Determinants of Delayed First Presentation to Antenatal Care at Four Selected Health Centers in Gasabo Districts, City of Kigali Province, Rwanda Open Access

King, Dhondup Tso (Spring 2020)

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Objective: To identify the socio-demographic, cultural, and health system factors related to delayed attendance to antenatal care in Gasabo District, Rwanda.

Methods: A cross-sectional study women aged 18-49 who had given birth to a live child within 12 months prior to data collection, able to speak and understand Kinyarwanda, Rwanda national language, and have access to Antenatal Care Card from the last pregnancy. Data was collected using an interviewer-administered survey questionnaire. For the analysis, a bivariate and multivariate logistic regression were conducted, and odds ratios were presented with their 95% confidence intervals.

Results: Only 12% of the study participants presented to antenatal care within 12 weeks of gestation and of which about 68.6% (n=24) had timely initiation of the first ANC and met the previous WHO and Rwanda national health system recommended four visits during pregnancy. Among the study participants who initiated the first ANC after 12 weeks of gestation, a relatively higher proportion reported not having a partner/husband accompanying to ANC (38.5%) followed by not knowing one’s pregnancy status (34.8%) and lack of health insurance or money for treatment (16.4%). In the final logistical regression model, women with less than 4 ANC visits were more likely to delay service initiation (AOR, 20.42; 95%CI: 7.73-53.90) than women with ≥4 visits. The birth order of the last child, transportation modes, and highest-level education completed were significant in the bivariate analysis, however, lost significance when combined with each other in the final model.

Conclusion: A majority of the study participants had a delayed first ANC, while only 12% presenting on-time. Among those with delayed first ANC, almost 90% had less than the four visits. Health campaign and outreach activities need to prioritize community awareness messages targeting partners as well as community at large on the importance of timely initiation of ANC services. In addition, health facilities should be more flexible in policy and practice around male partner involvement when a woman is not able to present one or clarify any miscommunication regarding acceptance of pregnant women without the escort of a partner.

Table of Contents



Antenatal care models and revisions

Adverse perinatal outcome


Study setting, design, and population

Participant selection

Data collection

Analytic sample

Main outcome of interest

Socio-demographic factors

Statistical analysis


Sociodemographic and economic characteristics

Pregnancy related characteristics

Determinants of delayed Antenatal care service utilization





Table 1. Demographic characteristics of study participants

Table 2 Frequency distribution and Chi-sq test between background characteristics and Gestational Age at 1st ANC

Table 3. Pregnancy related characteristics of the study participants

Table 4 Associations between obstetric factors and delayed first presentation for ANC services


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