DIRE DAWA UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF MIDWIFERY

TITLE MAGNITUDE OF LATE INITIATION OF

ANTENATAL CARE AND ASSOCIATED FACTORS
AMONG PREGNANT WOMEN ATTENDING ANTENATAL
CARE IN GELEMSO GENERAL HOSPITAL, SOUTH
EASTERN OROMIA, ETHIOPIA, 2023

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 GROUP MEMBER

NAME ID
1.Riyad Mohammed…………………..1204206
2.Demeku Shegaw……………………..1200157
3.FetiyaHessen………………………….120035
4.Hamerenoh Meseret……………….1200537

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 Presentation outline

• Introduction
 Background
 Statement of problem
 Significant of the study
• Objective
• Method and materials
• Work plan
• Budget
• Reference
• Acknowledgement
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 Introduction
• Antenatal care ANC is a type of care given to pregnant
women.
• It is considered vital for maternal service in improving a wide
range of health outcomes for women and newborn.
• It is one of the key strategies for reducing maternal and
neonatal morbidity and mortality through
 preventing
 detecting

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 Cont.…
 Alleviating, or manage pregnancy related health problem.

• The new Antenatal care ANC model recommended by the

WHO a minimum of eight ANC contact should need for
positive pregnancy outcome.(WHO 2016)
 The first contact should be the initiated with in the first
trimester, the second two contacts on the second trimester and
the fifth contacts at the third trimester.

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 Cont….

• There are so many factors for late initiation of ANC

 Educational statuses
 Unplanned pregnancy
 Time taken to get to a health facility, and in adequate
knowledge of ANC service are most frequent causes

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 Statement of the problem

• According to WHO 2016 report, globally 303,000 maternal

death occurred as a result of pregnancy and child birth related
complication in 2015.on this 99% of them occurred in
developing region. These maternal death could have been
prevented if the pregnant women or adolescent girls had been

able to access quality antenatal care.

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 Cont….

• In low and middle income countries, ANC utilization has

increased since the introduction in 2016 of the WHO ANC
model.
• However the pooled prevalence women attended the WHO
recommended minimum eight contact for ANC are only 13%.

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• Globally 42.4% of women initiate ANC late. Frist ANC service

including essential screening Like human immunodeficiency

virus(HIV) and syphilis are important.

• Based on EDHS 2016 study prevalence of delayed first ANC

booking was 67.31.Despite majority of pregnant women at this

stud area with obstetric complication there is no objective

evidence shown the magnitude of late initiation and associated

factor.
• There fore this study aims to fill this gap by getting the
magnitude of late initiation and its associated factor among
pregnant women who has ANC follow up GGH 9
 Significant of the study

 This study is significant for

 Decrease maternal mortality and morbidity
 To improve early initiation of ANC.
 For development practitioners and policy makers.
 Used as a baseline for further researchers, Local health office,
MOH, and other stakeholders.

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 Conceptual frame work
o Socio demographic
factor
H • Maternal age
o Sociocultural factor
• Maternal status
• Un planned
• Residence
• Low decision authority
• Family size

o Obstatric facto r &pre

existing medical LATE ANC
disorder INITITION
• Gravida
• Parity
• Past medical illness
• Time of ANC initiation o Health facility factor
• Obstatric complication • Distance from health facility
during past • Long waiting times
• Counseling when to
start ANC
Previous ANC experience 11
 objective
 General objective

 To assess the magnitude of late initiation of antenatal care and

associated factor among pregnant women attending antenatal care

in Gelemiso general hospital, south eastern Ethiopia,2023

 Specific objective

 To determine the magnitude of late initiation of antenatal care

among pregnant women.

 To identify factor associated with late initiation of antenatal care

among pregnant women.

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 METHODS AND MATERIALS
 Study area and period

The study will be conducted at gelemso general hospital from Jun

to Nov 2023 in gelemso town, oromia, west hararge ethiopia which
is about 404 kilometer from Addis abeba, 270km from harar and
78km from chiro zonal town.
 Study design

Institution based cross sectional study.

 Source of population

All pregnant women who visit gelemiso general hospital for ANC
purpose. 13
 Source of population

All pregnant women who visit gelemiso general hospital for ANC
purpose.
 Study population

Those pregnant women who visit the hospital for ANC purpose
and fulfill eligible criteria during the data collection period.

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 Inclusion and exclusion criteria

 Inclusion criteria
• All pregnant women who come for ANC follow up at GGH
will be include.

 Exclusion criteria
• Pregnant women who will come ill and unable to

communicate during data collection will be excluded.

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 Sample Size Determination

• The sample size was calculating using a single population

proportion formula by the following assumption. The
prevalence of the late initiation of antenatal care among
pregnant women in mizan aman town, which was estimated at
70% ,95% confidence level ,margin of error to recruit study

participant ,10% non respondent rate.

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 Cont…
n= (za/2)2× p( p)/d2, (1.96)2×0.7(0.3)/(0.05)2= 323

where; n= Sample size

P= expected proportion of late ANC initiation 70%

za/2=1.96(at 95% confidence level)

d=0.05 % marginal error

Based on the above assumpution a minimum size of 323 is

required. To minimize error arising from the probable occurrence

of (non respondent rate),10% of the sample size will be added and

finaly,355 study subjects are included in the study. 17

• Sample size for second objective which is associated factor for
late initiation of ANC at GGH by using data from research
done at Addis Zeman primary hospital, from which one of the
associated factor was distance from health facility(AOR
≈1.72,95%CI:1.052.81) and using sample size determination

for case control study is 462.(Wolde et al., 2019a)

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 Table 1 sample size calculation based on associated
factors by using epi info.
Factor reference Assumption Sample size Reference
ci:95
Power:80%
Ratio:1:1
Distance from Exposed 53:42 462 (Wolde et
health facility al.,2019a)
Unexposed :40
Age Exposed :40 418 (Sema et al.,2020

unxposed:54:13

Family exposed:40 (Abuka et

al.,2016
Unexposed 54:55 396
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 Sampling technique

• The participant will be recruited from Gelemiso general

hospital, south eastern oromia ,Ethiopian.
• Through a systematic random sampling technique.

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 Study variable
 Dependent variables
 Late initiation of ANC
 Independent variables
 Socio demographic variable
 Maternal age
 Marital status
 Residence
 Maternal education
 culture
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 Pregnant women related factor

 Perceived ANC starting time

 Previous positive pregnant

 Awareness of danger sign during pregnant women

 Health care facility related factor

 Distance

 Waiting time in health facility

 Transportation cost

 Heath care provider behavior 22

 Operational definition

• Early initiation of antenatal care: first antenatal care

initiation up to 12 week of pregnancy.(WHO,2016)

• Late initiation of antenatal care: presenting for ANC

at a clinic for the first time after 12 week of pregnancy (WHO
2016).

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 Data collection procedure and
instruments
• Data collection tools will be developed after reviewing
different literature.
• A structured questionnaires will be used to address all variable
the questioners is initially prepared in English and then
translated in to Amharic and Afan Oromo.
• Data will be collected by face to face interview using
interview administer questionnaires.

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 Data quality assurance

• Recruiting data collector who had health background.

• Training for data collectors and supervisors.
• Questionnaires will structured and pretested 5% of respondent.
• Completeness of the data will checked before entry.
• Data will entered by the EPI.
• Clean before analysis.

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 Data processing and analysis

• Data will entered to epidata ver 7.1 then exported to SPSS vr

23.
• Descriptive using frequencies ,proportions and table will used.

• Bi variant and multivariate logistic regression analysis will

performed.
• 95% confidence interval will computed.

• Statical significance will considered at significance level of 5%.

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 Ethical consideration

• Written ethical clearance will be obtained from dire dawa

university college of medicine and health science.
• A formal letter will send to gelemiso general hospital.
• Verbal consent will obtained from study participant.
• Confidential and privacy of respondents will kept.

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 Dissemination of the result
• The study finding will be disseminated to diredawa university
college of medicine and health science,GGH,and other
relevant organization that can make use of the finding.it will
be communicate to the scientific community through
publication.

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 Work plan
table 2 work plan
activity schedule responsible
person
Jun July Aug. sep oct nov
Topic selection and submission Group team

Writing and submission of Group team

proposal

Finalizing & submission of Group team

proposal
Approval from advisor Group team
pre testing & data collection Group team
Data entry and cleaning Group team
Data process and analysis Group team
Preparation for Group team
presentation

Submission & presentation Group team

of the final research

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Dissemination of finding Group team
 Budget
table 3 budget

no Budget Unite cost Multiplying Total cost

category factor
1
Transport cost 250 10 2500
Material
2 Pen 15 10 150
Pencil 8 5 40
Pencil erasers 10 3 30
Paper 600 1 600
Stapler 10 6 60
Printing 6 600 3600
Note book 250 5 1250
Ruler 30 4 120
Secretory 550 1 1160
Binding 40 6 540
document
3 Grand total 10050
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 ACKNOWLEDGEMENTS
• First of all we gratefully acknowledge dire dawa university
college of medicine and health science department of
midwifery for offering us such an opportunity to undertake this
research proposal. We also gratefully thank the gelemso
hospital for giving us necessary information. Our last, but not
least gratitude run to our respected advisor Alemu
guta(assistant professor)for giving us a continuous and
plentiful comments and suggestions for this research proposal
by sacrificing his time and energy.
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 REFERENCES
1. lattof SR,Moran AC,kidul N,MOLLER A_B,jayathilaka CA ,diaz T,el

al.implimentation of the new WHO antinatal care model for a positive pregnancy

experience, a monitoring framework BMJ global health .2020,5(6) e002605

2. who WHO recommendations on antinatalcare for a positive pregnancy

experience .Geneva 27,switzeland.2016

3. topcu G, Savona Ventura c, Ayres de campos D, Mukhopadhyay S, Messinis

I, Mahmood T,et al. provision of antenatal care in Europe Ascientific study

commissioned by European Board and college of obstatric and gynecology

(EBCOG).European journal of obstetrics and gynecology and Reproductive

Biology.2022,272.30 6.

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THANK YOU

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