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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 25  |  Issue : 1  |  Page : 6-10

The profile and predictors of early prenatal booking among pregnant women in Enugu, Southeast Nigeria


1 Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Nsukka, Ituku/Ozalla campus/University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria
2 Department of Oral and Maxillofacial Surgery, College of Medicine, University of Nigeria Nsukka, Ituku/Ozalla campus/University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu, Nigeria

Date of Submission08-Oct-2019
Date of Decision22-Dec-2019
Date of Acceptance16-Jan-2020
Date of Web Publication03-Apr-2020

Correspondence Address:
Dr. Chidinma I Onwuka
Department of Obstetrics and Gynecology, College of Medicine, University of Nigeria Nsukka, Ituku/Ozalla Campus/University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu.
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmh.IJMH_31_19

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  Abstract 

Background: Early booking in the first trimester is recommended, and it is known to be of great benefit for the mother and the fetus. Aim: The aim of this study was to determine the profile and predictors of early prenatal booking among pregnant women in Enugu, Nigeria. Materials and Methods: A cross-sectional study was conducted on 200 consecutive pregnant women attending booking clinic at the University of Nigeria Teaching Hospital, Enugu, Nigeria. Statistical analysis was both descriptive and inferential at 95% confidence level, and carried out using the Statistical Package for the Social Sciences (SPSS) software, version 22.0, IBM SPSS, Chicago, Illinois. A P value of less than 0.05 was considered statistically significant. Results: The mean gestational age at booking was 18.6 ± 8.4 weeks. Although 37% (n = 74) of the women booked early in the first trimester; only 36% of the respondents (n = 72) were aware of the right time to book for prenatal care. More than half (56.8%, 42 of 74) of the women, who booked early for prenatal care, had problems in their last pregnancies, whereas 43.2% (n = 32 of 74) of them had problems in their index pregnancies. Parity, secondary level of education, and problems in the previous and index pregnancies were significantly associated with early booking after adjusting for other variables in the multiple logistic regression analysis (P < 0.05). Conclusion: Pregnant women in Enugu still book late for prenatal care. There is a need to create more awareness in this regard among women of reproductive age. Factors contributing to early booking in Enugu, include parity, secondary level of education as well as problems in the previous and index pregnancies.

Keywords: Early booking, gestational age, parity, pregnancy, prenatal care


How to cite this article:
Onwuka CI, Ugwu EO, Onwuka CI, Iloghalu EI, Menuba IE, Udealor PC. The profile and predictors of early prenatal booking among pregnant women in Enugu, Southeast Nigeria. Int J Med Health Dev 2020;25:6-10

How to cite this URL:
Onwuka CI, Ugwu EO, Onwuka CI, Iloghalu EI, Menuba IE, Udealor PC. The profile and predictors of early prenatal booking among pregnant women in Enugu, Southeast Nigeria. Int J Med Health Dev [serial online] 2020 [cited 2020 May 28];25:6-10. Available from: http://www.ijmhdev.com/text.asp?2020/25/1/6/281886




  Introduction Top


Prenatal care, which is one of the pillars of safe motherhood initiative, is a specialized care given to women while pregnant, leading to the birth of a healthy baby to a joyous and healthy mother.[1],[2] Prenatal care leads to improved pregnancy outcome, and it is associated with reduction of maternal and perinatal morbidity and mortality.[2],[3],[4]

A properly conducted prenatal care helps to reduce the risk of a woman dying as a result of complications during pregnancy. Regular prenatal care is important, and it is an important form of preventive medicine.[2]

Prenatal care starts with booking and subsequent follow-up. At booking, the pregnant woman is assessed by her doctor to determine her health status.[1],[2],[5] This ensures that medical conditions, which may have predated the pregnancy or may be worsened by the pregnancy, are detected early and appropriate management is instituted.[1] This first visit is therefore very expedient part of prenatal care because information obtained will be used to follow-up the woman throughout her pregnancy.[6] It is generally recommended that pregnant women should book early, before 14 weeks (usually after the second missed period) to achieve improved pregnancy outcome for the mother and her baby.[1],[2],[5],[7],[8]

Although there are great benefits in booking early, most pregnant women still book late in developing countries and Nigeria in particular. Previous studies from various parts of Nigeria showed that the mean gestational age at booking ranged from 19.1–26.1 weeks.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10] These women showed up late for booking due to various reasons, which included ignorance, poverty, mandatory blood transfusion, absence of sickness in the index pregnancy, and stress of registration among other things.[1],[8],[11] Pregnant women need to be counseled about the advantages of booking early for prenatal care.

A previous study in Enugu, Nigeria, showed that pregnant women booked as late as 26.1 weeks gestation.[5] With almost 10 years gone, it would be interesting to have an update to know whether pregnant women in Enugu now book early and also the factors that contribute to early prenatal booking. The aim of this study was to determine the profile and predictors of early booking among pregnant women in Enugu.


  Subjects and Methods Top


This was a cross-sectional study conducted at the booking clinic of the University of Nigeria Teaching Hospital (UNTH), Ituku/Ozalla, Enugu, Nigeria, which is a tertiary center that draws patients from neighboring states such as Ebonyi, Anambra, Abia, Imo, and Benue.

Two hundred consecutive pregnant women attending the first prenatal clinic (booking clinic) at the UNTH, between September 2014 and January 2015, were involved in the study. The respondents were told that their participation was entirely voluntary, and therefore they would not be penalized if they did not want to participate in the study. Written consent was then obtained from the participants. Approval was also obtained from relevant authorities.

Information was obtained using semi-structured interviewer-administered questionnaires. Information obtained included sociodemographic data, the gestational age at booking, their knowledge about the right time to book for prenatal care, any problem in the last and index pregnancy, and who took the decision to book at the time they did.

The gestational age was estimated using the last menstrual period (LMP) for those who were sure of their LMP. However, those who were not sure of their LMP but had first trimester ultrasound scan were included in the study. Those who were unsure of their LMP and did not have early ultrasound scan (first trimester) were excluded from the study. Early prenatal booking was defined as those who booked within the first trimester (<14 weeks),[1],[2],[5],[7],[8] whereas booking was defined as those who booked at 14 weeks and above.

Social class was as defined in previous study,[12] using the educational status of the woman and the occupation of her husband.

Data were entered into the Statistical Package for the Social Sciences (SPSS) software, version 22.0, IBM SPSS, Chicago, Illinois. Analysis was both descriptive and inferential. Logistic regression was used to analyze discreet variables. Value of P less than 0.05 was considered statistically significant at 95% confidence interval (CI).


  Results Top


A total of 200 pregnant women were interviewed, 40% (n = 80) of them were aged 26–30 years. The mean age of the respondents was 30.7 ± 4.2 (range = 21–41) years. They were mostly married (99%), had tertiary level of education (76%), of the tribe Igbo (97%), multiparous (79%), and all Christians (100%). Other details of the sociodemographic data are as presented in [Table 1].
Table 1: The sociodemographic characteristics of the respondents

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The mean gestational age at booking was 18.6 ± 8.4 weeks. More than half (63%, n = 126) of the respondents booked late for prenatal care, whereas 37% (n = 74) booked early. Of all the respondents, only 36% (n = 72) were aware of the right time to book for prenatal care, whereas 64% (n = 128) were not aware.

One hundred and twenty four of the respondents took the decision by themselves to book for prenatal care [Table 2].
Table 2: Decision to book for prenatal care

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More than half (56.8%, 42 of 74) of the women, who booked early for prenatal care, had problems in their last pregnancies, whereas 43.2% (n = 32 of 74) of them had problems in their index pregnancies.

[Table 3] presents analysis of the determinants of early booking. Secondary level of education was significantly associated with early booking (P = 0.045, odds ratio [OR] = 2.000, 95% CI for OR = 1.015–3.941). Parity had significant influence on early booking. Multiparous women were seven times more likely to book early (P < 0.001, OR = 7.557, 95% CI for OR = 2.574–22.186). Having medical problems in the last pregnancy was significantly associated with early prenatal booking (P = 0.022, OR = 2.242, 95% CI for OR = 1.124–4.473). The presence of problem in the index pregnancy was significantly associated with early prenatal care booking (P = 0.029, OR = 2.222, 95% CI for OR = 1.086–4.546). However, no significant differences were observed in the age (P = 0.058), marital status (P = 0.717), family setting (monogamy and polygamy) (P = 0.999), being aware of the right time to book (P = 0.678), and social class (P = 0.903) of the respondents who booked early compared to those who booked late.
Table 3: Analysis of the determinants of early booking

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Reasons given for late booking by the respondents included having booked elsewhere (3.2%, n = 4), incessant strike action (7.9%, n = 10), recent relocation (1.6%, n = 2), financial constraints (1.6%, n = 2), preference (1.6%, n = 2), and ignorance and others (84.1%, n = 106).


  Discussion Top


It is well known that early prenatal booking is essential in improving maternal and fetal outcome.[1] In this study, we found the mean gestational age at booking to be 18.6 ± 8.4 weeks. This is lower than 26.1 weeks recorded from the same study centre in 2008. A high percentage (63%) of the women in this study booked late for prenatal care. This seems to be the trend in developing countries, especially in Nigeria, where majority of the pregnant women book late.[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[13],[14] This is in contrast with a study from Saudi Arabia where the reported gestational age at booking was 13 weeks.[15]

In this study, only 37% of the women booked in the first trimester. This was higher than 16.9% in Abakaliki,[2] 27% and 6% in Lagos,[4],[8] 14.1% in Ibadan,[7] and 18.8% in Shagamu.[14]

Only 36% of the respondents were aware of the right time to book for prenatal care. This could have contributed to the low rate of early booking in this study. Ignorance of the ideal time to book for prenatal care has also been reported to contribute to late booking in previous studies.[8],[11]

Further analysis showed that parity had significant effects on early prenatal booking. This was similar to a previous study conducted in Enugu,[5] but at variance with a previous study from north-central part of Nigeria.[1] Problems in the previous and index pregnancies had significant association with early booking. Such problems make the women to seek medical attention, thus booking early. This finding was similar to that from north-central part of Nigeria.[1] Early prenatal booking was also significantly related to secondary level of education. This was unlike a previous study, where tertiary level of education was found to be more associated with early booking.[1]

Knowing the ideal time for booking did not have significant effect on early booking. This is similar to a study from Abakiliki, Nigeria where although, a high percentage (81.7%) of women were aware of the ideal time to book for prenatal care; 83.1% of them still booked late for prenatal care.[2]


  Conclusion Top


Pregnant women in Enugu, Nigeria are still booking late for prenatal care although earlier than a decade ago. There is a need to create more awareness among women of reproductive age. Factors contributing to early booking in Enugu include parity, secondary level of education as well as problems in the previous and index pregnancies.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ifenne DI, Utoo BT. Gestational age at booking for antenatal care in a tertiary health facility in north-central, Nigeria. Niger Med J 2012;53:236-9.  Back to cited text no. 1
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2.
Onoh RC, Umeora OUJ, Agwu UM, Ezegwui HU, Ezeonu PO, Onyebuchi AK. Pattern and determinants of antenatal booking at Abakaliki southeast Nigeria. Ann Med Health Sci Res 2012;2:169-75.  Back to cited text no. 2
[PUBMED]  [Full text]  
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Oladokun A, Oladokun RE, Morhason-Bello I, Bello AF, Adedokun B. Proximate predictors of early antenatal registration among Nigerian pregnant women. Ann Afr Med 2010;9:222-5.  Back to cited text no. 3
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Okunlola MA, Ayinde OA, Owonikoko KM, Omigbodun AO. Factors influencing gestational age at booking at the University College Hospital, Ibadan, Nigeria. J Obstet Gynecol 2006;26:195-7.  Back to cited text no. 7
    
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Adewunmi A, Rabiu K, Tayo A. Gestational age at antenatal booking in Lagos, south-west Nigeria. Internet J Gynecol Obstet 2009;12:8.  Back to cited text no. 8
    
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Ebeigbe PN, Igberase GO. Antenatal care: A comparison of demographic and obstetric characteristics of early and late attenders in the Niger delta, Nigeria. Med Sci Monit 2005;11:CR529-32.  Back to cited text no. 9
    
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Ekele BA, Audu LR. Gestation age at antenatal clinic booking in Sokoto, northern Nigeria. Afr J Med Med Sci 1998;27:161-3.  Back to cited text no. 10
    
11.
Ebeigbe PN, Igberase GO. Reasons given by pregnant women for late initiation of antenatal care in the Niger delta, Nigeria. Ghana Med J 2010;44:47-51.  Back to cited text no. 11
    
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Olusanya O, Okpere E, Ezimokhai M. The importance of social class in voluntary fertility control in developing country. West Afr J Med 1985;4:205-7.  Back to cited text no. 12
    
13.
Umoh AV, Umoiyoho AJ, Abasiattai AM, Bassey EA, James SR. Gestational age at first antenatal visit in Uyo, Nigeria. Ibom Med J 2006;1:13-17.  Back to cited text no. 13
    
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Lamina MA. Gestational age at first antenatal attendance in Sagamu, western Nigeria. Niger J Clin Pract 2004;7:1-3.  Back to cited text no. 14
    
15.
al-Shammari SA, Khoja T, Jarallah JS. The pattern of antenatal visits with emphasis on gestational age at booking in Riyadh health centres. J R Soc Health 1994;114: 62-6.  Back to cited text no. 15
    



 
 
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  [Table 1], [Table 2], [Table 3]



 

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