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CHAPTER 1

1.0 BACK GROUND INFORMATION

Antenatal booking is the first visit by a pregnant woman to the health facility for the purpose of

initiating antenatal care services. Early booking into antenatal is very cardinal because it provide

an opportunity for the health care provider to detect and treat pregnancy- related factors that may

lead into complications as well as increase positive patient outcomes. Currently Zambia has

recorded a reduction in maternal mortality rate which stand at 278 deaths per 100,000 live births.

This has been viewed as a reduction but the number is still alarming. Generally, identified factors

which contributes to maternal mortality includes: late antenatal booking, antepartum

haemorrhage, medical conditions such as (pregnancy induced hypertension, diabetes mellitus,

anaemia, cardiac conditions) early pregnancies (pregnancies in the under age), multiple

pregnancies unsafe abortions and many more. According to the latest update from the Zambia

national health demographic survey conducted in the year 2017, reveals that late antenatal

booking amongst pregnant women is the major contributing factor to maternal mortality. Being

the leading Couse of mortality, late antenatal registration if studied well and properly addressed,

may reduce maternal mortality.

Baker (2012) states that when a woman books early into antenatal care, it makes it feasible for

accurate estimation of gestational age. This will empower the health care provider with an

opportunity to evaluate the pregnant woman by identifying risk factors which should be

eliminated in order to promote a safe and healthy delivery. According to the safe motherhood

guidelines, it is advisable that a pregnant woman report to the health facility as soon as she feels

she is pregnancy for early identification and further technical health advice. This is also

highlighted in the World organization recommendations. Villar, J. (2002) recommend that

pregnant women should access ANC services as soon as they realize that they are pregnant and

this should be before twelve weeks of gestation. Any pregnant woman registering for her first

time after 12 weeks of gestation is considered to register late or late booking. This would mean

that such women may not have the opportunity to benefit from screening tests, antenatal

education and health advice, or supported decision-making regarding the place and choice of

delivery, Baker-(2012). Late booking has been linked to increased infant and maternal morbidity

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and mortality. This is because such women, report to the health facilities with already developed

complications that may be difficulty to control or manage due to various factors.

Globally, women who do not utilize antenatal care services are about 45 million in which the

bigger number is in sub-Saharan Africa, WHO (2012). Antenatal care is key strategy to

improving maternal and infant health globally. However, data from a survey done in sub-Saharan

Africa showed that women often initiate ANC late, therefore they fail to meet the recommended

number of ANC visits, Pell. et al. (2013). In this case, it would mean that such women might

have already missed some appointments which were made or planned with the health care

provider. Such women reports to the health facilities with already developed complications

which comes other cost of management.

Despite antenatal care services being provided free of charge or sometimes at a minimal cost in

Zambia, very few women attend antenatal care by their fourth month of pregnancy as per safe-

motherhood guidelines. As stated earlier on, although Zambia has achieved reductions in

maternal mortality rates, the current levels, are still unacceptably high. Unless additional and

significant efforts are made, Zambia may not attain the desired sustainable development goal

(SDG) number 3 targets by the year 2030. There is thus need to re-examine current efforts and

approaches in order strengthen or propose other interventions which should aim at ensuring that

set targets are achieved. Nyambe (2015) state that, strategies on how to operationalize and scale

up these interventions is the challenge. Spotted factors that are associated with the high maternal

mortality rate (MMR) in Zambia to be specific include challenges to accessing services (1st and

2nd delays), cultural factors, poor referral system, transport difficulties late ANC booking and

other factors. Poor antenatal coverage contributes to high levels of maternal mortality. Narrowed

down to Mwansabombwe district, the situation is not deferent. Late antenatal booking among

pregnant women is as high as 60% of the total number of pregnant women who registered in the

1st and 2nd quarter of 2018 (Mwansabombwe District-HMIS 2018)

1.2 PROBLEM STATEMENT

Perspectives of pregnant women on late ANC registration have been extensively studied

globally, internationally and locally. Findings include: health systems related factors, patient

related, social – economic, individual perceptions and knowledge, HIV and AIDS among many

are found to be the leading cause. However, various recommendations have been made in

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response to the findings such as deployment of various skilled personnel in the area of maternal

health to improve on human resource, increase and improvement of infrastructures, empowering

women and families and many more. These measures have been implemented in various

countries (Zambia inclusive) at various levels of obstetric care services successfully. Beside the

success in the implementation of such measure, the trend is still being observed in different

places more especially in rural places such as in Mwansabombwe district of Luapula province

Zambia. According to the desk reviewed data for the complete year of 2018, the catchment

population for the district was 55,478 representing (100%) based on Central Statistics Office’s

guide (CSO), 2,996 women registered for the first ANC registration representing 5.4% of the

total catchment population, 1029 pregnant women registered before 14 weeks of gestation

representing 34.5% and 1967 pregnant women registered after 14 weeks representing 65.7%. –

Zambia HMIS (2018). According to the guidelines 65.7% pregnant women registered late for

ANC services. Late ANC contribute largely to the maternal and prenatal mortality –Nkumbula et

al (2018). According to the Zambian daily mail dated 5th September 2019, the Zambian

government declared maternal and prenatal mortality as a public health emergency. Therefore,

prevention of maternal and prenatal mortality needs informed decisions from studies such as this

one which aimed at exploring women perspectives and further provide more information on how

pregnant women perceive late ANC booking. This study will largely provide evidences

pertaining to the women’s general perspective and perceptions concerning late ANC booking

which will help decision makers to make informed decisions that will help in the prevention of

complications that comes as a result of late ANC booking.

1.3.1 GENERAL OBJECTIVE

To determine the pregnant women’s perspectives towards late ANC registration in

Mwansabombwe rural district of Luapula province - Zambia.

1.3.2. SPECIFIC OBJECTIVES

Mwansabombwe district.

women in the district.

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To investigate the level of awareness on dangers of late antenatal registration amongst

pregnant women in the district.

rative/managerial and policy level measures that

could be put in place to reduce late ANC registration in the district.

1.4. RESEARCH QUESTIONS

specific factors contributing to late antenatal care registration in the

district?

antenatal registration in the district?

munity, administrative/managerial and policy level

measures that could be put in place to reduce late ANC registration in the district?

1.5. STUDY SCOPE

This study was confined to the selected clinics while in Mwansabombwe district. Communities

including relevant local neighborhood health catchment zones while targeting women that have

given birth before who were the study participants.

1.6 THEORETICAL FRAMEWORK - HEALTH BELIEF MODEL

The following theoretical framework is extracted from the Health Believe Model (HBM) which

was developed by Godfrey Hochbaum, Irwin Rosenstock and Stephen Kegels in 1950 and

revised in 1974. Later improved by Leventhal, Rosenstock, (1960) improved again by Becker

(1974).It has been adopted to help analyzing data related to general and specific objectives stated

above. It will be used to analyze individual pregnant women perceptions, modifying factors and

likelihood of action factors- Rosenstock et al (1974). The model addresses the individual’s

perceptions of the threat posed by a health problem like susceptibility and severity as well as

factors influencing the decision as explained below:

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PERCEIVED BENEFITS - This refers to a person's perception of the effectiveness of various

actions available to reduce maternal complications that comes as a result of late antenatal

registration – Rosenstock et al (1974). According to Rosenstock, the course of action a person

takes in preventing or curing an illness or disease relies on consideration and evaluation of both

perceived susceptibility and perceived benefit. This will help in determining women perception

of the effectiveness of their actions in order to reduce late ANC booking.

PERCEIVED BARRIERS – This refers to a person’s feelings on an obstacle to performing a

recommended health action – Rosenstock (1974). The model further states that, there is a wide

variation in a person's feelings of barriers, or impediments which lead to a cost/benefit analysis.

This will be applied to determine pregnant women perceptions on the obstacles which hinder

them from seeking early ANC registration. The model further states that, a person weighs the

effectiveness of the actions against the perceptions that it may be expensive, dangerous (e.g., side

effects), unpleasant (e.g., painful), time-consuming, or inconvenient.

PERCEIVED SUSCEPTIBILITY - This refers to a person's subjective perception of the risk

of acquiring an illness or disease. E.g. a person who sun bathes every day and does not believe

that he is at risk of skin cancer- Rosenstock (1974). This will help in understanding the women

perception on late ANC including the risk factors. The model further state that, if a person

believes he is at risk of an illness he is likely to do something about it. Hence if pregnant women

who register late for ANC believes they are at risk of complications, then they would suggest

something that they expected to do to prevent late ANC registration. Furthermore, Rosenstock

stated that, there is a wide variation in a person's feelings of personal vulnerability to an illness

or disease. Therefore, this will help in analyzing women perception involving their vulnerability

to late ANC registration.

SELF-EFFICACY - This refers to the level of a person's confidence in his or her ability to

successfully perform a behaviour – Rosenstock et al (1974). He further said that, Self-efficacy is

a construct in many behavioural theories as it directly relates to whether a person performs the

desired behaviour. This will help in assessing the pregnant women’s effort to start early ANC

booking.

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CHAPTER 2

2.0. LITERATURE REVIEW

This section gave an account of what other researchers had contributed to understanding of

women perceptions towards late antenatal booking and the extent to which they have addressed

perceptions of women on late antenatal registration.

WOMEN PERSPECTIVES ON LATE ANTENATL CARE (ANC) REGISTRATION

PERCEIVED NEED TO KEEP EARLY PREGNANCY SECRET.

Keeping the pregnancy secret has been a trend in many societies especially in rural areas of

developing countries. This is due to various reasons of which some are related to religion,

tradition, culture and many more. According to the study conducted by Nelly (2019), most

women become so reluctant to disclose a pregnancy before 12 weeks gestation and initiation

antenatal due to cultural beliefs about vulnerability of pregnancy in the early stages and the need

to safeguard the pregnancy by keeping a secret from friends, family and the general public. Early

attendance of ANC services requires disclosure of the pregnancy and ANC booking therefore is

postponed until disclosure is inevitable – Nelly et al (2019).

PURPOSEFUL POSTPONEMENT OF ANC BY MULTIGRAVIDA WOMEN

It is said experience is the best teacher. This has sunk deep in most of our older women who

believe to know it all. After going through a lot of ANC sessions for the previous pregnancies

and mastered what happens at ANC clinics, they tend to postponed ANC booking and sometimes

not booking at all. Some consider themselves as experts reaching an extent of conducting

deliveries for the young ones at home. According to Annesa et al (2019), women with previous

pregnancies, especially older women, do not value ANC services in early pregnancies and

purposefully postponed ANC attendance. This is attributed to women perceived experience and

knowledge gained in prior pregnancies – Annesa et al (2019). Further, the study reveal that

negative ANC experiences during previous pregnancies such as congestions and being shouted at

by the staff among many, retained for too long at the facility luck of support especially those

women are not married and many more are important deterrent to early ANC attendance among

older women. As a result, women prefer to book late for ANC in order to avoid going through

the some experience.

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PERCEIVED KNOWLEDGE ABOUT THE BENEFITS OF ANC

They say knowledge is power, because it empowers someone to be involved in carrying out a

particular activity willingly. With full knowledge about the benefits that comes with early ANC

registration pregnant women may be very much willing to participate in the early initiation of

ANC. According to Moola, most women who initiate ANC late do not perceive any benefits

from early ANC registration- Moola et al (2018). He further state that pregnant women believe

that ANC booking is only to receive the antenatal cards. The study further reveals that women

have a common perceptions that early booking led to more visits, hence prefer less visits by

postponing ANC attendance. Similar findings were reported in a study by Jewkes at al (2018)

where women did not perceive benefits of early booking and risks associated with late ANC

bookings. According to Jewkes, most pregnant women perceive pregnancy as natural

physiological process hence postponed ANC visits until any medical condition force them to

visit a health facility. According to Mayer and Harrison (2017), women do not perceive

pregnancy as an immediate health risk and their views are that, early booking is not necessary.

UNAVAILABILITY AND INACCESSIBILITY OF OBSTETRIC CARE SERVICES

Unavailability and inaccessibility of obstetric care services has been a challenge affecting most

developing countries. These include inadequate logistics such as drugs, inadequate infrastructure

leading into pregnant women covering very long distances to access obstetric care centers.

According to the study conducted by Onoya et al (2017), some pregnant women postponed their

ANC visits because of unavailability and inaccessibility of health services. Rural areas are

known to be poorly resourced and have fewer skilled health care workers. As a result, pregnant

women postponed their ANC visits in order to reduce on burdening the fewer health workers

who they feel are angered by too much pressure of work and reduce on the demand for logistics.

STIGMA RELATED PERCEPTIONS

Stigma related to HIV/AIDS is still a very big challenge in most countries. It is worse in rural

areas where sensitizations have not reached most of the people. Being a mandate that all

pregnant mothers have to be tested, most women shun ANC services for fear of being diagnosed.

According to the study conducted by Sibeko and Moodley, most women who are found to be

living with HIV are often reluctant to share the information with their partners and families.

They fear discrimination, stigma, violence, abandonment and other social consequences. Sibeko

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further reveal that women becomes so reluctant to initiate early ANC clinics to avoid HIV test

because the HIV test is part of PMTCT, hence women postponed ANC visits to avoid HIV

testing because they fear losing their partners if they disclose their HIV statuses - Sibeko and

Moodley (2019).

INDIVIDUAL PERCEPTIONS AND KNOWLEDGE

Perception differ from person to person. Persons with more information or knowledge about

something perceives situations differently compared to those with low level of understanding or

with little information. Pregnant women with low levels of education perceives ANC services to

be of no value as compared to women who are educated. Haddrill said, experiences of past

pregnancies had a direct impact on the timing of ANC bookings – Haddrill et al (2017). In his

study, he found that pregnant women who had low levels of education postponed their ANC

visits because they did not perceive any benefit from early ANC booking. The study further

reveals that women with low levels of education who attended ANC in the previous pregnancy

did not do it again. As a result luck of basic education leads some of the pregnant women not to

perceive the pregnancy as requiring ANC and medical attention.

TRAVEL COST, LOSS OF INCOME AND WORK COMMITMENTS

Travel costs, loss of income and work commitments are among many factors that contribute to

pregnant women to perceiving ANC services being an option and not a priority- Mongwenyana

et al (2017). This is due to fear of getting tired as a result of covering long distances to access the

health facilities. Others believe that when they fall pregnant, that’s the time to moving around

looking for money to prepare for baby. This is common to the single women – Mathias et al

(2016). To some extent, even those who are married when they fall pregnant unexpectedly, they

go into panicking in order to prepare for what was not planned for. It is a well-known fact that

travelling cost in initiating ANC services for pregnant women remain adherent to subsequent

visits more especially in developing countries particularly in rural and remote areas –

Mongwenyana et al (2017). According to Mongwenyana, employed women straggle to book

early for ANC because of work commitments. He said, employed women from the communities

that they serve could not have maternity benefits or paid leave to attend ANC. As a result, unless

physically unwell, attending ANC is of lower priority compared to other pressing

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responsibilities. Therefore, in order to save some money that could be used for transportation

women preferred to book late for ANC or even not book at all.

PARTNER NEGLECT AND LOSS OF SUPPORT

Partner neglect and loss of support is among challenges pregnant women faces in most countries

more especially in developing countries where the poverty levels are high. Both women in

marriages and those in relationships does everything possible to please their partners to the

extent of not booking for ANC if they are not told to do so. According to Isaac (2016) some

unmarried women’s opinion are that, fathers of the babies’ loose interest in them on early

disclosure of pregnancies. Therefore, many women do not want to disclose their pregnancy

because they fear loss of support from the partner. They tend to hide their pregnancy in a view to

delaying ANC registration that favors them to enjoy support from their partners – Isaac et al

(2016).

OVERCROWDING AT THE CLINICS AND LONG QUEUES

Inadequate infrastructure in most developing nations result into congestions at the obstetric care

facilities and these discourages pregnant women from registering early for ANC services- Banda

(2011). In many countries mostly developing countries, women endure long waiting times and

sometimes turned away because of limited staff to attend to them - W.H.O. (2017) .In some

cases, clinics imposes daily quota and turn away women who come after the quota is reached –

Constance et al (2018). These among many other discouraging decisions make women to book

late so that they reduce on the contact and avoiding frequent disappointments.

SOCIAL ECONOMIC FACTORS

Social – economic factors remain a challenge impacting negatively in early ANC booking for the

pregnant women. According to Daniel et al (2017) women choose to seek antenatal care at the

time convenient for them depending on their social circumstances, community perceptions and

health care provider related issues. The social circumstances are financial dependence on others

and easy accessibility of health care facility. Financially insecure women find it difficult to make

their own informed decisions on their pregnancies. As a result pregnant women prefer to delay

ANC registration so that they give time for their partners or guardian who may be planning for

abortion. Early initiation of ANC services would make the pregnancy known to the public.

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CHAPTER 3

3.1.0 RESEARCH METHODOLOGY

This section dealt with the means to answer the research questions and a justification as to why

this was the best available means.

3.1.1 RESEARCH DESIGN

This section provided a guide that was used to come up with the right answers to research

question. It is a systematically guides the processes the collected data, analysis and

interpretation. This qualitative study is aimed at exploring pregnant women’s personal

experiences about late ANC booking as well as their preferred actions and suggestions which

they feel when implemented by various stakeholders could help them register early for antenatal

care services thereby reducing maternal/neonatal mortalities related to late ANC registration.

3.1.2. SOURCE OF DATA

Data was collected directly from the participants (primary data) using a pretested structured

questionnaire that was administered through contact interview with the participants while in the

research area. Women’s perspectives on late ANC booking was assessed using a number of

questions organized in a questionnaire that was well designed. Three data collectors and one

supervisor was engaged during data collection period.

3.1.3. TARGET POPULATION

The target population which is the total group of individuals from which the sample was drown.

Participants are a group of people who took part in the study. The district has 6 operational

health facilities where reproductive health services are provided. These facilities have different

catchment populations which were targeted for this study. Of the six (6) only 5 facilities were

randomly selected for this study. 30 women from each randomly selected health facility were

picked to come up with a total of 150 participants who were interviewed. The study population

was composed of women aged 16 to 45 years who have delivered before to be interviewed

during primary data collection.

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3.1.4. INCLUSION CRITERIA

Refers to the technique used to select eligible participants to be included in the study. And the

following were criterion.

-45 years were interviewed using the women’s questionnaire in

the selected catchment areas during the study.

rs period preceding the study.

ANC in their last pregnancy within five years preceding the study.

emale respondents who remembered the number of months their pregnancy was when they

first received ANC evidenced and those who answered appropriately to the question that was

asked on how many months pregnant they were when they first received ANC.

3.1.5. EXCLUSION CRITERIA

Refers to the technique used to exclude participant before the interview or before data analysis

based on certain factors as outlined below.

Female respondents who had not been pregnant during the five years preceding the study or

those who answered ‘NO’ to the question whether they had fallen pregnant during the five years

preceding this study.

analysis)

to be interviewed during the survey.

3.1.6. SAMPLE SIZE

This referred to the number of participants that were drawn from the total population for research

purposes. This included all women who met the inclusion and exclusion criteria that was, history

of a live birth during the five years preceding this study, attended ANC for their last pregnancy

which resulted in a live birth and could remember the number of months they had their first

antenatal care visit to the health facility. The total number of participants were 150.

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3.1.7. DATA EXTRACTION AND CLEANING

All the information required for the analysis was obtained directly from the participants (primary

data). The individual recoding contained all the responses to the woman’s questionnaire used

during the data collection (interview). Only variables that were important for analysis were kept

as part of the data cleaning process.

The outcome variable was women’s perception on late ANC booking. The predictor variables

were checked for completeness and only those variables with complete information were

included for analysis. The predictor variables that were checked for completeness were the

respondent’s age, education level, number of years of education, previous pregnancies, number

of registered pregnancies, knowledge on the importance of early ANC booking economic status

and ideas on why some women register late for ANC and suggestions to the role of women in

reducing late ANC booking as well as health care satisfaction.

3.1.8 SAMPLING METHODOLOGY

Sampling referred to a technique in which a part or subset of a population (a sample) was

systematically selected for this study. The results from this sample were generalized onto the

entire population of the District. Systematic/interval sampling: Involves the selection of

participants at equal intervals. Every 5th participant was picked for the interview. Lists was

randomized and not in alphabetical.

3.1.9 RESEARCH INSTRUMENTS USED

The data was well collected using a structured questionnaire which was administered through

contact interview (one to one). Women’s perspectives on late ANC booking was assessed using a

number of questions. The questionnaire was prepared in English and then translated into

icibemba (local language) and later on it was translated back to English. The local language

version of questionnaire was used to collect data.

3.1.10. ETHICAL CONSIDERATION

Ethical approval was obtained from the relevant ethical committee to conduct a study (appendix

IV), while informed consent was obtained from the eligible participants. It was being made clear

to the participants before participation in the study. Furthermore, participant’s confidentiality

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was well maintained throughout the study. Regarding participant’s consent form, information

was explained in the language that the participant understood using the information sheet.

Concerns and questions that the participant had were answered and clarified in simple terms by

using icibemba as a local for those who could read and write, managed to consent orally and

signed the consent form while those who could not read nor write, information were given by the

researcher and the research team members and the and then oral consent got and a thumb print

was used in place of signing on the consent form. No participant was forced to participate in the

study. In order to maintain confidentiality, no information regarding names of the participant was

obtained. Data was only used for the purpose of this study and not given to any person or

organization. Since there was a direct contact with the participant in the study, obvious injury to

the participant was considered and were avoided.

3.1.11. DATA ANALYSIS

Data analysis was done using SPSS software, version 16.0 SE (SPSS Corporation, TX, USA).

Firstly descriptive statistics were used to compare the variables, cross tabulation to determine the

overall distribution of predictor variables in determining women perception on late ANC

booking and then graphical presentation of the determined variables.

Data validity: in order to ensure validity, all variables were covered in the interview schedule.

The questions were clearly constructed to avoid ambiguities

RESULTS

Descriptive statistics of factors used to depict women perception on late ANC booking in

Mwansabombwe district. 150 women were interviewed and overall response rate was 92 per

cent. Of the eligible and successfully interviewed population of all females aged 16 to 49, only

the records of respondents that had completed the interview (n=138), including answering the

information on perception on late ANC booking were included in the final analysis. Of the 138

women47% (66) were in the age group of 26- 35 year which was the majority, 30.4% (42) were

in the age group of 16-25 years and 21.7% (30)women were in the age group of 36 to 45 which

was the least. The frequency distribution of predictor variables for determining women

perception on late ANC booking is summarized in the following tables which are coupled with

charts

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CHAPTER 4

4.0 DATA PRESENTATION

This section gives out the research findings including their meaning or interpretation. This is

done through use of tables coupled with text/explanations to infer/illustrate aggregates or

strength/weakness of opinions or evidence against particular variable or research questions.

Tables will need to have a (table) number and title, and will be accompanied by a brief

explanations (below each table and on the same page) in terms of meaning or interpretation.

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Table 4.0.1: Pregnant women

age groups

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 16-25 42 30.4 30.4 30.4

26-35 66 47.8 47.8 78.3

36-45 30 21.7 21.7 100.0

Total 138 100.0 100.0

Findings on the variable numbered 1.1 (participants age groups)

The total number of 138 women were interviewed. 30.4% (42) were in the age group of 16- 25,

47.8% (66) fall in the age group 26-35 and 21.7% (30) were in the age group of 36-45. The

purpose of this variable was to find out whether age had an influence on the pregnant women

perception on late ANC booking. To some extent, this study revealed a small number of women

in the age group 36-45 who were deceived by experience.

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Table 4.0.2: SPOKEN

LANGUAGES

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid icibemba 129 93.5 93.5 93.5

others 9 6.5 6.5 100.0

Total 138 100.0 100.0

Findings on this variable

93.5% of participants were able to speak icibemba and 6.5 spoke other language in addition to

icibemba. The purpose of this variable was to assess if language has a role in influencing women

perception on late ANC booking. This study revealed that some women had challenges in

understanding some of the useful massages communicated to them by radio, newspapers and

other media since most of the massages comes in English. This was observed in the women who

had low education background and those who have never been to school.

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TABLE 4.0.3:

MARITAL STATUS

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid married 98 71.0 71.0 71.0

divorced 15 10.9 10.9 81.9

widowed 6 4.3 4.3 86.2

single 12 8.7 8.7 94.9

cohabiting 7 5.1 5.1 100.0

Total 138 100.0 100.0

Findings on the variable numbered 2.1 (participant’s marital statuses) 138 participants were

interviewed. 71% of participants were found to be in marriage, 10.9% were in divorce, 4.3%

singles and 5.1 cohabiting. The purpose of this variable was to determine whether marriage had a

role in influencing the women perception on late ANC booking. This study revealed that marital

status plays a role in influencing women perception regarding late ANC booking as it was

observed mostly in singles and those cohabiting who decided to delay booking due to financial

challenges and denial by their partners.

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TABLE 4.0.3:

EDUCATION

BACKGROUND

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid primary 43 31.2 31.2 31.2

secondary 54 39.1 39.1 70.3

college 21 15.2 15.2 85.5

university 4 2.9 2.9 88.4

never 16 11.6 11.6 100.0

Total 138 100.0 100.0

Findings on the variable named pregnant women education background

It was found that 32.2% of participants had reached only primary level, 39.1% reached

secondary level, 15.2% reached collage level, 2.9% reached as far as university level and 11.6%

never been to school. The purpose of this variable was to determine whether education had an

influence over pregnant women perception on late ANC booking. This study revealed that

education back ground.

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TABLE 4.0.4: ECONOMIC STATUS

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid formal employment 35 25.4 25.4 25.4

informal

employment 103 74.6 74.6 100.0

Total 138 100.0 100.0

Findings on the variable (economic status)

It was found that 74.6% of the participants were not in formal employment and 25.4% were in

formal employment. The purpose of this variable was to determine whether economic status had

an influence over pregnant women perception on late ANC booking. It was found that majority

of participants were in informal sector facing so many financial challenges. It was observed that

women in this category delayed booking early so as to reduce on the frequency of visiting the

health facilities and concentrate on doing business in order to prepare for their newborns.

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TABLE 4.0.5. NUMBER OF PREVIOUS PREGNANCIES

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 1 12 8.7 8.7 8.7

2 38 27.5 27.5 36.2

3 26 18.8 18.8 55.1

4+ 62 44.9 44.9 100.0

Total 138 100.0 100.0

Findings on the variable numbered 6.1 (previous pregnancies amongst participants)

Majority of the participants (women) conceived over four times. 44.9% of participants conceived

more than four times, 18.8% conceived three times, 27.5% conceived two times and 8.7%

conceived only one time. The purpose of this variable was to determine the influence of number

of pregnancies over the women perception on late ANC booking. This study revealed that

women with pregnancies took advantage of experiences and decided to delay ANC booking.

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TABLE 4.0.6: TERM PREGNANCIES

N Valid 138

Missing 0

Frequency Percent Valid Percent

Cumulative

Percent

Valid 1 (10/13 reported to reached

term 9 6.5 6.5 6.5

2 ((33/37 reported

pregnancies reached term 34 24.6 24.6 31.2

3 (22/26 reported pregnancies

reached term 32 23.2 23.2 54.3

4 (60/62 reported pregnancies

reached term 63 45.7 45.7 100.0

Total 138 100.0 100.0

Findings on the variable numbered 7.1 (number of pregnancies reached term)

At least majority of participants had pregnancies that reached term. It was found that 10 out of 13

participants who conceived once had their pregnancies reaching term, 33 out of those who

conceived twice had reached term, and 22 out of 26 women who conceived three times had

reached term and 60 out of 62 of those who conceived more than 4 times reached term.

22

TABLE 4.0.7 NUMBER OF PROTECTED PREGNANCIES

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid YES (protected

pregnancies during

ANC

112 81.2 81.2 81.2

NO Unprotected

pregnancies during

ANC

26 18.8 18.8 100.0

Total 138 100.0 100.0

Findings on this variable (reported protected pregnancies)

Over 80% of the total number of those that were registered were protected during ANC services.

The purpose of this variable was to assess women satisfaction of ANC services and the influence

this had on their perception on late ANC booking. In this study, it was observed that, of the few

(educated ones) who managed to register their pregnancies, were happy and perceived early

booking as a reasons to why their pregnancies reached term and up to normal deliveries.

23

TABLE 4.0.8. IDEAS ON THE IMPORTANCE OF PROTECTING A PREGNANCY

THROUGH ANC

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid Yes (has ideas about the

importance of

protecting the

pregnancy

101 73.2 73.2 73.2

No ( no ideas about the

importance of

protecting the

pregnancy during ANC

37 26.8 26.8 100.0

Total 138 100.0 100.0

Findings on this variable (reported protected pregnancies)

Over 80% of the total number of those that were registered were protected during ANC services.

The purpose of this variable was to assess women satisfaction of ANC services and the influence

this had on their perception on late ANC booking. In this study, it was observed that, of the few

(educated ones) who managed to register their pregnancies, were happy and perceived early

booking as a reasons to why their pregnancies reached term and up to normal deliveries.

24

TABLE 4.0.9. NUMBER OF ANC REGISTERED PREGNANCIES

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 9/13 women who had 1

pregnancy registered their

pregnancies

9 6.5 6.5 6.5

31/37 women who had two

pregnancies registered their

pregnancies

31 22.5 22.5 29.0

20/26 women who had 3

pregnancies registered their

pregnancies

20 14.5 14.5 43.5

59/62 women who had 4 or

more pregnancies’ registered

their pregnancies

78 56.5 56.5 100.0

Total 138 100.0 100.0

Findings on the variable numbered 8.1(reported protected pregnancies)

Over 80% of the total number of those that were registered were protected during ANC services.

The purpose of this variable was to assess women satisfaction of ANC services and the influence

this had on their perception on late ANC booking. In this study, it was observed that, of the few

(educated ones) who managed to register their pregnancies, were happy and perceived early

booking as a reasons to why their pregnancies reached term and up to normal deliveries.

25

TABLE 4.1.0. WOMEN WITH IDEAS ABOUT THE IMPORTANCE OF PROTECTING

PREGNANCIES DURING ANC

N Valid 137

Missing 1

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 0-3 months 35 25.4 25.5 25.5

4-6 months 102 73.9 74.5 100.0

Total 137 99.3 100.0

Missing System 1 .7

Total 138 100.0

Findings on this variable (women with ideas about the importance of protecting

pregnancies during ANC

About 73.2 % of the interviewed participants had some ideas about the importance of having a

pregnancy being protected during ANC and 26.8% had inadequate information about the

importance of protected pregnancies. The purpose of this variable was to determine the influence

of ANC service on women perception on late ANC booking. This variable revealed that majority

had some ideas on the importance of having their pregnancies being protected.

26

TABLE 4.1.1. WOMEN WHO HAD THEIR PREGNANCIES REGISTERED FOR ANC

N Valid 138

Missing 0

women

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 9/13 women who had 1

pregnancy registered their

pregnancies

9 6.5 6.5 6.5

31/37 women who had two

pregnancies registered their

pregnancies

31 22.5 22.5 29.0

20/26 women who had 3

pregnancies registered their

pregnancies

20 14.5 14.5 43.5

59/62 women who had 4 or

more pregnancies’ registered

their pregnancies

78 56.5 56.5 100.0

Total 138 100.0 100.0

Findings on the variable numbered 10.1(women who had their pregnancies registered for

ANC)

4 women out of 13 who conceived once had registered the pregnancies, 10 out of 37 women who

conceived twice registered their pregnancies, 12 out of 26 women who conceived three times

registered their pregnancies and 11 out of 69 who conceived more than 4 times had registered

their pregnancies. The purpose of this variable was to determine the influence of a number of

pregnancy over perception on late ANC booking. It was found that a bigger number of

unregistered pregnancies was found in women who conceived more than 4 times. The observed

reason was that this category had women who have more experience in pregnancies.

27

TABLE 4.1.2: EARLY BOOKING AMONGST THE SAMPLED PARTICIPANTS

N Valid 137

Missing 1

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 0-3 months 35 25.4 25.5 25.5

4-6 months 102 73.9 74.5 100.0

Total 137 99.3 100.0

Missing System 1 .7

Total 138 100.0

Findings in this variable (early booking amongst the sampled participants)

Findings revealed that 25.4% booked early for ANC and 73.9% booked late for ANC. The

purpose of this variable was to determine the general attitude of pregnant women over early

ANC booking which will further highlight on the general perception on late ANC booking. In

this study it was found that most women who booked, did so between 4th and 6th weeks

gestation.

28

TABLE 4.1.3. REASONS WHY SOME WOMEN REGISTER LATE FOR ANC

N Valid 137

Missing 1

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid 0-3 months 35 25.4 25.5 25.5

4-6 months 102 73.9 74.5 100.0

Total 137 99.3 100.0

Missing System 1 .7

Total 138 100.0

Findings on this variable (reasons why some women register late for ANC)

Among many reasons recorded, 40.6% of participants revealed economic challenges to be the

major factor that leads pregnant women to register late for ANC, 26.1 were personal related

reasons, 7.2% being traditional reasons and 26.1% to be other related reasons. The purpose of

this variable was to identify various reasons which influences women perception on late ANC

booking. It was found that economic factors were the major challenge that influences women

perception on late ANC booking. Majority decided to book late because they wanted to look for

finances to prepare for the new born baby.

29

TABLE 4.15: PREGNANT WOMEN PERCEPTION ON EARLY ANC BOOKING

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid positive 79 57.2 57.2 57.2

negative 59 42.8 42.8 100.0

Total 138 100.0 100.0

Findings on this variable (pregnant women perception on early ANC booking)

84.1% of participants showed wrong perception on early ANC booking due to various reasons

and only 15.9 to have a good perception. The purpose of this variable was to determine how

women perceive early ANC compared to late ANC booking. It was found that majority of

women perceived early ANC being a challenge because it forced them to book at the time they

were not ready to. This reason was recorded mainly to those who conceived unknowingly and

those who were cohabiting.

30

TABLE 4.1.6: PREGNANT WOMEN KNOWLEDGE ON THE IMPORTANCE OF ANC

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid high 25 18.1 18.1 18.1

average 22 15.9 15.9 34.1

low 91 65.9 65.9 100.0

Total 138 100.0 100.0

Findings on this variable (pregnant women knowledge on the importance of ANC)

Findings showed that majority 65.9% of the participants had inadequate information on the

importance of early ANC booking, 15.9% had some information and 18.1 had more information

on the importance of ANC. The purpose of this variable was to determine the influence of

knowledge level over women perception on late ANC booking. In this study it was found that

majority had inadequate information on the importance of ANC services.

31

TABLE 4.1.7: PREGNANT WOMEN IDEAS ON THE DANGERS OF LATE ANC BOOKING

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid more ideas 22 15.9 15.9 15.9

less ideas 30 21.7 21.7 37.7

no ideas 86 62.3 62.3 100.0

Total 138 100.0 100.0

Findings on this variable (pregnant women ideas on the dangers of late ANC booking)

It was found that majority (63.3%) of the participants had inadequate ideas on the dangers of late

ANC booking, 21.7% had some ideas and 15.9% had more ideas concerning dangers of late

ANC booking. The purpose of this variable was to determine women ideas on the dangers of late

ANC and the influence this has on their perceptions. It was found that more than half (62.3%)

had no ideas on the dangers. Hence perceived ANC booking as nothing at all.

32

TABLE 4.1.8: PREGNANT WOMEN IDEAS ON HOW TO AVOID LATE ANC

BOOKING

N Valid 138

Missing 0

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid more ideas 22 15.9 15.9 15.9

less ideas 27 19.6 19.6 35.5

no idea 89 64.5 64.5 100.0

Total 138 100.0 100.0

Findings on this variable (pregnant women ideas on how to avoid late ANC booking)

Findings showed that majority 64.5% had inadequate ideas, 19.6% had some ideas and 15.9%

had adequate information on how they can avoid late ANC registration. The purpose of this

variable was to determine the women ability to change in relation to their perception on late

ANC booking. It was found that more than half (64.5 %) had inadequate ideas on how to end late

ANC booking. Therefore, they perceive late ANC as a normal thing which need to be continued.

33

TABLE 4.1.9: PREGNANT WOMEN SATISFACTION ON THE ANC SERVICES

N Valid 137

Missing 1

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid highly

satisfied 25 18.1 18.2 18.2

less satisfied 32 23.2 23.4 41.6

not satisfied 80 58.0 58.4 100.0

Total 137 99.3 100.0

Missing System 1 .7

Total 138 100.0

Findings on this variable (pregnant women satisfaction on the ANC services)

Findings reveals that a majority (58%) of women were not satisfied with ANC services that they

received in health care facilities, 23.2% were partially satisfied and only 18.8% were satisfied

with ANC services. The purpose of this variable was to determine how service satisfaction

influences women perception on late ANC booking. It was found that more than half (58%) were

not satisfied with ANC services. Hence for them staying at home or if possible book at a later

time was very normal.

34

TABLE 1.2.0: IDEAS ON PREGNANT WOMEN ROLES IN PREVENTING LATE ANC

BOOKING

N Valid 136

Missing 2

Frequency Percent

Valid

Percent

Cumulative

Percent

Valid more ideas 22 15.9 16.2 16.2

less ideas 44 31.9 32.4 48.5

no idea 70 50.7 51.5 100.0

Total 136 98.6 100.0

Missing System 2 1.4

Total 138 100.0

Findings on variable (ideas on pregnant women roles in preventing late ANC booking)

Findings reveals that 53.2% had inadequate ideas, 31.9% had some ideas and only 15.9 had

adequate ideas on women’s roles in the prevention of late ANC booking. The purpose of this

variable was to determine women ability to initiate change based on the perception on late ANC

registration. It was found that more than half of the participants (53.2%) had inadequate

information on how to initiate change to end late ANC booking. This means that late ANC

booking is expected to continue if it will not addressed soon by the relevant authorities.

35

CHAPTER 5

5.0. DISCUSSION

A high proportion of women who perceived late ANC booking not being a problem was found in

the category of women with lower education background, those who have never been to school,

those with no idea of the importance of early ANC booking, those with inadequate financial

resources and those who are unsatisfied with ANC services in health facilities. Similar results in

a study in London done using routinely collected data showed that women who are not well

sensitized were more likely to book for ANC late, similar to the findings reported here (Baker

and Rajah, 2012, Emelieh et al., 2014). The reasons for this is unclear but it is reasonable to

think that women who may not see a good reason of early registration for ANC services may not

know or understand the importance of booking early for ANC meaning they will have wrong

perceptions on early ANC. Women with inadequate financial resources on the other hand may be

more likely to book late for ANC. This is because they may take the period when they become

pregnant as the time for them to start moving up and down to look for the resources for

preparation (Emelieh et al., 2014). In addition, unmarried, women aged 16 to 19 years may feel

ashamed to disclose their pregnancies or be uncomfortable going for ANC without their partners

and thus perceives delay in booking for ANC as a favor. Some of this might be related to

availability and affinity of health promotion messages regarding child and maternal survival. In

the present it was thus not surprising to find that women exposed to the media tended to book

early suggesting that they may have heard health promotional messages that modified

perceptions positively their understanding on the role of early ANCs in both child and maternal

survival (Nyambe et al 2006).

It looks reasonable that, the unmarried may perceive late ANC booking as a favor or not perceive

early ANC booking with much attention as shown in this study. Various barriers to early ANC

booking may surround unplanned pregnancies more especially for women who are just

cohabiting or who are not yet made up their mind whether to be with their partners or not.

Results similar to the findings in this study were seen in a study done in the Copperbelt province

of Zambia which showed that women with unplanned pregnancy were 4.4 times more likely to

perceive late ANC booking as a usual thing compared to those with planned pregnancies (Banda

et al., 2012). A survey done in Tanzania similarly showed that women with unplanned

36

pregnancies were two times more likely to book for ANC late compared to women with planned

pregnancies (Exavery et al., 2013). The question, which arises, is whether the women will

develop a good perception on early ANC booking. If they will, when and what role do they need

to play in order for them to initiate the change. Do the health promotion messages cater for many

with wrong perceptions on late ANC booking? These and more questions are among topics

which need to be looked at in the future studies. While it sounds logical that women with

inadequate information about the importance of early ANC booking, the results from this study

did not support this reasoning. What this may be telling us is that women may be aware of the

consequences that comes with late ANC booking but my fail to do away with it due to various

reasons. If women with inadequate information about the benefits of early ANC booking, would

most likely be ashamed to book for ANC early, as they would fear being questioned why they

never register early.

In this study, evidence was provided that women with low education background had a wrong

perception on late ANC booking and are more likely to book for ANC late than women with

high education back ground. This is supported by studies done in Nigeria, New Zealand Uganda

and a systematic review of literature from African countries which similarly showed that women

with higher education are more likely to book for ANC early because of a good perception that

they have toward early ANC service (Simkhada et al., 2008, Ebeigbe and Igberase, 2010,

Oladokun et al., 2010, Corbett et al., 2014). This may be attributed to differences in perceiving

late booking for ANC as well as the levels of understanding on the importance of early ANC

booking among the different levels of education of women (Baker and Rajasingam, 2012,

Emelumadu et al., 2014). This suggests that women with higher education are more likely to read

newspapers and watch television more frequently than less educated or not educated women.

37

CHAPTER 6

6.0 CONCLUSION AND RECOMMENDATION

In this study, it was found that majority of women are still perceiving late ANC booking as a

usual practice which provide favor to many (wrong perception). This is still a problem in the

district suggesting that a large proportion of pregnant women perceive late ANC booking not

being a problem there by missing an opportunity to have early detection and preventing any

possible complications of pregnancy and the unborn fetus. These observations further shows that

this challenge is concentrated in women with little or no education or those with inadequate

information about the importance of early ANC booking and those women who are not in

marriage. The concentration of this problem in lower or no education groups may be an

illustration of existing inequalities which might further explain past and present limitations in

health promotion messages meant to mitigate this challenge. This could also have strategic

hindrances in planned interventions aimed at enhancing both maternal and child survival. There

is thus urgent need to re-pack health promotion message to specifically target these population

sub-groups.

6.1 RECOMMENDATIONS

From the findings in this study, it’s recommended that women should be educated beyond

primary and secondary level, women should be empowered with some life skills to enable them

being self-reliant and not depending on others for financial help. Have access to family planning

methods and should be able to use them. To support this, the health promotion packages that

encourage pregnant women to develop a good perception on early ANC booking must be

repackaged to suit women’s differential background characteristics that account for their

differences in education status, age and parity as observed in this study. This is critical as these

factors may have been missed in past maternal survival strategies in this population. If we look at

this as a right for the women, an obligation for policy makers and a responsibility for primary

care workers, we may save many lives, and consequently save millions of dollars currently

incurred in current maternal health strategies. There is need to conduct a similar study using a

deferent sources of data and places in order to compare and analyze trends in women perception

on late ANC booking at inter-provincial level.

38

6.3 LIMITATIONS

One limitation in this study include the small sample size which has been taken to represent the

district. However, this study was not linked to evaluations of associated maternal survival

strategies, it is difficult to estimate the effect of this limitation. Other limitations were that some

variables of interest like education of the partner and age of the partner had significantly missing

data and could not be included in the analysis and certain questions could only be answered

using other qualitative method approach and were thus not included in this analysis. This study

only asked women with previous live births in the five years preceding the survey questions

about perceptions on late ANC and this may be a source of bias because those women without

live births may be the ones with wrong perceptions in booking early for ANC. Despite these

limitations, the observed results were from a representative high-powered population based

sample of women in the district and hence point to a significant problems associated with

women’s perceptions on late ANC booking which are difficult to ignore.

39

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Sky Journal of Medicine and Medical Sciences 5(2): 15-19.

WHO (2016) Provision of Focused Antenatal Care for Pregnant Women. World Health

Organization, Geneva.

Glaser BG, Strauss AL. The discovery of grounded theory: Strategies for qualitative research

New York: Aldine de Gruyter, 1994.

44

ANNEX .I

BUDGET

S/N DETAILS TOTAL

QUANTITY

UNITY COST TOTAL

COST

01 DATA

COLLECTION

QUESTIONNAIRE

150 K5 k750

02 LUNCH

ALLOWANCE

FOR THE

COMMUNITY

VOLUNTEER

3 K50 K150

03 LUNCH

ALLOWANCE

FOR THE

RESEARCHER

3 K85 K255

04 TRANSPORT

FROM HEALTH

FACILITY TO

OTHER

FACILITIES

3 K20 K60

Total K1,215

45

ANNEX. II

DESIGNED QUESTIONNAIRE

NAME OF HEALTH FACILITY: …………………………… DATE: ………. /……../……..

1. PART 1. BIO DATA

a) AGE IN YEARS

What is your age?

16-25 Years

26-35 Years

36-45 Years

b) MARITAL STATUS

Married

Divorced

Widowed

Single

Cohabiting

c) LANGUAGE

What language do you usually use at home?

Kindly Specify …………………………………………..…………………………………………

d) EDUCATIONAL LEVEL

What is the highest educational level did you attained?

Primary

Secondary

46

College

University

Never

e) ECONOMIC STATUS

What are you doing to support your living?

Formal employment

Informal employment

Kindly Specify…………………………………………………………………………….

PART 2

PREVIOUS OBSTETRIC HISTORY

a) How many pregnancies have you ever had?

1

2

3

4 +

b) How many of the above pregnancies reached term?

1

2

3

4 +

c) Of the above stated pregnancies, did you have any that did not reach term or delivery?

YES NO

d) If yes how many? ………………………………………………………………………………

47

e) Do you have an idea of what was the cause of the pregnancy(s) not reaching term or

delivery? Kindly share with me any

………………………………………………………………...………………………………...

f) Do you think that cause could have been avoided? YES NO

g) If yes what do you think could have been done?

……………………………………………………….………………………………………….

…………………………………………………………………………………………………

g) How many of stated pregnancies did you register at the health facility?

1

2

3

4

c) When on average did you register for antenatal for the previous pregnancies at how many

months?............................................................................................................................................

h) Why did you decide to register at that time? …………………………………………………..

d) Do you have an idea of the right time for a pregnant woman to register for ANC?

YES NO

e) If YES when is the right time or at how many months? ………………………………………

f) Is it important for a pregnant woman to register early for ANC?

YES NO

f) Kindly share with me your thoughts about the importance of early ANC.

……………………………………………………………………………………………………

g) Do you have an idea of when a pregnant woman is considered to be late for ANC

registration? YES NO

48

i) If yes kindly share with me when? …………………………………...………………………..

………………………………………………………………………………………………………

k) Do you have an idea of why some women register late for antenatal?

YES NO

l) If yes, kindly share with me any?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

m) Do you have an idea of any danger(s) associated with late ANC registration to a pregnant

woman?

YES NO

n) If yes, kindly share with me any?

…………………………………………………………………..…………………………………..

o) Is it okay for a pregnant woman to register late for antenatal care services?

YES NO

Kindly share your thought with me

………………………………………………………………………………………………………

………………………………………………………………………………………………………

p) Do you have an idea of anything that could be done to help you and other pregnant women to

be registering early for ANC? YES NO

p) If yes what would you suggest………………………………………………………………......

………………………………………………………………………………………………………

………………………………………………………………………………………………………

49

PART 3. HEALTH CARE SERVICE SATISFACTION

a) How far is the health facility from your household? ……………………………..……………

b) Are you comfortable with the distance? YES NO

c) Are you comfortable with the health care services offered at your nearest health facility in

relation to ANC? YES NO

d) If NO, what suggestions can you give in order to help the health care service providers to

improve on their service provision? ……………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

e) On the other hand what role should the women and community play to avoid late ANC

registration?

1. Women:…………………………………………………………………………………………

2. Community:…………………………………………………………………………………….

………………………………………………………………………………………………………

f) Do you have some questions that you would like to ask me concerning the conversation I had

with you?

………………………………………………………………………………………………….

I WOULD LIKE TO THANK YOU SINCERELY FOR YOUR TIME AND

COOPERATION.

THANK YOU AND GOD BLESS

50

ANNEX. III

DESIGNED QUESTIONNAIRE (BEMBA VERSION)

ISHINA LYACIPATAL: …………………………… DATE: ………. /……../……..

2. PART 1. BIO DATA

f) Iciimo mumyaka

Bushe muli nemyaka iyakufyalwa iinga?

16-25 Years

26-35 Years

36-45 Years

g) Ukuupwa

mwalyupwa

mwalilekna

mwalifwila

tamwaupwa

tamulaba pamo

h) ICILIMI

Bushe ciliminshi mubomfya pang’anda?

Mukwai kuti mwanjebako

……………………………………………………………………………………

i) Amasambilio Bushe mwapelele mugeredi shani?

Amasambililo yanono

Museconale

51

Amasambililo yapamulu

j) UKUBOMBA

Bushe mulimonshi mubomba pakuti mulessunga ulupwa?

Mulaibombela mwebeene?

Kwaliba uko muboma ?

Nga kuli umulimo umbi uyo mubombako, kuti mwalanda

mukwai…………………………………………………………………………….

ICIPUTULWA CALENGA BUBILI

UBUFYASHI MUNSHITA YAKUNUMA

a) Bushe mwakwatapo amafumo yanga?

1

2

3

4 +

b) Pali aya mafumo mwalanda bushe niyanga mwalembeshepo ku cipatala ?

1

2

3

4 +

c) Pali ayamafumo mwalanda, bushe bushe mwalikwetepo ayakumashe imyeshi ikumi

YES NO

j) Nga cakuti mwaliikwatapo bushe niyannga?

………………………………………………………………………………

52

k) Bushe finshi mwaishibapo ifyalengele ukuti ayo mafumo yonaike?

……………………………………………………………………..............................................

l) Bushe filya fyacike kwena kuti fyacingiliwa

m) YES NO

n) Nga cakuti mwasuminisha landenipo inshila imofye?

………………………………………………………………………………………………………

k) bushe mafumo yanga mwalembeshepo pali yalya ayo mwakweete?

1

2

3

4

c) Bushe mumafumo yonse ayo mwakwete, niyanga ayo mwalembeshepo kucipatala elo

pamyeshi inga?

………….................................................................................................................................

o) Bushe ninshi mwasaliile ukulembesha pali iyo myesnhsi?…………………………………

f) Bushe mwalishiba imyeshi iyapelwa ukulembeseshapo ifumo?

YES NO

g) Nga cakuti mwalishiba , bushe niinga? ………………………………………

f) Bushe cikankala ukulembesha ifumo?

YES NO

f) Bushe bukankalanshi ubwaba mukulembesha ifumo.

……………………………………………………………………………………………………

g) Bushe nililali umunte engebwa ukuti nabangilila ukulembesha ifumo kucipatala? Bushe

mwalishiba? YES NO

53

p) Naga cakuti mwalishiba, nipamyeshi iinga?…………………………………………………

k) Bushe mwalishiba nililali umuntu engebwa ukuti naceelwa ukulembesha ifumo kucipatala?

YES NO

l) Ngacakuti mwalishiba nililali?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

m) Bushe mwalishiba amafya yesa ngacakuti umuntu aceelwa ukulembesha ifumo?

YES NO

n) Naga mwalishiba, landenipo ubwafya bumofye

……………………………………………………………………………………………………..

o) Bushe caliwama namayo ukuceelwa ukulembesha ifumo?

YES NO

Mukwai landeni naine ifyo mwaishibapo

………………………………………………………………………………………………………

p) Bushe finshi ifingafwaikwa ukwafwilisha banamayo ukulembesha bwangu amafumo, bushe

pali ifyo mwaishibapo? YES NO

p) Nga cakuti mwalishibapo fimo landeni naine mukwai

………………………………………………………………………………………………………

………………………………………………………………………………………………………

ICIPUTLWA CALENGA FITATU (3). IMIBOMBELE YABABOMFI BACIPATALA

g) Bushe paleepa shani apo mwikala naapabela icipatala? ………………………………………

h) Bushe mulasekelamo mumibombele yababomfi bapacipatala? YES NO

i) Bushe mwalitemwa imibombele yababomfi bapacipatala?

j) YES NO

54

k) Nga cakuti tamwasekelamo, finshi mwingatemwa ukutila balecita pakuti banamayo

balelembesha bwangu?

………………………………………………………………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

l) Mulubali lumbi, finshi banamayo nabekala mushi balingile ukucita pakuti belcelwa

ukulembesha?

Banamayo………………………………………………………………………………………

Abekala mushi …………………………………………………………………………………

m) Bushe namukwatako iliipusho pafryo twalanshanya mukwai?

………………………………………………………………………………………………….

KUTI NATEMWA UKUMITOOTELA APAKALMBA PAKUIPEELA MULI UKU

KULANSHANYA.

LESA AMIPAALE APAKALAMBA

55

ANNEX .III

NOTIFICATION LATTER

Dear Participant,

My name is MUSONDA ALEX, a student pursuing a degree in nursing and midwifery sciences

at Cavendish University Zambia in Lusaka.

Questions will be asked to help in obtaining data that will help in coming up with

recommendations that will contribute to the reduction of maternal/neonatal mortality related to

late ANC booking.

The study will ensure strict confidentiality. There are no known risks. You may not immediately

benefit from the study but the information will help to understand the prevailing outcomes and

explain the women perceptions on late ANC booking so as to improve maternal and unborn child

survival.

Your participation is completely voluntary. You are free to withdraw at any time and this will

not affect the level of care you and your family including the community receive in any way.

If you agree to take part, please sign the consent form which will allow us to interview you if you

chose to be part of the study.

In case you need some clarification you can contact me on the address below.

MUSONDA ALEX

CELL: 0978140199.

Email: musondaalex88@gmail.com

56

ANNEX .IV

CONSENT FORM (ENGLISH VERSION)

EXPLORING WOMEN PERSPECTIVES ON LATE ANC BOOKING IN

MWANSABOMBWE RURAL DISTRICT OF ZAMBIA.

I have read and understood all the information concerning late ANC booking and what this Study

is all about is clear to me. I therefore voluntarily consent to take part in this study.

Participants’ name: ______________________________________________________________

Signature: __________________________ Date: __________________________________

Right Thumb Print: ___________________ Date: __________________________________

WITNESS

Name: ________________________________________________________________________

Signature: ________________________ Date: _____________________________________

Right Thumb Print: _________________ Date: _____________________________________

57

ANNEX V

GANTT CHART OR SUMMARIZED WORK PLAN FOR THE RESEARCH PROJECT.

YEAR: 2020

DETAILS OF

THE ACTIVITY JA

NU

AR

Y

Feb

ruary

MA

RC

H

AP

RIL

MA

Y

JU

NE

JU

LY

AU

GU

ST

Sep

tem

ber

Oct

ob

er

Novem

ber

Dec

em

ber

Presentation of

proposal to the

supervisor.

Presentation to the

ethical committee

Mobilization of

resources

Data Collection

Data Analysis

Report Writing

Submission of

research project

58

ANNEX VI

CONSENT FORM (BEMBA VERSION)

UKUFWAILISHA IMITONTONKANISHISHE YABANA-CIFYASHI PAMULANDU

WAKUCEELWA MUMILEMBESESHE YAMAFUMO MUFIAPATA MUMUSUMBA

WAMWANSABOOMBWE ICITUNGU CA LWAPULA.

Ine nabelenga nokwishiba ifya pamulandu wabana-cifyashi ukuceelwa mumilembeseshe

yamafumo. Eico ndeibimba muli uku kulanshanya mukuipeleshafye ukwabula amalipilo.

Ishina lyabaibimbilemo:

___________________________________________________________________________

ukusaina: __________________________ Date: __________________________________

ukufwatiak: ___________________ Date: _______________________________________

BAKAMBONE

ishina: ________________________________________________________________________

ukusaina: ________________________ Date: _____________________________________

ukufwatika: _________________ Date: ___________________________________________

59

ANNEX VII

60

ANNEX VIII