Institutional based cross-sectional study was conducted among pregnant women who attended ANC at Nekemte Referral Hospital.
Source of population
The source population was all pregnant women in the catchment area.
The study population was all pregnant women who were attending ANC.in Nekemte referral hospital.
Pregnant mothers who were attending an ANC visit who was mentally and physically capable of being interviewed.
Pregnant women who were seriously sick and unable to respond
Sample size determination
The sample size was estimated using sample size determination formula for a single population proportion formula for which point of estimation was taken from the study done in Gondar university referral hospital in which early imitation of ANC was 47.2% . Therefore, the total sample size was calculated with the marginal error of 0.05, with a 95% confidence interval. Ten percent of the total sample size was considered for non-respondents. Accordingly, a total of 376 pregnant women who attended ANC follow up at Nekemte Referral Hospital during the study period participated as study units.
The average monthly client load from the daily average ANC clients flow of the hospital and health center was taken from the registry book. It was 650 and 160 per month in the hospital and the health center respectively which was added up to 810. This ranges from 25–30 clients per day. Systematic random sampling with 810/376 = 2 was used to select women who participated in the study. Thus, every other pregnant woman entering ANC service were selected for the study in both hospital and health center.
The sample size was allocated proportionally to the client flow of the respective facilities. The first women arrived at the waiting area for ANC clinic on the first day of data collection and met the eligibility criteria was taken as the first candidate for the study. This process continued until the desired sample was attained.
Data collection instrument
The structured questionnaire adapted from other literatures of similar studies was developed in English, translated into Afan Oromo (the official and local language) by language experts. Retranslation from Afan Oromo to English was also made by another expert to ensure consistency.
The pretest was conducted among pregnant women who were attending ANC in Gute health center which is located in another district than the study area. After conducting the pretest, the consistency of the question was checked and the necessary corrections were made.
Data collection procedures
The data was collected by interviewing pregnant women after getting informed consent. Four B.Sc. degree midwives who were not working at the study facilities participated as data collectors after given two days training on the data collection tools and collection procedures by the principal investigator. Finally, ANC attendants were interviewed based on the preset sampling techniques of the study. The collected data was carefully checked for completeness as well as consistency by the supervisor and any confusion during data collection was handled timely.
Data processing & analysis
After the data collection, data were checked manually for its completeness and consistency. It was entered into Epi-info 7.2 version, cleaned and rechecked for its completeness. The cleaned data was exported to SPSS window versions 20.0 for further analysis.
Logistic regression was used to identify the association between independent and dependent variables. Thus, the independent variables with p<0.25 in the binary logistic regression was transferred to multiple logistic regression model to control for cofounders and the independent variables with p<0.05 were considered as having statistically significant associations with the dependent variable. Finally, frequency, percentage and mean values were computed; presented using tables, graphs, cross tabs and describing words.
Data quality management
Data quality was ensured during instrument development, collection, coding, entry, and analysis. The questionnaire first translated to Afan Oromo language and retranslated to English before data collection and different translator was used to keeping the consistency of the questionnaire and necessary corrections were made. The data collectors were trained about the purpose of the study and how to administer the questionnaire, training incorporating role play was undertaken on how to approach with participants in the field and interview techniques. The Instrument was tested on 5% of the respondents and correction was taken accordingly. During data collection, the questionnaire was checked for its completeness on a daily basis by supervisors. The data used for pretest was not included in the main study.
Timing of first ANC booking
Socio-demographic factors (Maternal age, Educational status, occupation, marital status, income, and residence), parity, past experience of ANC utilization, knowledge and awareness on the importance of timing of first ANC, attitude towards ANC service and husband involvement.
Early ANC booking: refers to initiating of ANC before and at the 12th week of gestation.
Late ANC booking: refers to initiating ANC after 12th weeks of gestation.
Predisposing Factors: The socio-cultural characteristics of individuals that exist prior to their service utilization (Maternal Age, Educational Status, Occupation, Marital Status, Ethnicity, Religion, Parity, Attitude towards the care, how the woman valued the care, and knowledge concerning the service).
Enabling Factors: The logistical aspects of obtaining care (distance from health institution, means, and cost of transportation, financial source for care and other expenses, availability of health personnel and facilities, waiting for time, acceptability and approval of pregnancy by women and significant others)
The researchers secured ethical clearance and got approval from the Ethical Review Board of Wollega University and support letter was written to the study facilities ahead of the study period. The purpose of the study was shared with the facility heads, service unit team leaders and study participants. Written consent was obtained from the participants before the interview was commenced.