Identifying contributory factors to adolescents’ late utilisation of antenatal care at primary healthcare clinics in a sub district north of eThekwini District, South Africa.

Abstract

Background The late utilisation amongst adolescents of Antenatal Care (ANC) has shown to be detrimental to the pregnancy and the mother as inappropriate screening, testing and management is done due to delayed initiation. This is especially so, in the vulnerable population of adolescents where they are more susceptible which can contribute to maternal and child mortality. The adolescent is exposed to many challenges during pregnancy that can affect their utilisation of ANC, resulting in late booking. Aim The aim of the study was to identify the contributing factors to the adolescent’s (15-19 years) late entry to ANC at the select Primary Health care clinics. Methodology A quantitative study was conducted with self-administered questionnaires to adolescents who had booked late (>20 weeks) for ANC. The questionnaire was adapted to identify the contributory factors to the late utilisation of ANC with adolescents in which the variables socio-economic factors, knowledge of ANC, experiences of ANC services and obstetrical history were examined. The questionnaire was structured to maintain anonymity and had asked short ended questions and has Likert scales. Content and face validity was used to verify the questionnaire and show evidence that the tool is measuring the target construct. Face validity was obtained with the help of three health care experts (Medical officer, Nursing service manager and Midwife). Data analysis was performed using IBM Statistical Package for the Social Sciences (SPSS) version 26. Descriptive statistics such as frequencies and percentages were used to summarise categorical variables. Central tendency and dispersion of data were measured using means and standard deviations for normally distributed variables and medians and interquartile ranges for skewed variables. The Anderson and Newman`s Health Utilisation model guided the study. Results The response rate was 88%, with 96 respondents completing the questionnaire (anticipated sample size of 109). The data was collected from participants (15-19 years) in 13 clinics (eight Primary Health Care Clinics and five Community Health Care Clinics). The demographics showed majority age group of 18 years (n= 27, 28.1%), 95.8% (n= 92), of participants were single and 85.45% (n= 82) unemployed. The obstetrical and current history results showed the majority of participants had not used any contraception method (n= 68, 70.8%), 88.5% (n= 85) had not planned their pregnancy and 77.1% (n= 74) had no health problems. The majority of participants reported that they were satisfied with the experiences at the clinics, with 78.1% (n= 75) and 65.6 % (n= 63) were satisfied with the privacy and the staff respectively. A quarter (n =24, 25%) of the participants did not know the importance of ANC for pregnancy, while a lesser number (n=18, 18.8%) were unaware of the significance of ANC for their unborn baby. Conclusion Study findings highlighted the contributory factors to adolescents’ late utilisation of Antenatal Care. Basic Antenatal Care Plus Programme (BANC PLUS) has been shown to be beneficial to the adolescent as early utilisation of ANC can reduce maternal mortality. However, based on the Anderson and Newman Health Utilisation framework contributory factors, specific to the select geographical area were identified for late ANC utilisation. The targeting of the contributory factors through the recommendations can add value to the maternal health of the adolescent and in so doing recognise the global goal of universal health coverage and achieving Sustainable Development Goal 3.1. Recommendations Recommendations included Antenatal learning and supports, strengthening of health care systems and promotion and recognition of staff. Limitations Only selecting one district from eThekwini and only including the Department of Health clinics.