| dc.description.abstract | Optimal antenatal care (ANC) uptake is critical for improving maternal and neonatal health outcomes. Despite global efforts to promote ANC, maternal and neonatal mortality rates remain high. In Kenya, neonatal mortality stands at 21 deaths per 1,000 live births, emphasizing the need to enhance ANC uptake. In Changamwe Sub-County, data from the MOH 711 digital reporting tool revealed persistently low adherence to the recommended eight ANC contacts, alongside rising fresh and macerated stillbirths and fluctuating maternal deaths. This study assessed the determinants influencing ANC uptake among prenatal mothers in Changamwe, Mombasa, Kenya. Specifically, the study examined the role of community health promoters, the quality of ANC services, health need-related factors, and household status in determining the completion of eight ANC contacts. A mixed-method research design incorporating both qualitative and quantitative approaches was employed. The target population included postnatal mothers attending maternal child health clinics in public health facilities and maternal child healthcare clinic nurse managers as key informants. A total of 370 mothers and 4 nurse managers participated in the study, selected using purposive and simple random sampling techniques. Data collection involved structured questionnaires for mothers and key informant interviews with nurse managers. Descriptive statistics were used to summarize the findings, while correlation and multiple regression analyses assessed relationships between study variables. The results indicated that household status, health need-related factors, and the quality of ANC services significantly influenced ANC uptake. Specifically, household status was positively associated with ANC uptake (β = 0.45, p = .002), indicating that increased support within the household correlates with higher ANC attendance. Health need-related factors also showed a significant positive relationship (β = 0.38, p = .005), suggesting that mothers with greater health needs are more likely to attend ANC services. The quality of ANC services was another significant predictor (β = 0.42, p = .003), emphasizing the importance of service quality in encouraging ANC visits. However, community health promoters had no statistically significant impact on ANC uptake (β = 0.10, p = .08). Based on the findings, the study recommends strengthening household support systems by involving spouses in ANC education and empowering women in healthcare decision-making. Enhancing ANC service quality through respectful care, skilled provider training, and ensuring reliable supply chains for ANC commodities is also advised. Addressing health need-related barriers by promoting early screening for pregnancy complications and increasing maternal health literacy is crucial. Additionally, re-evaluating the role of community health promoters through targeted training, supervision, and structured home visit and referral frameworks is necessary. Implementing broad community sensitization campaigns to boost awareness and dispel myths surrounding ANC. Further research on community health promoters’ effectiveness in ANC promotion within varied contexts and explore the underlying factors contributing to the low rate of antenatal care (ANC) initiation before 12 weeks of gestation recommended. These recommendations underscore a need for multi-level interventions ranging from household empowerment to service delivery improvements to increase ANC uptake and ultimately reduce maternal and neonatal morbidity and mortality. | en_US |
