TABLE OF CONTENTS
DECLARATION…………………………………………………………………………………………………. ii
DEDICATION……………………………………………………………………………………………………. iii
ACKNOWLEDGEMENT……………………………………………………………………………………. iv
TABLE OF CONTENTS………………………………………………………………………………………. v
LIST OF TABLES…………………………………………………………………………………………….. viii
LIST OF FIGURES…………………………………………………………………………………………….. ix
ABBREVIATIONS AND ACRONYMS………………………………………………………………. x
OPERATIONAL DEFINITION OF TERMS………………………………………………………… xi
ABSTRACT…………………………………………………………………………………………………….. xii
CHAPTER ONE: INTRODUCTION…………………………………………………………………. 1
- Background to the Study………………………………………………………………………… 1
CHAPTER TWO: LITERATURE REVIEW……………………………………………………. 8
- The Concept of Adolescent Mothers………………………………………………………… 8
CHAPTER THREE: MATERIALS AND METHODS……………………………………… 28
- Introduction…………………………………………………………………………………………. 28
CHAPTER FOUR: RESULTS…………………………………………………………………………. 34
- Demographic characteristics of the respondents……………………………………….. 34
4.3.3. Social cultural factors………………………………………………………………………….. 40
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATIONS44
Appendix 1: Consent form……………………………………………………………………………. 66
Appendix 2: Semi Structured Questionnaire……………………………………………………. 68
Appendix 3: Approval of Research Proposal by Graduate school………………………. 72
Appendix 4: Research Authorization letter by Graduate school…………………………. 73
Appendix 5: Research Permit by Kenyatta University Ethics Review Committee… 74
Appendix 6: Research Permit by NACOSTI…………………………………………………… 75
LIST OF TABLES
Table 3.1: Sampling frame………………………………………………………………………………………………. 30
Table 4.1: Socio-demographic Characteristics of the respondents………………………………………… 36
Table 4.2: Association between demographic factors and utilization of ANC services
among adolescent mothers in Mathare Valley informal settlements……………………… 38
Table 4.3 Association between obstetric factors and utilization of ANC services among adolescent mothers………………………………………………………………………………………………………… 39
Table 4.4: Socio-cultural factors influencing utilization of ANC services among
adolescent mothers in Mathare Valley Informal settlements………………………………… 40
Table 4.5: Association between Economic factors and utilization of ANC services among adolescent mothers in Mathare Valley informal settlements………………………………………………… 41
Table 4.6: Association between Quality of ANC services and utilization of ANC services……… 43
LIST OF FIGURES
Figure 1.1: Conceptual framework-adopted from Anderson and Newman (Babitsch,
Gohl, & von Lengerke, 2012)……………………………………………………………………………. 7
Figure 4.1: Number of times adolescent mothers visited ANC Clinics for check-ups……………… 37
Figure 4.2: Health facility factors that affected adolescent mother’s in Mathare Valley
informal settlements utilization of ANC services……………………………………………….. 42
ABBREVIATIONS AND ACRONYMS
| ANC | Antenatal Care |
| APH | Ante-Partum Hemorrhage |
| APHRC | Africa Population Health Research Centre |
| BSC | Bachelor of Science |
| FND | Food Nutrition and Dietetics |
| KDHS | Kenya Demographic and Health Survey |
| MDG | Millennium Development Goals |
| MMR | Maternal Mortality Ratio |
| MPH | Master of Public Health |
| NACOSTI | National Commission for Science, Technology and Innovation |
| PIH | Pregnancy Induced Hypertension |
| PPTCT | Prevention of Parent to Child Transmission |
| SBA | Skilled Birth attendance |
| SPSS | Statistical Package for Social Sciences |
| TBA | Traditional Birth Attendance |
| TV | Television |
| UK | United Kingdom |
| UN | United Nations |
| UNDP | United Nations Development Program |
| UNICEF | United Nations Children Education Fund |
| WHO | World Health Organization |
OPERATIONAL DEFINITION OF TERMS
Adolescence: A period between childhood and adulthood characterized by emotional, biological and psychological changes (Casey, Jones, & Hare, 2008)
Adolescent mother: Any woman between 10 and 19 years who has delivered a baby irrespective of gravida, parity, neonatal outcome or marital status (Ehlers, 2003).
Antenatal care: An umbrella term used to describe the health care procedures and care rendered during pregnancy (Ekabua, Ekabua, & Njoku, 2011)
Quality of care: Care provided according to the set WHO standards and national guidelines, based on Evidence-Based Medicine, and meeting client needs (Banda, 2013).
ABSTRACT
Antenatal care contributes to good pregnancy outcomes and often times benefits of antenatal care are dependent on the timing and quality of the care provided. Antenatal care is necessary to establish confidence between the woman and her health care provider, to individualize health promotion messages, and to identify and manage any maternal complications or risk factors. In low and middle income countries, complications of pregnancy and childbirth are the leading cause of death in women aged 15–19 years. This study aimed at determining the level of utilization of antenatal care services among adolescent mothers in Mathare Valley informal settlements, Nairobi County, Kenya. Ethical clearance was sought from Kenyatta University Ethics committee, consent was sought from respondents and confidentiality was maintained by not using any form of identification. The study adopted a descriptive cross-sectional study design. The target population consisted of all adolescent mothers aged 10 years to 19 years within Mathare Valley informal settlements. Data collection instruments was researcher administered questionnaires. The questionnaire was administered to the adolescent mothers who met the inclusion criteria. Data collected was coded and entered into the computer for analysis using SPSS version 20. Results of the study were summarized using percentages, tables and charts. Chi-square statistics were used to test for strength of association between the research variables and the relationship between the dependent and independent variables under study. The study established that source of income (χ2=17.700; df=4; p=0.001), person living with the adolescent mothers (χ2=11.332; df=4; p=0.023) were significantly associated with ANC utilization. About 78.9% of the respondents had visited ANC at least once and above for checkup while 21.1% had never visited ANC clinics. Only 31.6% of the adolescent mothers managed the recommended 4 and above ANC visits. Number of children adolescent mothers have given birth (Parity) χ2=46.998; df=2; p<0.0001, adolescent mother complications during pregnancy χ2=17.799; df=2; p<0.003, Fear of disclosing pregnancy (χ2=8.150; df=2; p=0.017) and peer Influence (χ2=10.014; df=2; p=0.007) influenced utilization of ANC services by adolescent mothers. This study recommends customized ANC services targeting adolescent mothers to be established to increase utilization of ANC by adolescent mothers in Mathare Valley informal settlements.
CHAPTER ONE: INTRODUCTION
Background to the Study
Antenatal care (also known as prenatal care) refers to the regular medical and nursing care recommended for women during pregnancy (Catling et al., 2015). Prenatal care is a type of preventative care with the goal of providing regular check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the course of the pregnancy while promoting healthy lifestyles that benefit both mother and child (Atuyambe et al., 2008) ANC offers a woman advice and information about appropriate place of delivery, depending on the woman’s condition and status. It also offers opportunity to inform women about the danger signs and symptoms which require prompt attention from a health care provider. Furthermore, ANC may assist in abating the severity of pregnancy related complications through monitoring and prompt treatment of conditions aggravated during pregnancy, such as pregnancy induced hypertension, malaria, and anemia which put at risk both the life of the mother and unborn baby (Banda, 2013)
Antenatal care should begin at the early stages of pregnancy as accessing antenatal care in a timely manner enables women to receive information early enough concerning the full range of screening tests available (National Collaborating Centre for Women’s and Children’s Health (UK), 2008). Antenatal care provides an opportunity to monitor the health of mother and baby, to detect hypertension, anaemia or malaria, and offer tetanus toxoid immunization, iron and nutrition supplements as appropriate (Koblinsky, Conroy, Kureshy, Stanton, & Jessop, 2000)
More than 50 percent of the world’s population lives in urban areas. While Asia has the largest number of urban slum residents, Africa is urbanizing faster than any other continent and 72 percent of city residents in sub-Saharan Africa live in slums (United Nations, Department of Economic and Social Affairs, Population Division, 2014).
Globally, an estimated 287,000 maternal deaths occurred in 2010, of which 99% (284,000) occurred in developing countries (World Health Organization, 2014). Implementing and assuring utilization of maternal health care services is potentially one of the most effective health interventions for preventing these deaths as well as maternal morbidity (Birmeta, Dibaba, & Woldeyohannes, 2013).
In Kenya, less than half (47%) of pregnant women (including adolescent mothers) make four or more antenatal visits according the 2008/09 Demographic health survey. Antenatal health seeking behaviour in these young mothers is a concept that influences them to reflect positively on their antenatal maternal health (Kenya demographic Health survey 2008/09).
The fifth Millennium Development Goal (MDG) aims to reduce the maternal mortality ratio by 75% between 1990 and 2015 (Nour, 2008). However, maternal mortality remains high at 488 maternal deaths per 100,000 live births (KDHS 2008/09). While this is below the Sub-Saharan average of 640 deaths per 100,000, Kenya experiences a very slow progression in maternal health (Kenya National Bureau of Statistics and ICF Macro, 2010)
Effective level of utilization of ANC services can enable adolescents to develop into mature adults, complete their education, start their lifelong careers, become economically independent and prepare for marriage and childbearing when their personal and social circumstances are favorable. This study sought to investigate the level of utilization of ANC services by adolescent mothers in Mathare Valley informal settlements, Nairobi County.
Statement of the problem
Less attention has been paid to the reproductive health problems of urban poor populations than to those of rural residents (Fotso, Ezeh, & Oronje, 2008). This is probably due to the fact that most income-earning opportunities, the major hospitals, and a disproportionate high share of health budgets are concentrated in cities and towns (Zulu, Dodoo, & Chika-Ezee, 2002). Low income areas especially in urban informal settlements, adolescent mothers struggle with access and utilizing of the ANC services due to the social determinants that are a challenge to them. 11% of adolescents’ attend for ANC services in their first two trimesters, while 14.6% deliver their babies without utilizing any ANC services at all in Nairobi urban slums (Fotso et al., 2008)
Despite the relatively high proportion of antenatal care from a health professional among urban slum women (about 97%), 48% made less than the recommended four visits. This figure compares with nearly 25% in Nairobi as a whole and 28% in urban Kenya. Noticeably, this proportion of slum resident women with less than four visits was slightly higher than that observed in rural Kenya (45%). This suggests that with regard to the
frequency of antenatal care, urban poor women are at least as disadvantaged as their rural counterparts (Fotso et al., 2008).
There are a number of health centers located on the periphery of Mathare valley that offer Antenatal care services. The dwellers however use other health care providers, including traditional healers and unqualified pharmacists, because of low cost, accessibility, longstanding cultural beliefs and distrust of the official health system (Izugbara, Ezeh, & Fotso, 2009).
Justification of the study
First pregnancy at an early age is risky. Although births among adolescents account for 11% of all births worldwide, they account for 23% of the overall burden of disease (in terms of disability adjusted life years) due to pregnancy and childbirth among women of all ages (WHO, 2014a). Low income areas especially in urban informal settlements, adolescent mothers struggle with access and utilizing of the ANC services due to the social determinants that are a challenge to them. 11% of adolescents’ attend for ANC services in their first two trimesters, while 14.6% deliver their babies without utilizing any ANC services at all in Nairobi urban slums (Fotso et al., 2008)
The worsening of key demographic and health indicators Maternal Mortality Ratio (MMR) and Skilled Birth Attendance (SBA) call for immediate action to provision of reproductive health services to adolescent mothers (Kenya National Bureau of Statistics and ICF Macro, 2010). There is therefore need for utilization of antenatal care services especially in urban low-income level settings where majority of the adolescent girls don’t transit to secondary education after completion of primary level. Recent studies done in
the urban informal settlements targeting adolescent mothers are minimal and so this will help the government in their new plan of free ANC services to all mothers in Kenya.
Research Questions of the study
The study sought to answer the following questions:
- What is the extent of ANC utilization among adolescent mothers in Mathare valley informal settlements?
- What factors influence adolescent mother’s utilization of ANC services in Mathare Valley informal settlements?
Hypothesis of the study
Socio-demographic, cultural, economic and facility factors are not associated with utilization of ANC services among adolescent mothers in Mathare Valley informal settlements.
