Influence of early booking for antenatal care on antenatal and early pregnancy outcomes at Kenyatta National Hospital

Abstract

Objective: To determine whether mothers who book early experience better birth preparedness, ANC investigations and pregnancy outcomes compared to those who book late.
Design: A retrospective cohort study.
Setting: Kenyatta National Hospital, Nairobi, Kenya.
Study population: An exposed group of patients who had early booking (<16 weeks) for antenatal care and an unexposed group of patients who had late booking (> 28weeks). Sample size: A total of 300 participants, 150 for each group.
Results: Late booking was associated with lower odds of birth preparedness evidenced by: lower knowledge of expected date of delivery (OR 0.26; P=0.005; 95% CI 0.1-0.66), and lower likelihood of having a birth plan in terms of desired place of delivery, preferred skilled birth attendant, birth companion, means of transport and blood donor (OR 0.24; P=0.006; 95% CI 0.09-0.67). Late booking was also associated with lower odds of emergency preparedness like knowledge of danger signs during pregnancy (OR 0.09; P=<0.001; 95% CI 0.05-0.18) and postpartum emergency preparedness like knowledge of danger signs in puerperium (OR 0.16; P=<0.001; 95% CI 0.08-0.33) and during infancy (OR 0.05; P=<0.001; 95% CI 0.03-0.09). Late booking was associated with lower knowledge on modern family planning methods (OR 0.17; P=0.001; 95% CI 0.1-0.29), and childhood immunization (OR 0.1; P=<0.001; 95% CI 0.06-0.17). Late booking was associated with lower likelihood of interventions like: Folic acid supplementation (OR 0.02; P=<0.001; 95% CI 0.01-0.03) and iron supplementation (OR 0.39; P=0.001; 95% CI 0.23-0.66).
Conclusion: Early booking for antenatal care confers better birth preparedness and better antenatal care interventions compared to late booking. Hence need for structures to be put in place to increase early antenatal bookings.