Paradise Valley College Faculty of Health Sciences Department of Nursing

Factors Affecting Antenatal care Service Utilization in Shashamene Town, West Arsi Zone,
Oromia, Ethiopia.
BY:
1. Abdulatif Jemal
2. Addisu Edeo
3. Arega Tafese
4. Aster Kelaye
5. Emebet Balcha
6. Eyerusalem Esayas
7. Feyisa Gemedi
8. Konjit Abda
9. Mitiku Bekele
10. Mohammed Boru
11. Shitaye Tirkaso
12. Tesema Ermias
A Research Proposal Submitted to Department of Nursing for Partial Fulfillment of the
Requirement for Bachelor of Science in Nursing.
Advisor: Yadessa Tegene (MSc/Lecturer.)
June, 2016
Shashemene, Ethiopia.
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Acknowledgement
We would like to appreciate and thank Paradise Valley College and Nursing Department for
technical support to prepare this research proposal and for willingness to admit to the department
to study in the field of nursing. Our heartfelt gratitude goes to our Advisor Mr. Yadesa Tegene
(MSc), Lecturer at University of Hawassa, for his invaluable effort; without him this proposal
would not have come to be completed. Our deep gratitude also goes to our study participants
who volunteered and took their time to give us all the relevant information for the study. Last but
not least, we would like to thank the Shashamene town Health Office for their cooperation and
help during the proposal development.

TABLE OF CONTENTS
Acknowledgement........................................................................................................... 2
TABLE OF CONTENTS................................................................................................... 3
Abstract...................................................................................................................... 6
Chapter One............................................................................................................... 7
Introduction................................................................................................................ 7
1.1, Background........................................................................................................... 7
1.2, Statement of the problem........................................................................................... 8
1.3, Significance/Rationale of Study..................................................................................9
Chapter Two.............................................................................................................. 10
Literature Review..................................................................................................... 10
Chapter Three........................................................................................................... 13
Objectives................................................................................................................. 13
3.1 General Objectives................................................................................................. 13
3.2 Specific Objectives................................................................................................. 13
Chapter Four............................................................................................................. 14
Methods and Materials............................................................................................. 14
4.1 Study setting and period........................................................................................... 14
4.2 Study design......................................................................................................... 14
4.3 Source population.................................................................................................. 14
4.4 Study population.................................................................................................... 14
Women of reproductive age who had delivered at least one alive baby in their life in shashemene.....14
4.5, Inclusion and Exclusion Criteria:............................................................................... 14
4.5.1, Inclusion Criteria............................................................................................. 14
4.5.2 Exclusion Criteria............................................................................................. 14
4.5 The sample size..................................................................................................... 15
4.6 Sampling method................................................................................................... 15
4.7. Variables............................................................................................................. 15
4.7.1 Dependent Variables.......................................................................................... 15
4.7.2 Independent Variables........................................................................................ 16
4.8 Operational definitions............................................................................................ 16
4.9 Data collection procedure......................................................................................... 16
4.10 Data quality assurance........................................................................................... 16
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4.11 Data analysis....................................................................................................... 17

4.12 Ethical consideration............................................................................................. 17
4.13 Dissemination of the findings.................................................................................. 17
5. Result...................................................................................................................... 18
5.1 Socio Demographic Characteristics of the Study Population..............................................18
DISCUSSION............................................................................................................... 24
6. STRENGTH OF THE STUDY....................................................................................... 25
7. LIMITATION OF THE STUDY..................................................................................... 25
8. CONCLUSION.......................................................................................................... 25
9. RECOMMENDATION................................................................................................ 25
References................................................................................................................... 26
Annexes...................................................................................................................... 31
Annex 1: consent form and questionnaire English version...................................................31
Questionnaires.............................................................................................................. 32

LIST OF TABLES
4

Tables

Page

Table 1: work plan for research activity on assessment of factors affecting ANC
Service utilization in Shashamene town, 2016----------------------------------------18
Table 2: Stationery Cost --------------------------------------------------------------------------------19

Table 3: Personnel expenses ------------------------------------------------------------------------19

Table 4: Transport Cost ------------------------------------------------------------------------------20
Table 5: Miscellaneous expense--------------------------------------------------------------------20
Table 6: Budget Summary---------------------------------------------------------------------------20

Abstract
Background: Antenatal care is one of the four pillar initiatives of the Safe Motherhood. This
study was carried out to identify the factors affecting the utilization of antenatal care by women
of child bearing age and womens opinion regarding antenatal care.
Methods: A cross-sectional questionnaire based survey was conducted from April 2016 to July
2016 at Shashamene town, Oromia , Ethiopia.
Miscarriages during the study were excluded. The subjects were further classified on basis of
educational status, and number of visits they paid for antenatal care.
Keyword: Antenatal care, Parity, Primipara, Multipara, Safe Motherhood, Health Facility

Chapter One
Introduction
1.1, Background
Antenatal care is one of the four pillar initiatives of the Safe Motherhood. It provides
reassurance, education support for the women on screening programs and detects the problems
that make the pregnancy high risk (1). Health of the mother is health of the nation. A healthy
mother leads to healthy baby. Healthy babies are future of our nation. However mothers are at
risk at various stages of pregnancy. Antenatal period is crucial due to the fact that most of the
6

complications during pregnancy can be identified through a regular antenatal check up and
maternal mortality could be reduced by adopting risk approach i.e, giving priority to risk
pregnancy.
There are many socioeconomic and cultural factors which act as barriers to use of antenatal care
(2). Although it cannot be claimed that antenatal care is the only solution for the high maternal
and perinatal death, it can help to reach the Millennium Development Goals for the maternal and
child mortality (3).
World Health Organization recommended four antenatal visits for the low risk pregnancy.
There is still debate regarding the optimal number of visits for the antenatal care (4). Early
commencement of antenatal care by pregnant women as well as regular visits has the potential to
affect maternal and fetal outcome positively (5). The recommended gestational age for booking
is within the first 12 weeks of pregnancy (6). Many developing countries do not have national
guidelines on antenatal care but commencement of antenatal care within the first 14 weeks of
gestation is widely accepted as early (7). Commencement of focused antenatal care before 14
weeks of gestation allows for early commencement of health education and counseling on
expected physiological changes, the normal course and possible complications of pregnancy,
labour and puerperium (8).
In our country, probably one of the main causes of human resource loss is the maternal mortality
and death of child under the age of one year; this includes prenatal and neonatal periods (9).
Factors leading to these deaths have not been systematically analyzed.
In order to ascertain the dilemma, this loss needs to be diagnosed. The aim of this study was to
determine the factors affecting utilization of antenatal care services. The major factors affecting
mothers utilization of Antenatal Care (ANC) are perception about the capacity of facilities,
concerns about the attitudes of health workers towards community members, perception about
the cost of the care lack of planning and preparation for pregnancy, inaccessibility of facility
based delivery care.
Womens health seeking behavior, however, is influenced by intervening social relation that may
prescribe the range and extent of their autonomous action. In traditional patriarchal societies
7

where restrictions are placed on a women's freedom of movement and contact with unrelated
men, a husband's attitude toward prenatal care may be an important factor in determining
whether such care is received [10].It is relevant to look into the problem so as to have to the
basic information which will help for policy makers working ANC follow-up to design
intervention measures. To achieve one of the millennium development goals and decrease
maternal mortality conducting research on factors influencing ANC utilization is essential.
1.2, Statement of the problem
Ethiopia is a major contributor of maternal deaths in the world with a maternal mortality ratio of
673 per 100,000 live births and 19,000 maternal deaths annually. However, improvements have
been reported in regard to infant and child mortality reduction, there has been slow progress
regarding achieving Millennium Development Goal 5 [11]. The 2005 Ethiopian demographic
and health survey (EDHS) has shown that only 28% of women received antenatal care and only
6% of women were assisted by a health professional for their most recent birth in Ethiopia, the
maternal mortality was estimated to be 673 deaths per 100,000 live births and infant mortality
rate was 77 per 1,000 live births, which is among the highest in the world [12].
In the Ethiopia the mean maternal mortality burden, measured by Maternal Death Risk Factor
Index (MDRFI), is at 3.03 and Somali is with the highest mean maternal mortality burden
(mean=3.33) followed by Afar (mean=3.21) regions. Similarly, high MDRFI mean values were
found in SNNP (mean=3.11), Amhara (mean=3.09), and Oromia (mean=3.08) regions. The
overall maternal mortality burden was in the three most populous regions of the country (SNNP,
Oromia and Amhara) constituting over 75% of the countrys population [13, 14].
In the last decade the trend in utilizing antenatal care was significantly different based on urbanrural residence and region [15]. A cross sectional study done in Tigray Region, Ethiopia showed
that utilization of antenatal care service was significantly associated with marital status,
education, proximity of health facility and husbands occupation [16]. Another study done in
Hadiya Zone, Ethiopia also showed that maternal age, husbands attitude, family size, maternal
education, and perceived morbidity were siginificantly associated with antenatal care service
utilization [17]. Several studies have identified urban-rural disparities in utilizing antenatal care
services in different countries [12, 18, 19]. The higher coverage of antenatal care in urban areas
than rural areas worldwide has been due to the inequalities in the number of accessible health
8

facilities [20-22]. Futhermore, utilization of antenatal care services is affected by sociodemographic characteristics. Service fees were an important barrier in utilizing antenatal care [23
-25]. Distant health facilities and insufficient number of antenatal care providers at various health
institutions negatively affect utilization of antenatal care services [26]. Despite the enormous
efforts that the Ethiopian government made, universal access to maternal health services remains
limited. Each year 3.3 million babies or maybe even more are stillborn, more than 4 million
die within 28 days of coming into the world, and a further 6.6 million young children die before
their fifth birthday. Maternal deaths also continue unabated the annual total now stands at
529,000 [27].
Therefore, this study was aimed to determine antenatal care utilization and its determinants
among mothers of reproductive age groups in Shashemene town, South Ethiopia.
1.3, Significance/Rationale of Study
This study will enable the health care professional to determine the factors causing poor or
irregular utilization of antenatal care services and how to eradicate it. It will also help the
government to develop and implement new policies towards encouraging proper utilization of
antenatal care services, which will help to reduce maternal and neonatal morbidity and mortality
rates.

Chapter Two
Literature Review
The United Nations estimates that 529 000 women die each year from complications during
pregnancy and childbirth [29]. In Nigeria, it is estimated that approximately 59,000 of maternal
deaths take place annually as a result of pregnancy, delivery and post delivery complications [30]
despite the available antenatal health care services. Antenatal care refers to the care that is given
to an expectant mother from the time that conception is confirmed until the beginning of labor
[31].
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Adequate utilization of antenatal health care services is associated with improved maternal and
neonatal health outcomes. Antenatal care is expected to have impact on the development of the
fetus and the infant as well as mother and this can only be achieved through early booking and
regular attendance of antenatal clinic. The trend of maternal mortality in developing countries
has been increasing and various international organizations have reported that an important
factor related to maternal and infant mortality has been linked to lack of antenatal care [32].
According to Federal Ministry of Health [2005], some of the dangers of pregnancy and childbirth
can be avoided if the pregnant woman attends antenatal regularly. In order to decrease these
mortality rates, regular antenatal care has to be instituted or reinforced which can only be
achieved through identifying factors causing poor utilization of antenatal care services.
Antenatal care services refer to a critical intervention aimed at reducing maternal morbidity and
mortality. Its a medical care given to expectant mothers whose major aim is to identify and treat
problems and complications during pregnancy.
In Africa, provision of universal antenatal care services face difficulties not only expenses
involved but inability of facility staff to recognize obstetric emergency emergencies, shortage of
skilled attendants at Health care facilities (Making motherhood safer).The coverage for at least
two doses of Tetanus Toxoid immunization currently stands at 42%. (33). 31% overall
adolescents attending Antenatal care services (World report 2005) tend to fear thus this
increasing complications and difficulties, by the time they discover the complications, it looks to
be late to the realizing to attend the services (34). Long awaiting hours have contributed to under
utilization of antenatal care Int. Statistical Inst.: Proc. 58th World Statistical Congress, 2011,
Dublin (Session CPS001) p.60122 services thus adolescent expectant mothers get tired and give
up thus dropping out (35). Longer hours of waiting are due to inadequate medical staffs in the
health centers as being reported by health workers. The high client load leads to minimal or
nonexistent provider client interaction. Marital status is another important factor in affecting the
utilization of antenatal care services among adolescent expectant mothers.
They are often initiated into marriages and sex quite early when they are still growing thus
contributing to 31% making Uganda one of the top ranking countries in sub-Saharan Africa
(36).Adolescent expectant lack support from their spouses thus lack of user fee to access
10

antenatal care services (37). They depend on another member of the family who may not be well
prepared for emergencies which may arise. In many settings, there are unexpected costs among
adolescent expectant mothers associated with obstetric emergencies. They are unable to meet
transport costs to antenatal care clinics.
The proportion of donor funding has been reduced in other areas in particularly in family
planning. In Malawi, health workers ceased to provide reproductive health services in order to
offer voluntary counseling and testing for HIV/AIDS (38). Its reported that expectant mothers
from 19-24 years tend to be employed thats middle adolescents (20%) compared to those below
18 years of age (23%) (39). However, with lack of education some adolescent expectant mothers
are ignorant about the use of attendance to ANC services.
Pregnancy is one of the most important periods in the life of a woman, a family and a society.
ANC (Antenatal Care) is special care for women during pregnancy through the public health
services. The goal of ANC is to prevent health problems in both infant and mother and to ensure
that each newborn child has a good start. To achieve this objective, the service is organized into a
booking (first visit) and a follow up clinic. The aims of the first visit are primarily to establish a
rapport with the client and collect information to evaluate the state of health of the mother, and
her preparedness for motherhood and chart the likely course of the pregnancy [40].
WHO (World Health Organization) recently recommended a reduction in the number of ANC
visits because of evidence suggesting that having fewer ANC visits do not affect the outcomes of
care.
The newly proposed, focused ANC recognizes that every pregnant woman is at risk for
complications. In this model, four ANC visits are recommended for most pregnant women.
Ideally, the first visit during first trimester; the second, close to week 26; the third around week
32; and the fourth and final visit between weeks 36 and 38 [41]. This model, four ANC visits are
recommended for most pregnant women.
Ideally, the first visit during first trimester; the second, close to week 26; the third around week
32; and the fourth and final visit between weeks 36 and 38 [41]. In most developing countries,
women of reproductive age constitute more than one-fifth of the total population. These women
are exposed repeatedly to the risk of pregnancy and childbearing and, under existing
11

socioeconomic conditions and the inadequacy of medical and health facilities, are at greater risk
of morbidity and mortality from causes related to pregnancy. The death of women, who, in most
developing countries plays the principal role in rearing of children and the management of family
affairs, is important in social and personal tragedy [42]. The child bearing functions of women,
especially in developing countries, have been granted as a normal or routine process yet these
valued and precious parts of daily functioning are among the most hazardous experiences that
women often engage in without being aware of the risks that they are in [43].
Antenatal care (ANC) among pregnant women is one of the important factors in reducing
maternal morbidity and mortality. Unfortunately, many women in developing countries do not
receive such care. Reports from neighboring countries show that a high utilization rate of the
ANC service results in lowering the risk of maternal mortality. For example, in South East Asia
in 20002006, based on the ANC coverage among five ASEAN member countries, Thailand had
the highest rate at 98.0%, whereas Laos had the lowest at only 27.0%. The highest rates after
Thailand were: Viet Nam (91.0%), Myanmar (76.0%), and Cambodia (69.0%). According to the
2005 statistics of Maternal Mortality in South East Asia, Laos had the highest maternal mortality
rate at 660 per 100,000 live births (44, 45).

Chapter Three
Objectives
3.1 General Objectives
To assess antenatal care service utilization and factors that affects it in Shashemene town, West
Arsi Zone, Oromia, Ethiopia.
3.2 Specific Objectives
1. To determine prevalence of ANC in Shashemene town
2. To assess those factors affecting ANC utilization in Shashemene town.

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Chapter Four
Methods and Materials
4.1 Study setting and period
This study will be conducted in Shahemene town among reproductive age women from May to
June2016.Shashemene town is the largest town and administrative center of West Arsi Zone and
located 250Kms to the south of Addis Ababa, the capital of Ethiopia. Shashemene has an
elevation of 1967- 2009 meters. The town was structured into 11 sub-cities. The population of
Shashamene town was 193984. Of which 96877(49.9%) were males and 97107 (50.1%) were
females .The economy of the town is widely based on trade and agriculture being teff and
potato are the main staple food of the population. [Profile of the town].

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4.2 Study design

Community based cross sectional study design will be used to assess utilization of ANC in
Shashemene town reproductive age group women.
4.3 Source population
The source population will be all reproductive age group women of Shashemene town.
4.4 Study population
Women of reproductive age who had delivered at least one alive baby in their life in shashemene
.4.5, Inclusion and Exclusion Criteria:
4.5.1, Inclusion Criteria
Women of reproductive age group who delivered one live birth in their life will be included.
4.5.2 Exclusion Criteria
However, those mothers who will be sick, mentally ill and who will not be able to communicate
will be excluded from the study
4.5 The sample size
The sample size for the study will be estimated using single population proportion formula.
Prevalence level of (86%) was considered from the report of a research conducted in East Shoa
zone. Sample size will be determined based on the following formula:

n = (z/1-) 2p (1-p)

d2
Where
n = estimated minimum sample size
z = standard normal variable at 95% (1.96) level
p = 86% population proportion
d = 5% margin of error
n = (z/1-) 2p (1-p) =

d2

(1.96) 20.86 (1-0.86) =185

0.052
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Since we will use two stage clusters sampling, design effect of 1.5 will be used and with 5%
contingency the total sample size will be 292.
4.6 Sampling method
The study participants will be selected using a two stage cluster sampling technique: at stage one
three kebeles will be selected from the total 11 kebeles in the town. In the three kebeles to be
selected, the number of households who had mothers who gave live birth in their life will be
identified. Therefore, at stage two 292 households will be selected using a systematic sampling
method with proportionate allocation to size in each sub cities. Then in each household one
mother who gave live birth in life preceding the survey will be interviewed and two visits will be
made for absences in the first visits. .
4.7. Variables
4.7.1 Dependent Variables
ANC service utilization
4.7.2 Independent Variables
Socio economic and demographic Characteristics: educational level, marital status religion,
income, age, occupation.
Attitude, waiting time, distance from service center / proximity to ANC, availability, parity,
knowledge about ANC services.
4.8 Operational definitions
ANC service utilization: Having at least two antenatal care visits.
Professionally assisted delivery (PAD): Deliveries that took place in a health facility.
Distance from health facilities: Based on a Proximity to health facilities individuals and groups
who will be near (within 1 km) facilities, far from such facilities (5 to 10 km); and very far
(i.e., more than 10 km)."
Parity: the number of delivery.

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4.9 Data collection procedure

Data will be collected using structured questionnaire. Different literatures will be assessed for
necessary data then the questionnaires developed in relation to the objective of the study by
modifying the questionnaire from previous study. Questionnaire will be developed first in
English. The final version of the English questionnaire will be translated to Afan
Oromo/Amharic version and then back to English to ensure message consistency and coherency.
Finally pretesting will be carried out in 5% of population outside the study area. Data collectors
will be oriented / trained for data collection. Beside this, they will be trained on their
responsibilities for describing the purpose of the study, giving orientation, telling service users
and providers the importance of honest and sincere reply, on responding to questions.
4.10 Data quality assurance
Thus training will be given for data collectors for two days before the pretest of the
questionnaire. Data collection tool will be taken and modified from standard questionnaire. The
principal investigators also will check the activities of the data collectors randomly on daily
basis. Data collectors will be instructed to check the completeness of each questionnaire at the
end of each interview. The quality of the data will be assured through careful design, translation
and retranslation and pretesting of the questionnaire, proper training of the interviewers and
supervisors, close supervision of the data collectors and proper handling of the data. It will be
monitored frequently both in the field and during data entry.
4.11 Data analysis
The unit of analysis for this study will be women who had at least one live birth in life preceding
the survey. The collected and cleaned data will be manually analyzed using SPSS version 21 for
statistical analysis.
4.12 Ethical consideration
Before starting of the data collection process, ethical clearance will be obtained from Paradise
Valley College. Participants confidentiality of information will be assured by limiting the data
exposure to the third party and the clients name will be excluded from data. Informed consent
will be obtained from study participants. They will be informed about objective of the study.

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4.13 Dissemination of the findings

The result of the study will be presented to the College community and a copy of the finding will
be submitted to Shashemene town health Office, kept at College library and will be published in
the future.

5. Result
5.1 Socio Demographic Characteristics of the Study Population
A total of 292 women who delivered in the 12 months before the date of survey were
interviewed, with a response rate of 100%. The mean age of the respondents was 27.5 (SD
6.07) years. 173 (59.25%) were Oromo by ethnicity, 128 (43.84 %) Muslims and 292 (99.66 %)
married. Slightly less than half percent, 135(46.23%) have attended primary education while
31(10.26%) have attended high level education and the remaining 121 (41.44%) have attained a
secondary level of education (Table 1)
5.2 ANC practice of study participants
Out of the total study participants most majority of them 283(96.92%) have previous ANC
follow up. Out of those who utilized ANC services, 168(57.53%) of them made their first visit in
their second trimester of pregnancy and 109(37.33 %) had four or more visits during their last
pregnancy. Two hundred twenty (75.34%), received antenatal care from the Health center, while
30(10.27%) and 25(8.56%) from private clinic and district Hospital, respectively. In majority of
them193 (66.10%) ANC service was provided by midwifes (Table 2).
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Table 1. Socio-demographic characteristics of study participants, Shashemene town, Oromia, 2008 (n=292).
Variables

Frequency

Percent

15-19

26

8.90

20-24

107

36.64

25-35

126

43.15

>35

33

11.30

Married

291

99.66

Single

0.34

Other specify

No schooling

1.71

Primary school(1-5 grade)

135

46.23

Secondary school(6-12 grade)

121

41.44

High level

31

10.26

Age of the mother in years

Marital status

Educational status

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Ethnicity
Oromo

173

59.25

Amhara

48

16.44

Tigre

2.74

Wolita

57

19.52

Others specify

2.05

Orthodox

84

28.77

Protestant

66

22.60

Catholic

11

3.77

Muslim

128

43.84

Others

1.03

Religion

Table 2. ANC practice of study participants in Shashemene town, Oromia, 2008 (n=292).
Variable

Frequency

Percent

Yes

283

96.92

No

3.08

<4

183

62.67

109

37.33

1st trimester

124

42.47

2nd trimester

168

57.53

Provincial Hospital

17

5.82

District Hospital

25

8.56

Health center

220

75.34

Previous ANC visit

Number of visit

Time of ANC visit

ANC visit sites

19

Private clinics

30

10.27

Doctors

37

12.70

Health officers

35

11.99

Midwifery

193

66.10

Nurses

17

5.82

Others specify

2.39

ANC service providers

5.3 Knowledge and attitude of ANC of study participants

All of the study participant 292(100%) women know the provision of ANC service. Of the total
studied women, 208(71.23%) reported that ANC check-up is essential to detects complication during
pregnancy and the same number of them knows as ANC service reduces maternal mortality and morbidity (Table 3).
Table 3. Knowledge and attitude of ANC of study participants in Shashemene town, Oromia, 2008 (n=292).
Variable

Frequency

Percent

Yes

292

100

No

Yes

208

71.23

No

84

28.77

Knowledge on service provision

ANC detects complication during pregnancy

ANC helps to reduce maternal mortality and morbidity

20

Yes

208

71.23

No

84

28.77

5.4 Accessibility to ANC service and social support of study participants

Two hundred eighty six (48.8 %) women reported that their sources of information about ANC
service was health institutions and 126 (21.5%) said TBA. Din majority of them1989 (67.81%)
distance from health facility was near less than 4 km. Two hundred fifty five (87.33%) of the
study subjects were reported as the road status is inconvenient. Majority 204(69.86%) of them
reported as the coast of the service was not expensive. The response of slightly more than half
percent of the study subjects 164(56.16%) shows as they get the service in less than 30 minutes
after arriving the facility. In most of the study participants 123(42.12%) information about the
service was obtained from mass media (Table 4).
Table 4. Accessibility to ANC service and social support of study participants in Shashemene town, Oromia,
2008 (n=292).
Variable

Frequency

Percent

Near <4km

198

67.81

Far 5-10km

84

28.77

Very far more than 10km

10

3.42

In convinant

255

87.33

Convinant

37

12.67

Some times

247

84.59

Every day

45

15.41

Exccpencive

88

30.14

Not expensive

204

69.86

Distance of the facility

Status of roads

Transportation to service area

Cost of service

Waiting time

21

>30min

128

43.84

<30min

164

56.16

TBAs

1.03

Health professional

54

18.49

Friends

67

22.95

Mass media

123

42.12

Family

29

9.93

Others specify

16

5.48

Source of information

5.5 Factors associated with ANC service utilization

Logistic regression model was used to identify factors that influence the utilization of ANC
services. In the binary logistic regression analyses educational status, Distance travelled, waiting
time, Status of roads and age of mother, were some of the predisposing factors that showed a
statistically significant association with antenatal care utilization.
Table 3. Selected determinants of antenatal care utilization, Shashemene town, 2008 (n=292)
ANC service utilization
Variables

Frequency

Percent

Crude OR

Adjusted OR

<4km

198

67.81

4km

94

32.19

35 years

259

88.69

2.38(1.52,3.71)

4.14(2.18,7.85)
*

>35 years

33

11.30

1.71

6.81(3.76,12.32

3.90(1.66,5.20)

Distance travelled in km
7.32(4.69,
11.42)

8.01(4.57,14.0
6) *

Age of mother

Educational Status of women

No schooling

22

Primary school(1-5 grade)

135

46.23

3.9 (2.64,5.78)

2.11(1.01,4.44)

Secondary school(6-12 grade)

121

41.44

3.02(1.87,4.88)

4.82(2.74,8.45)
*

High level

31

10.26

<30min

164

56.16

2.27(1.52,3.39)

1.34(0.78,2.31)

>30min

128

43.84

In convenient

255

87.33

2.14(1.40,3.28)

2.94(1.66,5.20)
*

Convenient

37

12.67

Waiting time

Status of roads

* Statistically significant at p<0.05

DISCUSSION
Improving maternal health care, particularly providing antenatal and delivery care, are important
mechanisms identified to reduce maternal mortality and hence attain MDG goals on maternal
health (18, 19). Antenatal care allows for the management of pregnancy, detection and treatment
of complications, and promotion of good health. However, women rarely perceive childbearing
as problematic and therefore do not seek care. In this study ANC service coverage was very high
96.92% when compared with EDHS 2005 which showed that women who received assisted
antenatal care were only 28 % (23). In this study majority of the study subjects 62.67% received
ANC service only less than four times contrary to the WHO recommends, that a woman without
complications have at least four focused visits to provide sufficient care (7,8).
This study has identified various factors that influence antenatal care utilization among the study
population. Among the predisposing factors educational status, residence and age at first
pregnancy were found to be independent determinants of antenatal care utilization. This study
revealed that women with education level of secondary were more than four times more likely to
use antenatal care than those less than this grade ( Adjusted OR: 4.82, 95% CI; 2.74,8.45).
23

Likewise, the 2005 EDHS reported that the use of antenatal care services was strongly related to
mothers education (9,25) .
Age of the mother was also an independent predictor of antenatal care utilization Where women
whose age less than or equal to thirty five years were nearly three times more likely to use
antenatal care services than whose age greater than thirty five years

(AOR=4.14, 95%CI;

2.18,7.85). The possible explanation might be young women are more careful about their
pregnancy and therefore require seeking institutional care than multigravida women, or older
women, tend to trust traditional birth attendants due to previous experiences they had. Young
women may also be likely to be educated than older women Similar finding was seen in study
conducted in Yem special woreda (13)
Distance was found to be independent predictors of antenatal care service utilization where
women who live within <4km walking distance from the health facility were about eight times
more likely to visit prenatal care than above this distance (AOR=8.01, 95%CI; 4.54, 14.06).
Similar finding was seen in the research conducted in SNNPR (25).

6. STRENGTH OF THE STUDY

The study was community based approach and it may represent the level of problem in
the study population.
Logistic regression was used in the statistical analysis, so the interaction was analyzed
and confounding factors were controlled, and also the most important risk factors were
identified.

7. LIMITATION OF THE STUDY

This study is based on the reported answers there might be recall bias. All factors are not
exhaustively addressed.
8. CONCLUSION
In conclusion, the study demonstrated that the overall and effective utilization of antenatal care
was in Shashemene town. The study also showed that there is a large difference in the utilization
of ANC services with educational status, distance from health facility, and womens age
24

9. RECOMMENDATION
Since better educational status has shown good contribution in effective utilization of
antenatal care in Shashemene town the concerned body should encourage women
education

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29

Annexes
Annex 1: consent form and questionnaire English version
Consent form: Paradize vallyey University College
Verbal and/or written consent form prepared to assess Factors Affecting Antenatal care
Service Utilization
Hello, we are working as a data collector for the study being conducted by Paradize vallyey
University College on Factors Affecting Antenatal care Service Utilization in Shashamene Town,
West Arsi Zone, Oromia. We would like to interview you a number of questions about the subject
matter being studied. The information that you provided will help the concerned body to improve
Antenatal care Service Utilization in the country. To attain this purpose, your honest and genuine
participation by responding to these questions is very important and highly appreciable. We
expect the interview may take about 20-30 minutes. Your name will not be written in this form
and all information that you will give kept strictly confidential. Your participation in this study is
voluntary and you are not obliged to answer any question that you do not wish to answer. If you
are not still comfortable with the interview, please feel free to drop individual or entire questions/
interview completely any time you want. However, we hope that you will participate in this
study and provide correct information to all questions.
At this time, do you want to ask any thing about the purpose or content of this interview?
Do we have your permission to continue? Respondent agrees to be interviewed ____________
1. If yes, continue to the next page. 2. if no, skip to the next participant.
Signature of the respondent____________________
May we begin the interview now?
Name of data collector _________________________ Signature__________________
Date of interview__________________________

30

Questionnaires

I. Socio economic and demographic characteristics of respondents.

S.no Variables
1
Age

Marital status:

Ethnic groups:

Religion

Occupation:

Average monthly income (in ETB)

Educational level

Parity (children)

Category
<15 years
15-19 years
20-24 years
25-35 years
>35 years.
Never married
Married
Other (specify)
Oromo
Amhara
Tigre
Wolyta
Others specify
Orthodox
Protestant
Catholic
Muslim
Others
House wife
Farmer
Merchant
Government worker
Others (specify)
<1000
1000
No schooling
Primary school (1-5 grade)
Secondary school (6-12 grade)
High level
Primipara
Bipara
Multipara
31

Number Percent

S.no Variables
1
ANC visit for previous pregnancy
2

Reason for no ANC

Number of visits

Time of visits

ANC visit sites

ANC service providers

Category
No
Yes
Too busy
Healthy, not necessary
Feel embarrassed
Live far away from ANC services
Pregnancy is ordinary issue
Poor
Others (specify)
<4
4
1st trimester
2ndtrimester
3rdtrimester
Provincial hospital
District hospital
Health centers
Private clinics
Others (specify)
Doctor
Medical assistant
Mid wife
Nurses
Others

Number Percent

II.ANC Practice

II.

Knowledge and attitude of respondents

S/No Variables
Category
Do you know the services rendered at Yes
1
antenatal clinic?

2
3

No
ANC helps detect complications during Yes
pregnancy
No
ANC helps to reduce maternal and neonatal Yes
morbidity and mortality.
32

Number Percent

No

III.

Accessibility to ANC services and social support

S/No
1

Variables
Category
How far the health facility from your Near 9with in 1km)
Far (5-10km)
residence?
Very far (more than 10km)
Status of roads to nearest ANC services
Inconvenient
Convenient
Public transportation to nearest ANC services Some times
Every day
Cost of service
Expensive
Not expensive
Waiting time for ANC service (minutes)
30
<30
Source of information
TBAs
Health professional
Friend
Community leader
Mass media
Family
Others (specify)

2
3
4
5
6

33

Number Percent