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CHAPTER ONE:
1.0 Introduction
This chapter covers the study’s background, problem statement, objectives, research questions, scope, and significance.
1.1 Background
Delayed antenatal care (ANC) attendance beyond 12 weeks of pregnancy is an increasing global health issue (Acup et al., 2023). Annually, 303,000 maternal deaths occur due to pregnancy and childbirth complications, with 99% happening in sub-Saharan Africa (Ekholuenetale, 2024). Worldwide, the estimated first ANC attendance within 12 weeks is 58.6%, with developed countries having higher coverage (84.8%) compared to developing countries (48.1%) as of 2013. South Asia faces similar challenges, while the U.S. reports 10–15% of women miss first-trimester care, and in Europe, rates are often below 10% (Chilo, 2023).
In East Africa, ANC attendance within the first 12 weeks ranges from 8.9% to 50%. In Uganda, only 34% of women attended their first ANC visit within the first trimester, as of the 2017 Uganda Demographic and Health Survey (UDHS), leaving 66% without early ANC (Magqadiyane, 2022). Complications arising from delayed ANC include preterm birth, low birth weight, stillbirths, and maternal mortality, all of which hinder progress toward achieving Sustainable Development Goal 3.
The World Health Organization (WHO) recommends ANC contact within the first 12 weeks of pregnancy, with subsequent visits for risk identification, health education, and the management of pregnancy-related conditions (Abera et al., 2023). However, various barriers impede timely ANC attendance. These include financial constraints, indirect costs like transport, and low maternal education levels that hinder awareness about early ANC benefits (Magadi, Madise, & Rodrigues, 2000; Titaley, Hunter, Dibley, & Heywood, 2010).
Despite interventions from Uganda’s Ministry of Health, such as free ANC clinics, trained health workers, and community mobilization, first ANC attendance within 12 weeks remains low at 29%, contributing to negative maternal and neonatal health outcomes (UDHS, 2019).
Malaria in pregnancy (MIP) is another critical concern. Malaria increases the risk of preterm birth, low birth weight, and maternal anemia. In 2016, malaria caused an estimated 445,000 deaths worldwide, with 88% occurring in Africa, where pregnant women and children under five bear the greatest burden (Anchang-Kimbi, 2020). Uganda remains one of the highest malaria-burden countries, with the disease responsible for up to 50% of outpatient visits, 20% of hospital admissions, and a high proportion of maternal deaths (Chijioke, 2020).
1.2 Statement of the Problem
Despite global efforts, malaria in pregnancy continues to cause significant maternal morbidity and mortality, contributing to around 10,000 maternal deaths yearly worldwide (Buhuguru Nasanairo, 2021). Uganda, ranked among the highest malaria-burden countries, sees malaria accounting for 50% of outpatient visits among pregnant women and up to 20% of hospital deaths (Chijioke, 2020). Although the government has implemented measures to reduce malaria, such as free ANC clinics and preventive treatments, malaria remains a severe public health issue for pregnant women, with late ANC attendance exacerbating the problem. This study seeks to analyze MIP care among first-time ANC mothers at Mulago National Referral Hospital.
1.3 Objectives of the Study
1.3.1 General Objective:
To analyze the reception of malaria in pregnancy care among first ANC mothers in Uganda.
1.3.2 Specific Objectives:
i. To examine community-related factors for delayed ANC attendance in the first trimester.
ii. To analyze health-related factors contributing to malaria prevalence among pregnant women.
iii. To identify individual factors associated with malaria in pregnant women.
1.4 Research Questions
i. What are the community-related factors for delayed ANC attendance in the first trimester?
ii. What health-related factors contribute to malaria prevalence among pregnant women?
iii. What individual factors are associated with malaria in pregnant women?
1.5 Scope of the Study
1.5.1 Time Scope:
The study will be conducted in 2024 and 2025.
1.5.2 Content Scope:
The study will explore community-related factors influencing delayed ANC attendance, health-related factors for malaria prevalence, and individual factors contributing to malaria in pregnant women.
1.5.3 Geographical Scope:
The study will be conducted at Mulago National Referral Hospital.
1.6 Significance of the Study
This study is crucial for understanding the factors influencing late ANC attendance and malaria in pregnancy, which remain significant challenges to maternal and neonatal health in Uganda. Findings will inform healthcare providers and policymakers, offering insights to improve ANC services, reduce maternal and neonatal morbidity, and help achieve better health outcomes aligned with Sustainable Development Goal 3.
