Factors associated with late antenatal care attendance in selected rural and urban communities of the copperbelt province,Zambia

Background: Despite antenatal care services being provided free of charge or sometimes at a minimal cost in Zambia, only 19% of women attend antenatal care by their fourth month of pregnancy, as recommended by World Health Organization (WHO). An estimated 21% of pregnant women in urban and 18% in rural districts make their first ANC visit by 4th months of pregnancy. A number of factors have been found to contribute to late initiation of Antenatal care among pregnant women and these may vary between rural and urban areas. Therefore, a study aimed at examining factors associated with late ANC attendance amongst pregnant women in selected communities of the Copperbelt Province was conducted.
Methodology: A cross- sectional study using a semi-structured questionnaire was conducted in selected health facilities of Mpongwe and Ndola districts. A total number of 613 women attending antenatal clinic, distributed evenly between Mpongwe rural district (51% (307/613) and Ndola urban district (49% (306/613) were included in the study. Data from the completed questionnaires was entered using Epi InfoTM 3.5.1 and finally analyzed with SPSS version 16.0.
Results: The prevalence of late ANC attendance was 72.0 % (n=221) and 68.6% (n=210) in rural and urban districts respectively. However, the difference between two districts was not statistically significant [OR 0.851 (95% CI=0.6, 1.2), p=0.363]. In the rural district, nulliparous women were 59% (AOR 0.411, 95% CI 0.238, 0.758) less likely to initiate ANC late compared to multiparous women, while the proportion the urban was 48% (AOR 0.518, 95% CI 0.316, 0.848). Inadequate knowledge about ANC resulted into 2.2 times high odds for late ANC attendance (AOR 2.205, 95% CI 1.021, and 4.759) than women who had adequate knowledge in urban district. Women who fell pregnant unintentionally had a higher odds of starting ANC late in both rural [4.2 times (AOR 4.258, 95% CI 1.631, 11.119)] and urban [3.1 times (AOR 3.103, 95% CI 1.261, 7.641)] respectively. The perception of no benefits derived from commencement of ANC early was associated with 4 times (AOR 3.983, 95% CI 1.365, 11.627) likelihood of late attendance in the urban district. Compared to lack of privacy at health institutions,pregnant women in rural were 3.4 times (AOR 3.377, 95% CI 1.180, and 9.660) more likely to initiate ANC late because of long distance to health facilities. Compared to misconceptions on ANC, pregnant women in rural areas were 2.2 times (AOR 2.211 95% CI 1.049, 4.660) more likely to start ANC late because of community norm(less value attached to ANC); while in urban late ANC attendance was 2.9 times (AOR 2.899, 95% CI 1.372, 6.083) higher due to cultural beliefs than misconceptions.
Conclusion: Late antenatal care attendance remains high in both rural and urban districts indicating the need for intensified and more focused utilization of resources aimed at increasing sensitization of the importance of early attendance for high risk groups, such as women with unplanned pregnancies, inadequate knowledge about ANC cultural beliefs and multiporous