Article Info
Year: 2010
Month: July
Issue: 3
Pages: 17-28,23
Reference: Al-Elyani M., Choudhry A., .Saudi Epidemiology Bulletin. 2010;17(3):17-28,23.
One of the most important elements of mother and child services is antenatal care (ANC). ANC ensures that pregnant women go through regular check-ups and can prevent mother and child deaths by identifying pregnancy related complications and fetal abnormalities at an early stage.1 This study aimed to assess the knowledge and practices of Saudi mothers giving birth at King Abdulaziz Specialist Hospital in Taif City, regarding ANC and to identify their socio-demographic determinants.
This cross-sectional study was conducted among Saudi mothers resident of Taif governorate, who had delivered in the hospital during the month of October 2009. Data was collected using a self-administered questionnaire in the post-partum period, before discharge from hospital. Some technical information about pregnancy, delivery and laboratory investigations was extracted from the mothers’ files. If the mother was illiterate, a trained nurse assisted the mother in completing the form.
A total of 400 Saudi mothers participated in this study, with a mean age of 28.5 years (SD ±5.91), and 63.0% were living in Taif city. Regarding educational status, 14.3% of the mothers were illiterate, 14.0% had completed primary school, 12.3% intermediate school, 28.0% secondary school and 31.5% had a level of education higher than secondary school.
The obstetric history showed that 25.5% were primigravida, 28.5% had a history of previous abortions. For the current delivery, 22.9% had Caesarian section while the rest had vaginal delivery.
A number of aspects of knowledge of mothers regarding ANC were assessed. In response to the question about the number of visits required during pregnancy, responses were: three times or less (1.0%), 4-6 times (6.3%), 7-9 times (25.9%), 10-12 times (33.7%), more than twelve times (12.1%) and did not know (21.1%).
Regarding antenatal practices, 74.6% mothers had their first antenatal visit in the 1st trimester, 12.1% in the 2nd trimester, 6.3% in the 3rd trimester and 3.5% came di-
directly for delivery. Overall 3.5% mothers had no ANCvisit, 13.3% had 3 or less visits, 23.0% had 4-6 visits, 22.3% had 7-9 visits, 18.8% had 10-12 visits, and 9.8% had more than 12 visits, while 9.0% did not remember the number of visits. During this pregnancy, 81.0% of mothers had taken iron supplements, 70.6% had taken folic acid and 54.4% had taken multivitamins.
Regarding overall satisfaction with ANC, 50.6% mothers were completely satisfied, 31.9% were somewhat satisfied and 17.5% were not satisfied.
Based on 13 questions exploring different aspects of mother’s knowledge about ANC, a cumulative knowledge score was calculated. The score was divided at median score of 9, into 2 groups of “above-” and “below average knowledge score”.
While studying the relationship between mother’s knowledge and her ANC practices, it was observed that 83.3% of the mothers with “above average knowledge score” had their first visit during the first trimester, compared to 64.2% of mothers with “below average knowledge score” (P<0.001). Only 6.1% of mothers with “above average knowledge score” had less than four antenatal visits, compared to 34.1% of mothers “below average knowledge score” (P<0.001). The number of missed ANC visits were significantly lower among mothers with above average knowledge score as compared to mothers with low average knowledge score (P <0.001). About 12.3% of mothers with “above average knowledge score” took non-prescription medications compared to 24.4% of mothers with “below average knowledge score” (P<0.001). A much higher proportion of mothers with above average knowledge scores were satisfied with ANC (P <0.001). (Table 1)
The study also showed that there was a statistically significant association between actual number of antenatal visits and mothers’ satisfaction with the antenatal services (P < 0.001).
Editorial note:
As the major focus of this study was to assess knowledge and practices of mothers during pregnancy regarding ANC, they were assessed by covering a variety of aspects including time of first ANC visit, number of ANC visits, number of missed visits, taking nutritional supplement and non-prescription medications.
Regarding total number of ANC visits, excluding the mothers who had first contact with the health system during labor, the vast majority had 4 or more visits, i.e. the minimal stipulated visits recommended by WHO.2
However, the number of the visits is not the best indicator to judge the quality of care; timing of these visits and failure to attend an appointment can add more insight to the issue. It is encouraging to note that almost three fourths of the mothers had made their first antenatal visit during the first trimester, thus providing them with the opportunity to obtain health advice earlier in the pregnancy. The study also highlighted that a substantial proportion of mothers had their first AN visit during the third trimester or, for some of them, reaching hospital during labor was the first contact with the health system for this pregnancy; indicating a failure of the health system for these mothers. In addition, under half of the mothers had missed at least one appointment due to a variety of reasons; many of them personal. However, some responsibility has to be shared by health care providers who had not adequately emphasized the need of ANC visits.
Knowledge of mothers about ANC related issues was found to be a leading determinant of mothers’ practices in regard to ANC, since the majority of mothers who had made their first ANC visit in the first trimester, and the higher number of ANC visits was more among mothers who had above average level of knowledge. It is well known that health education on maternal care is mainly provided to pregnant women by health workers at the time of antenatal
visits. Xue described maternal health knowledge level was higher among pregnant women who attended ANC than those who did not.3 Knowledgeable mothers were unlikely to miss any scheduled ANC visits or to take non-prescription medications.
This study showed that utilizing ANC services was higher among mothers with higher knowledge score which agrees with other studies confirming that the utilization of ANC among women with sufficient knowledge on the benefits of ANC was higher than among women lacking such knowledge.4 Improving knowledge on the benefits of ANC for pregnant women is an important element to support women in protecting both their, their children’s, and their families health.
References:
1.Akyuz A et al. Reasons for using antenatal care in women coming to the antenatal outpatients department. Balkan Military Medical Review 2007;10: 38-39.
2.Overbosch G, Nsowah-nuamah J, Vanden B, Damnyag L. Determinants of antenatal care use in Ghana. Center for world food studies. Staff working paper workshop, 2-13, November 2002.
3.Xue L, Jia YJ, Pang SL, Su JQ. A survey on knowledge of prenatal care of 300 pregnant women. Maternal and Child Health Care of China.2007; 22: 2115–2117.
4.Erlindawati, Chompikul J, Isaranurug S. Factors related to the utilization of antenatal care services among pregnant women at Aceh Darussalam Province, Indonesia. J Public Health Dev 2008; 6: 99–108.
Table 1: Relationship of mothers’ practices during pregnancy with their knowledge about ANC, Taif city, 2009.
|
Mothers’ Practices
|
Knowledge score
|
|||
|
Total
|
Above
average level
|
Below
average level
|
P-value
|
|
|
Time of 1st Antenatal visit
|
||||
|
During 1st trimester
|
297
|
83.3%
|
64.2%
|
<0.001
|
|
After 1st trimester
|
103
|
16.7%
|
35.8%
|
|
|
Total
|
400
|
100.0%(210)
|
100.0%(190)
|
|
|
No. of total antenatal visits
|
||||
|
Less than 4 times
|
69
|
6.1%
|
34.1%
|
<0.001
|
|
4-9 times
|
181
|
51.8%
|
47.3%
|
|
|
10 times or more
|
114
|
42.1%
|
18.6%
|
|
|
Total
|
364
|
100%(197)
|
100%(167)
|
|
|
Missed antenatal visits
|
||||
|
Yes
|
206
|
46.6%
|
58.0%
|
<0.001
|
|
No
|
176
|
52.9%
|
35.1%
|
|
|
No visits
|
14
|
0.5%
|
6.9%
|
|
|
Total
|
396
|
100.0%(208)
|
100.0%(188)
|
|
|
Taking non-prescription medications
|
||||
|
Yes
|
68
|
12.3%
|
24.4%
|
0.002
|
|
No
|
311
|
87.7%
|
75.6%
|
|
|
Total
|
379
|
100.0%(203)
|
100.0%(176)
|
|
|
Satisfaction with ANC
|
||||
|
Completely satisfied
|
200
|
60.4%
|
39.9%
|
<0.001
|
|
Somewhat satisfied
|
126
|
30.4%
|
33.5%
|
|
|
Not satisfied
|
69
|
9.2%
|
26.6%
|
|
|
Total
|
395
|
100.0%(207)
|
100.0%(188)
|
|