JIGJIGA HEALTH COLLEGE

DEPARTMENT OF PUBLIC
HEALTH

ASSESSMENT OF KNOWLEDGE ATTITUDE PRACTISE UTTILIZATION OF

ANTENATAL CARE AMONG PREGNANT WOMEN IN JIGJIA TOWN,SOMALI
REGIONAL STATE, EASTERN ETHIOPIA

RESEARCH PROPOSAL TO BE SUBMITED JIGJIGA HEALTH SCEINCE COLLEGE

DEPARTMENT OF PUPLIC HEALTH PARTIAL FULFILMENT OF REQUIRMENT
BACHELOR DEGREE SCIENCE OF DEPARTMENT OF PUBLIC HEALTH

June ,2022.GC JIGJIGA, ETHIOPIA

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ASSESSMENT KNOWLEDGE ATTITUDE PRACTISE OF UTTILIZATION
ANTENATAL CARE AMONG PREGNANT WOMEN IN JIGJIGA TOWN SOMALI
REGIONAL STATE, EASTERN ETHIOPIA

S/no Name of student ID NO Group numbers

A/Kadir Mohamed Omar 08/11 Group One

Dhuh Abdullahi Mohamud 20/11 Group One

Bashir Tahir Moalin 19/11 Group One

Abdulrahman Amin Abdi 09/11 Group One

Fatha Abdulahi Mohumed 21/11 Group One

Said Nur Hassan 40/11 Group One

Mustafa Mahad Dhinbil 34/11 Group One

Advisor :- Hamse Mowlid (Bsc, mph, epidemiology)

MAY 2022 JIGJIGA ETHIOPIA

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i
 ACKNOWLEDGEMENT
Above all, we would like to express our gratitude to our creator Allah who gives us this chance to
prepare this research thesis. We would like to acknowledge and appreciate jigjig a health science
College and department of public healthy for all its inputs and facilitations, it would grant to us
during the preparations up to the final session of this thesis they provide us.
We would like to extend our heartfelt gratitude to our major advisor, MR. hamse mowlid (BSc,
mph, epidemiology), who set-aside encouraging us to indefinite support and our grate full thanks
also tour family and colleague of jigjig a healthy science collage.

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 ABSTRACT
Background: Antenatal care is a care routinely provided for all pregnant women at primary care
level, or every aspect of care from screening to intensive life support provided to any women
while pregnant and up to delivery. Antenatal care provides an opportunity to inform and educate
pregnant women on a variety of issues related to pregnancy, birth and parenthood. Besides the
benefits of identifying high-risk pregnancies and providing timely assessment and treatment, one
of the expected utilities of antenatal care is the utilization of antenatal care services for gaining
health knowledge and accessing other health services.

Objective: the aim of this study is to assess knowledge and attitude practice of utilization
antenatal care among pregnant women in jigjig a town, Somali regional state, Eastern Ethiopia.

Methods and materials: communitys based cross sectional study design was conducted June to
july 2022GC.

Result: Concerning socio-demographic characteristics, a total of 384 women of reproductive age

were interviewed and the response rate of 100% included in the study, majority 304 (79%) of them
were ranged in the age between 21 and 34, 47 (12%) of them were ranged in the age between 15
and 20 and 33(9%) of them were ranged in the between 35 and above are pregnancy women.
110(29%) of them were ranged in the less than 18and 274(71%) of them were ranged in the 18
and above are at age Majority of the women 384(100%) were married of marriage. The religion
distribution of the respondents show that the largest proportion of them 279 (73%) were Muslim,
105(27%) orthodox. The of them were Somali 254 (66%), 72(19%) of them were Ahamar and
58(15%) of them were Gurage . majority 141(37%) Most of the respondents were no formal but
can read and write, 98 (26%)) some unable to read and write, 57(15%) of them were primary,
35(9%) of them were secondary,41(11%) of them were college and above,12(3%) of them were
other, 55(14%) of them were employed ,Most of the women’s are 236(61%) house wife,47(12%)
of them were merchant, 25(7) of them were student 20(5.31%) other and Most women’s income
between 3000-5000 birr

Discussion: The age distribution of last pregnancy mostly show that it was 21-34 (79%) majority
304 (79%) of them were ranged in the age between 21 and 34, 47 (12%) of them were ranged in
the age between 15 and 20 and 33(9%) of them were ranged in the between 35 and above are

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pregnancy women. age at merrige 110(29%) of them were ranged in the less than 18and 274
(71%) of them were ranged in the 18 and above are at age Majority of the women 384(100%) were
married of marriage.
.Most of the pregnant women have No formal education but they can read and write only {37%}
and are house wife in their Occupational status (61%).
The other study conducted in Ethiopia, Addis Ababa, and Gulele district shows that the majority
of the respondent age group 25-34yrs (78.72%). Most of the pregnant women were illiterate
(14.89%), the substantial majority of them married (100%) and the median income.
Conclusion: Majority of the pregnant women in this study has knowledge and Attitude toward
ANC Service. But Practice it is Low. And the major reason not to attend is lack of awareness.
Majority of the pregnant women starts ANC follow up at early gestational age such that at 1st
trimester and most of them has one visit. So it needs a great effort to increase this low ANC
coverage by informing the Society towards ANC Service, benefits of ANC Service utilization and
the Complication associated with pregnancy. Also one should work on the factors associated with
not to attend ANC.
This Study also shows that majority of the pregnant women prefer to deliver in home than health
institution and from those who prefer health institutional delivery most of them are educate.

Keywords: - Knowledge, Attitude, Practice, Antenatal Care, Utilization, Jigjiga town, Ethiopia

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Contents
ACKNOWLEDGEMENT..................................................................................................................i

ABSTRACT.......................................................................................................................................ii

Contents..............................................................................................................................................i

LIST OF TABLE...............................................................................................................................ii

LIST OF FIGURES...........................................................................................................................ii

ACRONYMS....................................................................................................................................iii

1.1Background................................................................................................................................1

1.2 Statement of the problem.....................................................................................................2

1.3 Significance of the study.....................................................................................................3

LITERATURE REVIEW...................................................................................................................4

2.1. Utilization of Antenatal Care...............................................................................................4

Conceptual Framework..................................................................................................................6

OBJECTIVES....................................................................................................................................7

1.1. General Objectives..............................................................................................................7

1.2. Specific Objectives..............................................................................................................7

METHODS AND MATERIALS.......................................................................................................8

4.1. Study area and period..........................................................................................................8

4.2. Study design........................................................................................................................8

4.3. Study Population.................................................................................................................8

4.4. Inclusion criteria and Exclusion criteria..............................................................................8

4.4.1. Inclusion Criteria..........................................................................................................8

4.4.2. Criteria Exclusion.........................................................................................................8

4.5. Sample size determination...................................................................................................9

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 4.7 Sampling technique..................................................................................................................9

4.8 Data collection procedure..................................................................................................10

4.8.1 Dependent variables.................................................................................................10

4.8.2 Independent variables:.....................................................................................................10

4.9 .Data quality management......................................................................................................11

4.9.1Operational definitions.........................................................................................................11

4.9.2 Data analysis....................................................................................................................12

RESULT...........................................................................................................................................13

5.1. Socio-demographic characteristics of the study participants................................................13

5.2. Obstetric History and knowledge about ANC.......................................................................15

5.3. Contents of ANC Interventions (BASIC...............................................................................17

5.4. Utilization of Antenatal Care among Pregnant Women...........................................................18

DISCUSSION..................................................................................................................................19

CONCLUSIONS& RECOMMENDATIONS.................................................................................19

7.1. Conclusions...........................................................................................................................19

6.2 Recommendation................................................................................................................20

7. REFERENCES.............................................................................................................................20

ANNEXES.......................................................................................................................................23

Annex-I. Consent Form............................................................................................................23

LIST OF TABLE
Table 1socio demographic characteristics of the respondents (n=384) in jigjiga town...................13

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Table 2 Obstetric history and knowledge on ANC..........................................................................15
Table 3 contents of intervention.......................................................................................................17
Table 4 utilization of Antenatal care pregnant women....................................................................18

LIST OF FIGURES
1.1. Conceptual Frame Work …………………………………………………14

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ACRONYMS
ANC Antenatal care

BCS Bachelor of Science

CHW Community Health Workers

CSA Central Statistical Agency

DHS Demographic Health Survey

EDHS Ethiopia Demographic Health Survey

EPHI Ethiopian Public Health Institute

FDRE Federal Democratic Republic of Ethiopia s

HSDP Health Sector Development Program

NTTBA None Trained Traditional Birth Attendant

TTBA Trained Traditional Birth Attendant

WHO World Health Organization

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1
1. INTRODUCTION

1.1Background
Antenatal care is a care routinely provided for all pregnant women at primary care level, or every
aspect of care from screening to intensive life support provided to any women while pregnant and
up to delivery(1). Antenatal care provides an opportunity to inform and educate pregnant women
on a variety of issues related to pregnancy, birth and parenthood (2). Besides the benefits of
identifying high-risk pregnancies and providing timely assessment and treatment, one of the
expected utilities of antenatal care is the utilization of antenatal care services for gaining health
knowledge and accessing other health services(3).

It is suggested on millennium developmental goals of Ethiopia that maternal mortality rate should
be decreased by two thirds in the years 1990-2015(19). And this can be achieved through antenatal
care provision to all pregnant women (4). The maternal mortality rate among women aged 15-49 is
1.14 maternal deaths per 1,000 woman-years of exposure in the 2017 EPHI(18). This rate is 15
percent lower than that reported in the 2005 EDHS and 32 percent lower than in the 2000 EDHS.
In the 2011 EDHS maternal deaths represent 30 percent of all deaths to women aged 15-49,
compared with 21 percent in the 2005 EDHS and 25 percent in the 2000 EDHS. Maternal
Mortality ratio shows 676 deaths per 100,000 live births (6.76 mothers die per each 1,000 of live
births), currently (5).

It is stated on the EDHS 2011 that there was a fall in the ANC coverage from the 2005 of 42% to
28% by 2011(5). Under normal circumstances, WHO recommends

That a woman without complications should have at least four antenatal care visits, the first of
which should take place during the first trimester (1). 19% of women with a live birth in the five
years before the survey made four or more ANC visits during the length of their pregnancy, a
marked improvement from 12 percent reported in the 2005 EDHS (5).

The regional health bureau based up on the national developed third health sector development
program (HSDP-III) with ultimate goal of improving the adequate and optimum quality of
promotion, preventive, basic curative and rehabilitative health services to all segments of the
population in the 2016 FDRE(19). On top of that the four pillars of WHO Safe Motherhood

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Initiative include provision of Antenatal care facilities, clean and safe delivery, family planning
and contraception and provision of emergency obstetric care in the 2016 FDRE (19).As one of the
health bureau’s major objectives is reducing the MMR from 600/100000 to 400/100000 live
births, it’s an obvious issue that this could be directly related to enhancement of the ANC services
utilization (6).

1.2 Statement of the problem

Despite the fact that most African cultures, and in fact the world in general, value children, only
few, including women themselves, understand the risks involved in child bearing. This is
accentuated in Africa, since the knowledge is lacking and so is the awareness, dragging the
practice of antenatal care along with it. This in effect was result in deaths of women in child
bearing age (15-49) through many complications of pregnancy and child birth, making it the most
common cause of death for this age group (15-49) (6).

The WHO has proclaimed that safe motherhood is attainable and does not require high-tech
investments and equipment and suggested mother-baby package to be used everywhere. This
package states that tetanus toxin injections and iron/folate supplements alone can actually aid
reduce the risk of maternal and neonatal mortality (7). Global advocacy groups also describe
maternal mortality as ‘avoidable’ and ‘preventable’. This is most likely because 70% of maternal
death occur due to the 5 major complications; hemorrhage, sepsis, unsafe abortion, eclampsia, and
obstructed labor; which could be avoided if the knowledge and awareness was created and
practiced and dealt with early if known on time(8).

The mother baby package is a simple practice and interventions which are indispensable
component of health care system. In brief, the minimum package of interventions includes:
antenatal care, clean and safe delivery, recognition to the mother and baby, early detection and
management of obstetric complications, post-partum care, family planning and sexually
transmitted infections diagnosis and treatment(9).According to the 2016 Ethiopian demographic
and health survey report; 62 percent of women who gave birth in the five years preceding the
survey received antenatal care from a skilled health care provider at least once for their last birth
and only 32 percent had four or more ANC visits for their most recent live birth. Many studies
indicate that most common reasons for low ANC service utilization could be; unawareness of the

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available services, unawareness of the importance of the service itself, lack of knowledge about
ANC service, time constraints (as women are more responsible for the family), and cultural and
ethnic barriers (beliefs , rumors…).Since prevention is better than intervention, it’s important to
concentrate on antenatal elements that are proved to be of benefit to the mother as well as the
newborn in reducing maternal and infant mortality. Complications related to pregnancy and
childbirth is one of the main causes of maternal deaths (20). ANC has demonstrated positive
impacts on the outcome of each pregnancy (19). ANC provides a valuable opportunity for
assessing the progress of the pregnancy, diagnosing and treating morbidities such as anemia,
hypertension, STI, for information and educational activities, and to make a contact with health
system in anticipation of any complications of pregnancy in 2016 FDRE(19). The EDHS 2011
shows that there’s 55.9% ANC coverage (4). And so this paper was attempt to assess the
utilization ANC of among pregnant women in Jigjiga town.

1.3 Significance of the study

Maternal and community behavior that affects utilization of ANC status of the women was
explored which could be possible to tackle the current problems. Based on the study findings and
the available knowledge, appropriate solution and information was suggested, also
recommendation regarding how to solve the current problem and if further studies seems to be
needed was suggested.

It’s important to measure the progress and impacts of the health interventions or programs to
determine the possible and appropriate service improvement measures. These should be a way to
identify the determinants behind the low service utilization/practice.

Therefore, this study might provide some important information as to why there is low ANC
coverage in women who resident of Jigjiga town and to assess the ANC services, and take
respective improving measures. And no study has ever been conducted in this hospital to assess
the possible causes for low ANC coverage in women who resident of Jigjiga town, and so this
paper could serve as a baseline for further investigations, after assessing the utilization of ANC
among pregnant women

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LITERATURE REVIEW

2.1. Utilization of Antenatal Care

A study in North Bengal shows that the Muslim mothers, Scheduled tribe mothers, non-educated
mothers with higher age group are less interested about ANC. A Family with an income of 2000
or less per month show only 62.42% ANC coverage. They also found that only 7.11% mother
used Government hospital and 2.65% used private clinic. The mother with medical and obstetric
problems has high ANC coverage so; socioeconomic factors significantly influence the antenatal
coverage and delivery practices (10).

A study in Nigeria, Malaysia shows that all women aged between 15 to 49 years old who had at
least one antenatal experience was interviewed using a structured, pretested questionnaire. A total
of 104 women were interviewed. Among them, 92.3% admitted attending antenatal clinic during
their previous pregnancies while only 48.1% came early for their first check-up. About 70% of the
women had history of home delivery and 44.2% had experienced at least one high risk pregnancy
before. Study revealed that 44.2% (95% CI, 34.7 – 53.7%) of the women have good knowledge
regarding antenatal care while 53.8% (95% CI, 44.3 – 63.1%) of them noted to have positive
attitude regarding antenatal care. However, result showed that the level of knowledge regarding
the importance of early antenatal care, screening test and complications of diabetes and
hypertension in pregnancy was poor. In conclusion, the rate of home delivery and late antenatal
booking was still high among the Orang Asli women and it is significantly associated with their
attitude regarding antenatal care (11).

A study in Laos showed that about 53.9% of mothers did not receive any ANC service due to the
following reasons: no time (93.4%), not necessary (83.8%), feeling embarrassed (74.3%), and
living far away from the ANC facility (71.3%). They found that significant predictors of ANC
utilization were: level of education, income, knowledge, attitude, and distance, availability of
public transportation, cost of transportation, and cost of service. Their study showed that the
utilization of ANC service was very low. Among other factors, limited knowledge, and lack of a
good attitude along with misconceptions about ANC services was the major constraints behind
this low utilization (12).

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A comparative study of knowledge, attitude and practices among ANC facilities utilizing and non-
utilizing women in Islamabad, Pakistan showed that there was higher rate of pregnancy related
complications in women who don’t utilize ANC than those who do. And not only was that, but
Knowledge about danger signals in pregnancy and realization of the importance of eating a
healthy diet during pregnancy, significantly higher among women utilizing ANC (13).

A study on a Survey of Knowledge, Attitude, and Practices of Pregnant Women of ANC showed
on a study that conducted 8 focus groups among married women and men separately in the
villages of Pattri Union Council and a cross-sectional quantitative survey was conducted among
513 pregnant women aged 18 to 40 years. Only 14.4% of the study respondents ever had received
ANC services at a government health facility. Short distance from residence to health facility, high
income, less number of parity, any education, and any perceived pregnancy related problem and
knowledge about ANC was positively associated with ANC utilization. However attitude toward
government health facility showed negative association with such ANC. A multivariable logistic
model also showed significant positive association of family income, education, parity, and
distance from residence to health facility with accessing ANC services. Attitude showed a
negative association. (Knowledge could not be assessed with logistic regression.) Qualitative data
also supported quantitative results as most of the male and female respondents revealed low
knowledge and negative attitudes towards the ANC services provided at the government health
facilities (14).

A study on ANC services utilization done in Harari showed that 85.2% of the respondents
experienced ANC visits in their recent pregnancy. Among those women who visited ANC clinic,
13.1% had 1 visit, 46.5 had 2 visits, 27.7% had 3 visits, and 12.7% had 4 and above visits. 46.55
of them visited beginning between 12th and 20th weeks of gestation. 81% of women who had no
ANC exposure during their recent pregnancy reported that the reason for not to visit ANC clinic
was cause they did not know of the importance and existence of such services (15).

A domestic study named community survey on maternal and child health services utilization in
rural Ethiopia which was carried out in 22 villages of a rural district of Arsis by E. Material, in
1993 showed that the coverage of ANC services was 26% and 61% of the women who received

5
ANC reported having had 3 or more antenatal visits. ANC was positively associated with living
within 10km radius of the health center (16).

Another study done by Belay Tessema in 2004 around yirgalem town on ANC services utilization
among pregnant women revealed that 39% of all women, 51% of rural women, and 25% of urban
women did not attend ANC services during their pregnancies. Fewer than 16% of all women
received ANC with in the first trimester and approximately 56% waited until the 3rdtrimester or
received no care at all. This study showed that, among women who attend ANC clinics at least
once, the median number of visits was three and the median gestational age of initial visit was 5
months. The primary reason for not attending ANC service was having no illness during
pregnancy, lack of knowledge about the significance of ANC and being too busy to visit ANC
(17).

Conceptual Framework
Figure 1 Conceptual Framework

Figture1.1 Conceptual frame work for attitude of ward ANC(constructed after reviewing
literature).

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 OBJECTIVES

1.1. General Objectives

 To assess the knowledge attitude practice Utilization of Antenatal Care among
Pregnant Women in Jigjig a Town, Somali Regional State, Eastern Ethiopia

1.2. Specific Objectives

 To identify knowledge the Utilization of Antenatal Care among Pregnant Women in
jigjig a town
 To determine practice the Utilization of Antenatal Care among Pregnant Women in
jigjig a town
 To find out attitude the Utilization of Antenatal Care among Pregnant Women in
jigjig a town.

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 METHODS AND MATERIALS

4.1. Study area and period

Somali Regional State is one of 10 regions of the Federal Democratic Republic of Ethiopia located
in the Eastern part of Ethiopian lowlands. It has boundaries with Djibouti, Somalia and Kenya,
locally bordering with Oromia, Harari and Afar regions. The region has 11 zones and 93 Woreda
administrations. The study is conduct in Jigjig a town, which is the capital city of Ethiopian
Somali Regional State. It is one of the eleven woreda as in Fafan zone located 635 km from Addis
Ababa, divided into 20 Kebeles& 67 sub-kebeles. According to (CSA, 2015)the population of
Jigjig a town is 250,000 from which 123,422 are males and 126,578 are females. The people are
mainly Somali tribe, Muslim and their income mainly based on small and large scale trading.
Regarding health facilities, the town has one referral hospital, one general hospital, 1 primary
hospital 3 health centers and 20 health posts (government) there is one private general hospital, 27
higher clinics, and 10 medium clinics. The study is being conduct from June-july ,2022 G.C.

4.2. Study design

Communities based cross sectional study design was be conducted
Source Population.
The utilization of ANC among all pregnant women living in jigjig a town

4.3. Study Population

All Pregnant mothers living in selected kebeles(05 & 06) in jigjig a town during data collection

4.4. Inclusion criteria and Exclusion criteria

4.4.1. Inclusion Criteria

All pregnant mothers who was mentally and physically capable to participate in the study during
the data collection

Pregnant women who had at least one previous ANC visit during their current pregnancy

4.4.2. Criteria Exclusion

Women who was unable to Pregnant communicate (mentally ill, critically sick) during data
collectors

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4.5. Sample size determination
Sample size is calculated by using single population proportion formula by taking of 50% b/c not
getting in previous prevalence Using the desired precision 5%, confidence level 95%
A total sample size is determined as follows: -
n= (Za/2)2p (1-p)
d2
Where, n=sample size
d=desired precision 5 %=( 0.05)
z=standard normal distribution value at confidence level 95%=1.96
p=prevalence rate of ANC coverage in Somali (50%) =0.5
Therefore, d=0.05
(Za/2)2= 3.8416
P=50%=0.5
d= (0.05)2 =0.0025
assume p=q
n= (Zα/2)2 P (q)

d2= 0.00252

n= (1.96)2×0.5(0.5)

(0.05)2

So, n=3.8416 (0.5) (0.5) = 384

0.0025
Therefore, the total sample size is 384
By considering 5% non-response rate final sample size for this study is 403

4.7 Sampling technique

Two kebeles are select purposely from 20 kebeles in jigjiga town. Then, the sample is allocated to
each kebeles proportionally (kebele 06, 162 and 05 ,kebele , 222 participants according to their
size of households.

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Finally, the systematic sample method was used to select household from each kebeles with every
11 interval. If the selected household was close at the time of data collection, we was replace next
door.

4.8 Data collection procedure

Seven public health degree students were recruit as data collectors; to all data collectors and
supervisors were orient.

For 21 days on data collection process based on the guide that were develop by principle
investigator for the data collectors and clarifying how to interview the questioner

They were allow to fill the questioner and the later discussion were made in all contents of the
format and the areas of difficult were revise the principle investigator and the coordinator strictly
follow overall activities for each activity on daily base to insure the completeness of questioner to
give father clarification and support for the data collectors

4.8.1 Dependent variables

Knowledge attitude practice Utilization of Ant natal care

4.8.2 Independent variables:

Socio-demographic characteristics

Age

Religion

Ethaticity group

Material status

Eductional level

Husband support

Occupation

Source of income

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Obstetric history

Parity

Gravida

age at first delivery

Place of most recent delivery

4.9 .Data quality management

The importance of the study, as well as the significance of the true information, is telling to the
respondents. Supervisors and data collectors are train for two days about pertinent data collection
principles and procedures before their participation. The questionnaire is administered by 6 train
interviewers who are complete grade 10th. The participant is interview in the irrespective places.
When a participant who is selected refused to participate in the study or is unable to answer the
questions, the next eligible respondent is interviewed. Moreover, the instrument use in the study
was pre-tested on a similar population (5% of the actual sample size). A total of 19 respondents
are asking questions in the pre test and it is not include in the research analysis. Continuous
checking of the complete questionnaires is doing, and a questionnaire is filling each day by the
principal investigator and the other trained supervisor. Incomplete questionnaires would referrer
back.

4.9.1Operational definitions
Parity: Delivery of fetus after 28 weeks of gestational age.

Gravidity: All forms of pregnancy (term, live birth still birth abortion).

First trimester: Gestational age between 1-3months.

Second trimester: Gestational age between 4-6 months.

Third trimester: Gestational age between 7-9 months.

Knowledge: Those pregnant women who will have information about ANC.

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Access to health facility: The healthcare centers will be not more than an hour from pregnant
women by local means of transportation or availability of health facility within one hour walk or
travel.

Antenatal care attendance: If a woman visited health facility at least once to receive ANC
services during the recent pregnancy.

Enabling resources: It implies providing clients with the means to make use of the services.
Antenatal care attendance: If a woman will visit health facility at least once to receive ANC
services during the recent pregnancy.

Need factor: It refers to health status, perceived by the individual or evaluated by the healthcare
providers.

4.9.2 Data analysis

Data is managed using manually prepared cross tabulate tally sheet using four vertical strokes and
one horizontal stroke, graphs, charts, scientific calculator and Open-ended questions grouped
based on the response of the respondents.

Ethical considerations
Letter of cooperation is obtained from jigjig a health science College and, research office. The
respondent is in form about the aim of the study and verbal consent is obtained before the data
collection. The confidentiality would be keep by not writing their names on the questionnaires.

Dissemination of results and discussions

At the end, the studies are present to jigjig a health science College, department of public healthy
and to other stakeholders. Soft and hard copy will sumetted

In addition to that the finding of this study are disseminating to different governmental and
nongovernmental organizations working on ANC including Woreda health office. Lastly the result
is present during presentation of the graduating class, of completion of Bsc degree public healthy

12
 RESULT

5.1. Socio-demographic characteristics of the study participants

Concerning socio-demographic characteristics, a total of 384 women of reproductive age were
interviewed and the response rate of 100% included in the study, majority 304 (79%) of them were
ranged in the age between 21 and 34, 47 (12%) of them were ranged in the age between 15 and 20
and 33(9%) of them were ranged in the between 35 and above are pregnancy women. 110(29%) of
them were ranged in the less than 18and 274(71%) of them were ranged in the 18 and above are at
age Majority of the women 384(100%) were married of marriage. The religion distribution of the
respondents show that the largest proportion of them 279 (73%) were Muslim, 105(27%)
orthodox. The of them were Somali 254 (66%), 72(19%) of them were Ahamar and 58(15%) of
them were Gurage . majority 141(37%) Most of the respondents were no formal but can read and
write, 98 (26%)) some unable to read and write, 57(15%) of them were primary, 35(9%) of them
were secondary,41(11%) of them were college and above,12(3%) of them were other, 55(14%) of
them were employed ,Most of the women’s are 236(61%) house wife,47(12%) of them were
merchant, 25(7) of them were student 20(5.31%) other and Most women’s income between 3000-
5000 birr

Table 1socio demographic characteristics of the respondents (n=384) in jigjiga town

VARIABLE FREQUENCY (%)

AGE AT LAST PREGNANCY 15-20yrs 47(12%)

21-34yrs 304(79%)

35 and above 33(9%)

Age at Marriage <18 110(29%)

18 and above 274(71%)
Marital status Single 0

Married 384(100%)

Religion Muslim 279(73%)

Orthodox 105(27%)

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Ethnicity Somali 254(66%)
Amhara 72(19%)

Gurage 58(15%)

Educational status of mother Unable to read and 98(26)

write
No formal but can read 141(37%)
and write
Primary 57(15%)

Secondary 35(9%)

College and above 41(11%)

Other 12(3%)
Occupational Employed 55(14%)
House wife 236(61%)

Merchant 47(12%)

Student 25(7%)

Other 21(5%)

Husbands education Unable to read and 19(5%)

write
No formal but can read 94(24%)
and write
Primary 39(10%)

Secondary 61(16%)

College 171(45%)

Husband occupation Maid servant 31(8%)

Merchant 108(28%)
Student 21(5%)

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 Employed 208(54%)

Other 16(4%)

5.2. Obstetric History and knowledge about ANC.

Concerning knowledge of women on utilizing of ANC, from the total of 384 respondents with
response rate of 100%, all of them were heard about utilizing of ANC In other words, out of 384
mothers interviewed about ANC follow up of history parity, majority of them 294(77%) of were
more than one and some of 90(23%) were one. Decisions of ANC 144(38%) of them were mother,
240(62%) of them were husband, hold purchase of 200(52%) of them were mother and 184(48%)
of them were husband, 60(1y%) of them were still birth and 324(84%) no birth, 115(30%) of them
were abortion and 269 (70%) of them were no abortion,198(52%%)of them were knowledge about
complication related to pregnancy and 186(48%) of them were have not knowledge about
complication related to pregnancy,
Family size 1-2, 64(17%) 3-4, 116(30%) <5, 204 (53%), place of service delivery 64(17%) of
them were home ,72(19%)of them were heath center,248(65%) of them were hospital, service
264(69%) of them were health professional and 120(31%) of them were urban health extension
worker, timing of trimester 214(56%)of them were first , 68(18%) of them were second and
102(27%) o f them were third, Number ANC visit 137(36%) of them were one ,106(28%) of them
were two, 77(17%) of them were three, 64(17%) of them were four and above provider said that
health institutions give for ANC.

Table 2 Obstetric history and knowledge on ANC

VARIABLE FREQUENCY %

History of parity One 90(23%)

More than one 294(77%)

Decision on ANC Mother 144(38%)

Husband 240(62%)

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 Both 384(100%)

Decision on house hold purchase Mother 200(52%)

Husband 184(48%)

Both 384(100%)
History of still birth Yes 60(16%)

No 324(84%)

History of abortion Yes 115(30%)

NO 269(70%)
Knowledge about complication related to Yes 198(52%)
pregnancy No 186(48%)

Missing 0

Family size 1-2 64(17%)

3-4 116(30%)

>5 204(53%)

Missing 0
Place of service delivery Home 64(17%)

Health center 72(19%)

Hospital 248(65%)

Service provider Health professional 264(69%)

Urban health extension 120(31%)
workers
Timing of trimester First trimester 214(56%)

Second trimester 68(18%)

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 Third trimester 102(27%)

Number of ANC visit One 137(36%)

Two 106(28%)
Three 77(20%)
Four and above 64(17%)1

5.3. Contents of ANC Interventions (BASIC)

Contents ANC intervention(Basic) Concerning knowledge of women on utilizing of ANC, from
the total of 384 respondents with response rate of 100%, all of them were heard about utilizing of
ANC In other words, out of 384 mothers interviewed about ANC follow up of health institution,
measured blood press 385 100% of them say YES ,blood or urine examination 384 100% of them
say YES, awareness to pregnancy related complication 350(91%) of them say YES and 34(9%) of
them were say NO, take intestinal parasite199(52%) of them were say YES and 185(48%) of them
were say NO, check iron table 348(91%) of them were say’s and 36(9%)of them were say NO, TT
vaccination 336(88%) of them were say YES and 48(13%) of them were say NO, said that health
institutions give for ANC.

Table 3 contents of intervention

Measured blood pressure Yes 384(100%)

No
Blood/ urine examination Yes 384(100%)

No 0
Awareness to pregnancy related Yes 350(91%)
complications
No 34(9%)
Take intestinal parasite Yes 199(52%)

No 185(48%)
Check iron tablet Yes 348(91%)

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 No 36(9%)
TT vaccination Yes 336(88%)

No 48(13%)

5.4. Utilization of Antenatal Care among Pregnant Women

Utilization of Ante anal Care among pregnant women 349(91%) of them were say YES and
35(9%) of them were say NO, gestation age should 234(61%) of them were 1-3month,76(20%) of
them were 4-6month,74(19%) of them were 7-9month,some women experience health pregnancy
130(34%) of them were say’s YES and254(66%) of them were say NO, main attend ANC follow
up 102(27%) of them were health problem 256(67%) of them were start regular check up and
26(7%) of them were other

If you went anc check up have you ever an injection on the arm to prevent agianst tetanus

Yes 338(88%) no 46(12%)

How far catchments health unit from your living area?

500m-1km 278(72%) 4km-5km 106(28%)

Do you have a plane to attend anc in catchments health unit for the future

Yes 314(82%) no 70 (18%)

Table 4 utilization of Antenatal care pregnant women

Do you visit last pregnancy ANC YES 349(91%)

NO 35(9%)

If yes what month/gestational age should you 1-3 Month 234(61%)

attend ANC 4-6 month 76(20%)

7-9 month 74(19%)

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Did you experience health problem last your Yes 130(34%)
pregnancy? No 254(66%)
What is the main reason to attend ANC follow Health problem 102(27%)
up? To start regular check up 256(67%)
Other 26(7%)
If You went ANC checkup have you ever an Yes 338(88%)
injection on the arm to prevent against tetanus No 46(12%)

How far catchment health unit from your living 500M – 1KM 278(72%)
area?
4KM-5KM 106(28%)
Do you have a plan to attend ANC in Yes 314(82%)
catchment health unit for the future NO 70(18%)

DISCUSSION
The age distribution of last pregnancy mostly show that it was 21-34 (79%)
majority 304 (79%) of them were ranged in the age between 21 and 34, 47 (12%) of them were
ranged in the age between 15 and 20 and 33(9%) of them were ranged in the between 35 and
above are pregnancy women. age at marriage 110(29%) of them were ranged in the less than
18and 274 (71%) of them were ranged in the 18 and above are at age Majority of the women
384(100%) were married of marriage.
.Most of the pregnant women have No formal education but they can read and write only {37%}
and are house wife in their Occupational status (61%). The other study conducted in Ethiopia,
Addis Ababa, and Gulele district shows that the majority of the respondent age group 25-34yrs
(78.72%). Most of the pregnant women were illiterate (14.89%), the substantial majority of them
married (100%) and the median income.

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CONCLUSIONS& RECOMMENDATIONS

7.1. Conclusions
Major of the pregnant women in this study have knowledge and attitude toward ANC service. But
practice it is low. And the major reason not to attend is lack of awareness. Majority of the pregnant
women starts ANC follow up at early gestational age such that at 1st trimester and most of them
has one visit. So it needs a great effort to increase this low ANC coverage by informing the society
towards ANC service, benefits of ANC service utilization and the complication associated with
pregnancy. Also one should work on the factors associated with not to attend anc. This study also
shows that majority of the pregnant women prefer to deliver in home than health institution and
from those who prefer health institutional delivery, most of them are educated.

6.2 Recommendation
The woreda health bureau had better to expand or design information education and
communication that help the community a clear understanding of anc.
The hospital should give better service and adequate information about ANC for the women and
advise then to inform their relatives or neighbor.
The woreda educational bureau should increase women’s empowerment.
Mass media should increase its role on the importance of ANC follow up.

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7. REFERENCES
1- WHO. Coverage of maternity care. A tabulation of available information [Internet]. Geneva:
WHO; 1998 [cited 2009 Sep 20]. Available from: http://www.who.int
2- Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal
education: an exploratory study. Health PromotInt [Internet]. 2001 [cited 2009 Sep 21];16:381-8.
Available from:http://www.heapro.Oxford journals.org
3- WHO, UNICEF. Antenatal care in developing countries promises achievement and missed
opportunities. An analysis of levels trends and differentials 1900-2001 [Internet]. Geneva: WHO;
2003 [cited 2009 Sep 24]. Available from: http://www.childinfo.org
4-Ethiopia Demographic and Health Survey 2011
5- Millennium developmental goal report: challenges and prospects for Ethiopia March 2004.
6- FMOH: 2005, National health sector development program-III, 59-60
7- WHO: mother baby: implementing safe motherhood in countries, Division of family health
WHO, Geneva (1994)
8- MOH, Ethiopia safe motherhood needs assessment, 1996: 13
9- White Ribbon Alliance for safe motherhood: what is the white alliance for safe motherhood?
[http://www.whiteribbonalliance-india.org/overview.htm]
10-Knowledge, Attitude and practices for ante natal care and delivery of mothers of Teagarden in
Jalpaiguriand Darjeeling districts, west Bengal, 2007/2008
11-Knowledge, attitude and practiceon Ante Natal Care on Organ AsliwomeninJempol, Negeri
Sembilan.
12-Factors affecting the utilization of Ante Natal Care services among women in Kham district,
Xiengkhouangprovince, Lao, PDR
13-Comparative study of Knowledge, Attitude and Practices among Antenatal Care Facilities
utilizing and non-utilizing women
14- A study on a Survey of Knowledge, Attitude, and Practices of Pregnant Women of ANC, 2007
15- ANC services utilization in rural part of Harari Region, Eastern Ethiopia, July 2007
16- Community survey on maternal and child health services utilization in rural Ethiopia, Arsi, by
E. Meteria, 2011
17-Belay Tessema, 2004; Correlates of ANC services utilization among women around Yirgalem
town; AAU

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18- Ethiopian Public Health Institute (EPHI). 2017. HIV and AIDS Estimation and Projection for
Ethiopia Based on SPECTRUM Modeling. Addis Ababa, Ethiopia: EPHI.
19- Federal Democratic Republic of Ethiopia (FDRE). 2016. National Guideline on Adolescent,
Maternal, Infant and Young Child Nutrition. Addis Ababa, Ethiopia: FDRE.
20- Joint United Nations Program me on HIV/AIDS. 2014. Elimination of Mother to Child
Transmission Five Years Strategic Plan (2015-2020). Addis Ababa, Ethiopia: Federal Ministry of
Health.

22
ANNEXES

Annex-I. Consent Form

Good morning/afternoon, my name is ……………………………………I am a fourth-year puplic
health students jigjig a health science college and , department of public health. I am here to study
the Utilization of Antenatal Care among Pregnant Women in Jigjiga Town, Somali Regional State,
and Eastern Ethiopia. I am glad to inform you that, you will one of the eligible participants and
you will welcome to take part in this study. We will also delight to tell you we really value your
participation as your individual contribution to the study output will be definitely very significant,
however it is up to you to decide whether to participate in this study or not. I will like to inform
you that your name will be not write in anywhere in this study.

Are you will to participate in this study?

1. Yes…………..
2. No……………
Annex-II. English Version Questionnaires

Part one. Socio-demographic characteristic of mothers

Part two; Obstetric history and experience
Part three Utilization of Antenatal Care among Pregnant Women

S. no Part one _Socio-demographic characteristics

1 Age at last pregnancy

15-20
21-34
≥35 
2 Age at marriage
<18
18 and above

23
3 Marital status
Single
married
4 Religion
Muslim
Orthodox
Ethnicity
5 Somali 
Amhara
Tigrey
6 Educational status of mother
Unable to read and write
No formal education, but Can read and write
Primary school
Secondary school
College and above
7 Occupation of mother
Employed/wage
Housewife
Merchant
Student
Other
8 Husband’s education
Unable to read and write
No formal education, but can read and write
Primary school
Secondary school
College and above
Other
9 Husband occupation
Employed/wedge

24
 Maid servant
Merchant
Student
Other
Part two; Obstetric history and experience
10 History of Parity
One
More than one
11 Decision on ANC
Mother
Husband
Both
12 Decision on household purchase
Mother
Husband
Both
13 History of Still birth
Yes
No
14 History of Abortion
Yes
No
15 Knowledge about complication related to pregnancy
Yes
No
missing
16 Family size
1-2
3-4
≥5
missing

25
17 Place of services delivery
Home
Health center
Hospital
Total
18 Services provider
Health professional
Urban Health extension workers
Total
19 Timing of first ANC visit
first trimester
second trimester
third trimester
Total
20 Number of ANC visits
One
Two
Three
Four and above
Contents of ANC interventions(basic)
21 Measured blood pressure
Yes
No
22 Blood/Urine examination
Yes
No
23 Awareness to pregnancy related complications
Yes
No
24 Take intestinal parasite
Yes

26
 No
25 Take iron tablet
Yes
No
26 TT vaccination
Yes
No

Part three Utilization of Antenatal Care among Pregnant Women.

27. Do will you visit last pregnancy ANC hospital?

A. yes B no

28. If yes what months/gestational age should you attend ANC?

A 1-3months B 4-6months C 7-9months

29. Do will you experience health problem last your pregnancy?

A YES B NO

30 .What will be the main reason that you attendant follow up?

A Health problem B family planning C to start regular checkup D other specify

31. If you will go for ANC checkup have you ever an injection on the arm to prevent against
tetanus?

A YES B NO
32. How far catchment health unit form ANC your living area?
A) In kilometers_______ B) in hours

33. Do you will have a plan to attend ANC in catchment health unit for the future?
A) Yes B) no

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28