الفهرس 
Distribution of the Health Directorates based on Dropout from Antenatal Care Visits Schedule 2019 in El-Beheria GovernorateOnly 14 pages are availabe for public view
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Abstract
Antenatal care is the main point of contact for pregnant women to receive a wide range
of services to promote the health of both mother and baby. Antenatal care is most effective
when it starts early and continues throughout pregnancy. Pregnant women who dropout from
ANC visits is considered at risk of potential complications during their pregnancy, and these
complications can include maternal health, fetal health, or both. WHO recommends that
pregnant women receive at least four antenatal care visits, and that ANC be provided by health
care providers from the time of conception to the onset of delivery. However, pregnant women
dropout of the ANC follow-up schedule, which is a noticeable problem in PHC facilities in
Beheira Governorate. Hence, the present study aims to assess factors associated with pregnant
women’s dropout from antenatal care visits in primary health care facilities.
A descriptive, retrospective research design was used to carry out this study. It had been
carried out in eight governmental primary health care facilities (4 urban health centers and 4
rural health units) in 4 health directorates in El Beheira Governorate namely: Kafer El-Dawar,
Abo Homs, Damanhour and Kom Hamada by using an equal allocation technique based on the
highest number of pregnant women’s dropout from antenatal care visits to be included in the
study.
The present study sample included a total of 354 women who were selected randomly
from each of the previously selected primary health care settings.
Tools of the Study
Two tools were used to collect data in this study; Tool (I): Antenatal Care Dropout
Related Factors Structured Interview Schedule, it was modified by the researcher after
reviewing the recent literature and translated into Arabic language. It is composed of 3 parts:
1st part: women’s factors, 2nd part health care provider factors and 3rd part community factors.
Tool (II): Women’s Satisfaction by Antenatal Care Services Structured Interview
Schedule, RATER model was adopted and translated into the Arabic language. It is divided
into: Reliability, Assurance, Tangibles, Empathy and Responsiveness.
Study tools were tested for validity and reliability. Approvals were obtained for
conducting the study at the specified settings. A pilot study was carried on 35 women to test
the developed tool. The study was conducted over a period of 5 months (from the beginning of
January 2021 to the end of May 2021). Data was collected by the researcher then appropriate
descriptive and analytical statistics were carried out.
The main results obtained from the study were as follows: -
• Part I: Descriptive data of pregnant women’s dropout from antenatal care visits in
their previous pregnancy
Women’s factors (socio-demographic & obstetric characteristics):
- Age of the studied women ranged from 18 to 45 years with a mean of
(27.71 ± 7.66) years, the vast majority (98.0%) of the studied women were married, and
more than half (53.4%) of the studied women were living in rural areas.
- More than two fifths (44.3%) of the studied women had basic education, the majority
(91.0%) of the studied women were housewives, nearly two fifths (39.3%) of the
women’s husbands had secondary education, the majority (95.5%) of the women’s
husbands were working and more than half (57.6%) of the participants stated that they
had enough income to meet the demands of their lives.
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96
- The highest percent (51.1%) of the studied women had gravidity three or more and more
than one third (36.7%) of the studied women had pregnancy complications.
- Nearly three quarters (73.7%) of the participants reported that their mode of delivery was
Caesarean Section (CS), most of the studied women (80.5%) preferred to receive their
ANC visits from private clinics in their previous pregnancy, more than half (53.1%) of
them initiated their ANC visits in the 2nd trimester in their previous pregnancy, and most
of the studied women (81.9%) received inadequate ANC (less than 4) visits in their
previous pregnancy.
Health care provider factors:
- Concerning registration, the highest percent (70.1%) of the studied women reported that
waiting time wasn’t appropriate and less than two thirds (61%) of the studied women said
that the health care provider’s communication was inappropriate during their last
pregnancy.
- Concerning history taking, the highest percent (40.4%) of the studied women reported
that the health care provider didn’t ask them about their family history and nearly one
third (31.1%) of them weren’t asked about their gynecological history during their last
pregnancy.
- Concerning physical examination, the highest percent (79.1%) of the studied women
complained that the uterine fundus examination wasn’t entirely performed, nearly three
quarters (74.9%, 72.3%) of the studied women reported that the position of fetus
examination wasn’t perfectly carried out and the ultrasound examination wasn’t done
during their last pregnancy respectively.
- The same percent 71.8% of the studied women mentioned that the fetal heart sound
examination and dental examination service weren’t entirely conducted, and more than
half (58.2%) of the studied women reported that the consultation time was rather
inappropriate during their last pregnancy.
• Concerning laboratory investigations, more than one third (34.5%) equal percent of the
studied women said that the albuminuria test, and glucosuria test weren’t done, and more
than one fifth (20.9%) of the studied women complained that the Rhesus factor (Rh) test
wasn’t implemented during their last pregnancy.
• Concerning health education, the majority (93.5%, 92.9%, 86.7%) of the studied women
reported that the health care provider didn’t give them any information about the
importance of ANC follow-up visits, a balanced diet, or the ANC visits schedule
respectively. And more than two thirds (67.8%) of the studied women reported that the
health care provider didn’t give them any instructions about danger signs.
• Nearly two thirds (65.5%) of the studied women said that the health care provider’s
information was unclear, and less than two thirds (63.6%) of the studied women claimed
that they didn’t get any information about ANC services.
• The majority (92.9%) of the studied women reported that their follow-up visits were
irregular, more than three quarters (82.2%) of the studied women reported that they
weren’t informed about the follow-up results, and more than two thirds (69.5%) of the
studied women complained that the health care provider didn’t conduct any home visits
in their previous pregnancy.
• The highest precent (59.0%) of the studied women had an average ANC visit dropout
related to health care provider factors.
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97
Community factors:
▪ The highest precent (57.9%) of the studied women indicated that they didn’t get any
support from their husbands and family, more than half (51.1%) of the studied women
reported that they had a problem with the accessibility to (Primary Health Care) PHC
facilities, more than one third (37.6%) of the studied women reported that the cost of
transportation wasn’t affordable, and only 15.0% of the studied women reported that the
cost of ANC service wasn’t affordable.
▪ The highest precent (52.6%) of the studied women had a low ANC visit dropout rate
related to community factors.
Women’s Satisfaction with the Quality of Antenatal Care Service:
• More than two thirds (68.9%) of studied women had a low level of satisfaction, and only
(1.2%) of them had a high level of satisfaction.
Part II: Relationship between Studied Variables:
• A statistically significant relation was existed between dropout from ANC visits and
women’s age ( 2 =18.637, p<0.001*), place of residence (2 =31.180, p<0.001*),
women’s education ( 2 =109.665, p< 0.001*), husband’s education ( 2 =15.336, p=
0.002*), women’s occupation ( 2 =5.312, p= 0.021*), husband’s occupation ( 2 =7.882,
MCp = 0.011*), socio-economic level ( 2 =12.348, p= 0.002*), gravidity ( 2 = 11.528,
p= 0.003*), parity (2 = 9.341, p= 0.006*), living child (2 = 5.954, p=0.015*), mode of
delivery (2 = 5.086, p=0.024*), place of antenatal care visits (2 = 19.069, p <0.001*)
and time of initial antenatal care visits (2 = 46.685, p <0.001*).
• Furthermore, communication of health care provider (2 = 26.724, p <0.001*), treat in a
respectable manner (2 = 68.055, p <0.001*), waiting time (2 = 68.055, p <0.001*),
medical procedures explanation (2 = 10.016, p=0.002*), ultrasound examination (2 =
35.424, p<0.001*), level of uterine fundus examination (2 = 8.045, p=0.005*), dental
examination (2 = 8.045, p=0.005*), consultation time (2 = 4.113, p=0.043*), health
education about the importance of ANC (2 = 15.718, p<0.001*). clear information (2 =
5.329, p=0.021*), danger signs (2 = 13.411, p<0.001*), balanced diet (2 = 5.833,
FEp=0.027*), taking prescribed medicines (2 = 11.845, p=0.001*), follow-up
appointments (2 = 6.385, p=0.012*), ANC follow-up results (2 = 66.651, p<0.001*),
home visits (2 = 9.871, p=0.002*), accessibility to primary health care facilities (2 =
54.511, p<0.001*), affordability of transportation (2 = 13.839, p<0.001*), husbands and
family support (2 = 20.188, p<0.001*) and overall studied women’s satisfaction (2 =
27.710, MCp<0.001*)
Part III: Most different risk factors associated with pregnant women’s dropout from
antenatal care visits:
• Finally, the most independent high-risk factors associated with pregnant women’s dropout
from ANC visits in primary health care facilities, working women (OR = 21.101,
p=0.009*), studied women who reported that PHC facilities inaccessible (OR = 16.023,
p<0.001*), ANC follow-up unscheduled (OR = 11.491, p=0.002*), those who were
unsupported from husband and family (OR = 8.117, p<0.001*), respondents who were
living in rural residence (OR = 8.078, p=0.002*). Moreover, studied women who had a
low class (OR = 6.535, p=0.006*), who reported that ultrasound examination not done
(OR = 6.427, p=0.001*), who preferred ANC follow-up in private clinic (OR = 5.889,
p=0.005*), women’s who had a Low level of education (OR = 5.411, p=0.001*), and who
had a low level of women’s satisfaction (OR = 4.590, p=0.008*).
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Conclusion and Recommendations
Based on the results of the present study, it could be concluded that: It’s worth noting
the high dropout rate from antenatal care services in El-Beheira Governorate. The result of the
present study shows that the majority of the mothers who attended ANC visits initiated them
later than recommended by WHO, additionally, the majority of the participants received fewer
than four ANC visits.
Both women’s factors, health care provider factors and community factors are associated
with dropout from ANC visits and most of these factors are preventable. There was a significant
relationship between dropout from ANC visits and studied women who were working, who
reported that PHC facilities were inaccessible, ANC follow-up was unscheduled, unsupported
by husband and family, respondents who were living in rural residence, who had a low socio-
economic class, had a low level of education., assumed that ultrasound examination wasn’t
done, preferred ANC follow-up in a private clinic, and had a low level of women’s satisfaction
Based on the current study findings the following recommendations are suggested:
➢ Recommendations directed to the Ministry of Health& Population (MOHP):
1. Support the implementation of the “Maternal and Fetal Health” presidential initiative in
various PHC facilities all over the Egyptian country.
2. The existence of evidence-based practice guidelines that help health care providers who
are working in antenatal clinics is beneficial for patients and healthcare systems.
➢ Recommendations for the Directorate of Health and Population
1. Continue its efforts to establish and improve health campaigns focusing on the health
of pregnant women and their unborn children.
2. Implementation of health education programs in primary health care settings to improve
their knowledge and skills to ensure their compliance with antenatal guidelines.
3. Reinforce the regular supervision of nurses in the antenatal clinics to ensure that they
comply with antenatal guidelines.
➢ Recommendations for the health directorate
1. A monitoring system should be established to ensure the smooth functioning of the
referral process for pregnant women and to detect any problems or rights violations.
2. The ANC clinics should be prepared with the required equipment and medical supplies
to guarantee the provision of good ANC services.
3. Increase the number of ANC clinics and the number of health care providers in PHC
facilities in order to decrease waiting times and increase provider contact times.
4. Minimizing waiting time and keeping the waiting area uncrowded is a good way for
healthcare practices to better satisfy pregnant women. This also makes healthcare
providers work without any inconvenience to women and their companions.
➢ Recommendations for healthcare providers
1. Health education programs should be initiated for those target men to create awareness
about the importance of ANC services in PHC facilities and why they should involve
themselves in ANC.
2. Health educators should include the minimum and maximum ANC contacts, pregnant
women are supposed to have according to the WHO recommendations in their education
and promotion sessions.
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3. More attention should be given to pregnant women, especially with their increasing age
to conduct their ANC visits on time.
4. Encourage pregnant women who first time ANC visitors to increase the chance for a
return ANC visit and recommended for other.
➢ Recommendations for mothers
1. ANC visit should be started as soon as a pregnancy is detected.
2. Pregnant women should be asked about their rights and asked for help if needed.
➢ Recommendations for further research
1. Further study is proposed to investigate the ANC nurse’s performance in primary health
care facilities.
2. Further study is needed to design awareness program to improve pregnant women
attendances ANC services in primary health care facilities.