Community Based Intervention on Adherence to Antenatal Care Follow-Up Contacts among Expectant Women in Nyamira County, Kenya

Abstract

Antenatal care (ANC) follow-up contacts are a critical link in the continuum of care of expectant women. Many women in Africa under-utilize ANC services making fewer than recommended number of ANC visits. ANC links the expectant woman and her family to the formal health care system and increases the chances to utilize a skilled birth attendant during delivery. The specific objectives of the study included; determining level of adherence, factors associated to ANC uptake, developing a community-based strategy and determining its effectiveness in enhancing adherence to ANC follow-up contacts. Mixed-method approach (explanatory sequential study design and quasi experimental) was used. Purposive sampling was utilized for key informants and cross-sectional study design utilizing census to select expectant women. Key informant interviews were conducted from eighteen (18) Nurse in charges working in the MCH. Quantitative data were collected from 327 expectant women through researcher-administered structured questionnaires. The main outcome measures of this study were the number of women making four or more antenatal care contacts. Chi-square test for independence, ANOVA test, Odds ratios and Independent t-test were used. Statistical significance was determined by 95% Confidence Intervals and p-value of ≤ 0.05. Qualitative data were entered into the N-vivo version 12 software and analyzed thematically. The study found less uptake of the 2nd to the 4th ANC visits. The level of adherence was 47.4% (CI: 37.6 to 57.95). Those in formal employment were 29 times more likely to complete the ANC contacts (AOR: 29.212; 95%CI: 1.535 to 555.9; p-value 0.025). Formal employment, ignorance, parity and accessibility were found to be statistically significant. At baseline there was no significant difference between Masaba North and Nyamira North subcounties study sites (p-value 0.065; OR 1.72, 95% CI: 0.963 to 3.076). After the intervention to expectant women with packaged health messages, a substantial difference emerged (P-value <0.001). The intervention group was 4.2 times more likely to complete recommended ANC contacts than the control group (OR: 4.1881; 95% CI: 2.274 to 7.69). The study concluded that formal employment, increase in the number of children, accessibility, convenient opening hours and packaged health message increased the odds of completing the ANC contacts. The study recommends that the county government of Nyamira adopts a packaged health messages tool and improve accessibility. This will ensure adherence to recommended ANC contacts uptake.