties for effective maternal healthcare provision and undermines attempts to enhance maternal and child health results. The challenge is intensified by socioeconomic conditions like poverty and low educational levels, which contribute to postponed healthcare-seeking among pregnant women (Gudissa et al., 2021). Cultural beliefs and traditional customs also affect decisions about when to begin antenatal care, causing additional delays in obtaining vital prenatal services (Ebonwu et al., 2018).

Structural weaknesses in the healthcare system, including a shortage of facilities, understaffing, and limited resources, further contribute to delays in accessing prenatal care (Tolefac et al., 2017). These systemic issues not only obstruct early antenatal care attendance but also overload healthcare resources and widen gaps in maternal healthcare access and results.

Consequently, resolving the problem of late antenatal booking is essential for advancing maternal and child health in Nigeria. Targeted strategies need to be created to recognize and overcome the obstacles that stop pregnant women from seeking timely antenatal care, thereby lowering associated risks and strengthening overall maternal health outcomes (Adere & Tilahun, 2020; Kea et al., 2018).

1.3 Objectives of the Study

The specific objectives of this study are 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 seeks to conduct a detailed analysis of the factors behind late antenatal booking in Lagos State and its important effects on pregnancy outcomes. Although there have been global campaigns stressing the need for early antenatal care, many pregnant women in Lagos State still delay their first prenatal visit until after 12 weeks of gestation. This research aims to reveal the multifaceted reasons for this pattern, encompassing socioeconomic factors, cultural influences, and challenges within the healthcare system.

By thoroughly investigating these elements, the study aims to deliver useful information to policymakers and healthcare providers. Understanding the reasons why women in Lagos State postpone antenatal care is key to designing focused interventions that promote timely attendance. Such efforts might include community education programs to increase awareness of the advantages of early antenatal care, as well as policy actions that reward prompt healthcare-seeking by expectant mothers.

Furthermore, this research will add to current knowledge by drawing attention to the particular healthcare system difficulties in Lagos State. Problems such as inadequate healthcare facilities, insufficient staffing, and resource shortages frequently worsen the issue of late antenatal booking. Tackling these systemic shortcomings is necessary to achieve equitable access to maternal healthcare services and to improve maternal health results across the state.

Ultimately, the outcomes of this study are anticipated to guide practical applications for healthcare practices and policy development in Lagos State. By supporting evidence-based approaches suited to local conditions, policymakers can more effectively distribute resources and carry out interventions that address the root causes of late antenatal booking. This forward-looking method not only aids maternal and child health but also corresponds with wider public health goals of lowering preventable maternal mortality and improving maternal well-being.

1.7 Scope of the Study

The study concentrated on pregnant women attending selected primary healthcare centers in Lagos State, Nigeria, over a defined period. It investigated 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.