Introduction: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general medical and pregnancy associated disorders. For it to be meaningful, early booking is recommended, however, late booking is still a major problem.\ud
Objective: To determine the prevalence of late booking in our environment and factors related to it.\ud
Methodology: A descriptive cross-sectional study using structured interviewer assisted questionnaires.\ud
Results: Mean gestational age at booking was 20.3±6.2 weeks. Prevalence of late entry to antenatal care was 82.6%. Maternal education and age remained significant factors influencing late booking.\ud
Conclusion: Late booking is still a major problem in this part of the world. Public enlightenment, health education coupled with women empowerment would be helpful in reducing the proble

Adekanle, DA

Isawumi, AI

English

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Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria

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Volume 7, Issue 1; Jan-Mar 2008
Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria 
Authors
Adekanle DA, Isawumi AI,
Department of Obstetrics and Gynaecology,
College of Health Sciences,
Ladoke Akintola University of Technology,
P M B 4400, Osogbo, Osun State, Nigeria.
Address For Correspondence
Dr. D.A Adekanle,
Department of Obstetrics and Gynaecology,
College of Health Sciences,
Ladoke Akintola University of Technology,
P M B 4400, Osogbo,
Osun State, Nigeria
E-mail: adekanle2000@yahoo.co.uk
Citation
Adekanle DA, Isawumi AI. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South 
Western Nigeria. Online J Health Allied Scs. 2008;7(1):4
URL
http://www.ojhas.org/issue25/2008-1-4.htm
http://ojhas.org 1
OJHAS  Vol 7 Issue 1(4) Adekanle DA et al. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria
Submitted May 26, 2007; Suggested revision Jan 28, 2008; Resubmitted Feb 7, 2008; Accepted: Mar 18, 2008; Published: Apr 10, 2008
Abstract:
Introduction: Antenatal care is concerned mainly with prevention, early diagnosis and treatment of general 
medical and pregnancy associated disorders. For it to be meaningful, early booking is recommended, however, 
late booking is still a major problem.
Objective: To determine the prevalence of late booking in our environment and factors related to it.
Methodology: A descriptive cross-sectional study using structured interviewer assisted questionnaires.
Results: Mean gestational age at booking was 20.3±6.2 weeks. Prevalence of late entry to antenatal care was 
82.6%. Maternal education and age remained significant factors influencing late booking.
Conclusion: Late booking is still a major problem in this part of the world. Public enlightenment, health 
education coupled with women empowerment would be helpful in reducing the problem
 Key Words: Antenatal care, Late booking, Gestational age, Risk factors
 Original Article
Introduction:
Early entry to antenatal care (ANC) is important for early 
detection  and  treatment  of  adverse  pregnancy  related 
outcomes. Antenatal care evolved over a period of about 
a  century,  with  the  trend changing  gradually  from in-
patient  to  out-patient  form  of  care  that  we  have 
today.1,2  This  form  of  care  for  pregnant  women  has 
become  an  important  pillar  in  the  safe  motherhood 
programme, as  the aim is  to improve the outcome of 
pregnancy  for  both  the  mother  and  the  fetus.2,3  The 
usual  recommendations  nowadays  is  for booking  (first 
antenatal visit) to take place in early pregnancy, prior to 
14  weeks.  The  World  Health  Organization  (WHO) 
recommends  that  pregnant  women  in  developing 
countries should seek ANC within the first 4 months of 
pregnancy.4 In developed countries  such as the United 
Kingdom and the United States,  ANC is recommended 
within the first 12 weeks of pregnancy.5,6
Early booking, makes fairly accurate dating feasible, es-
pecially in women who are unsure of their last menstrual 
period,  certain  baseline  measurements,  such  as  blood 
pressure,  body  mass  index  and  urinalysis  done  at  this 
gestational  age  give  a  fair  idea  of  the  pre-pregnancy 
state of the patient.7,8
Various  studies  have  reported  factors  associated  with 
late entry to ANC , these include place of residence 9-11, 
ethnicity  12,  age  10,  education  11,13,14,  employment  sta-
tus12,15, parity 10- 12,14, intention to get pregnant 9,12, use of 
contraceptive method 12, economic status 9,12,13, health in-
surance 9-11,13,16 and travel time.9
However,  in spite of  advantages of  early  booking,  late 
booking is common in the developing world.17,18 Studies 
from  Benin  and  Sokoto,  in  other  regions  of  Nigeria 
showed that  mean gestational  ages  at  booking  among 
the pregnant women were 23.7 and 23.55 weeks, respec-
tively.17,18 
The aims of this study were to assess the proportion of 
pregnant women who booked late for Antenatal care in 
South Western Nigeria during calendar year 2006 and to 
identify factors related to late booking.
Materials and Methods:
Structured  questionnaires  were  administered  to  willing 
pregnant  women  attending  antenatal  clinic  at  Ladoke 
Akintola University Teaching Hospital, State Hospital and 
Primary health Centre, Osogbo, Nigeria. Ethical approval 
was obtained from ethical committee of the institution 
and  verbal  consent  was  also  obtained  from  the 
participants.  Descriptive  statistics  was  used,  mean  and 
standard  deviation  for  continuous  variables  and 
frequency  for  categorical  variables.  Test  of  association 
was  carried out  using chi-square.  Multivariate  stepwise 
logistic  regression was performed to identify significant 
predictors,  all  at 5% level of significance.  Data analyses 
was done using SPSS version 10 (Statistical Package for 
Social Sciences, SPSS Inc., Chicago, IL, USA).
Results:
Four  hundred  and  eighty  questionnaires  were 
administered,  four  hundred  and  seventy  (97.9%)  were 
returned.  Mean age  of  the  respondents  was  28  ±  4.6 
years  (17  -  41).  Eighty  four  (18.5%)  booked  within  13 
weeks  of  gestation  while  majority,  370(81.5%)  booked 
after 13 weeks. Mean gestational age at booking was 20.3 
± 6.2 weeks. Three hundred ninety three (83.6%) were in 
monogamous  union  and  sixty  four  (14.0%)  were 
polygamous.  Three  hundred  and  eighty-eight  (82.6%) 
were  carrying  singleton  fetus,  22(4.7%)  multiple 
pregnancies and 60(12.8%) were unsure.
Majority, 324(69.3%) of the respondents were aged 25 - 
34  years  and  were  mostly  Yoruba  of  ethnic 
group,443(92.5%). Most, 215(46.2%) had secondary edu-
cation  while  majority,  207(44.6%)  were  self-employed. 
Three hundred and thirty one (70.4%) were multiparous 
while the remaining 139(29.6%) were nulliparous women 
(Table 1).
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OJHAS  Vol 7 Issue 1(4) Adekanle DA et al. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria
Table 1.Socio-demographic characteristics
Variables Number Percentage
Age(year)   
≤ 19 13 2.8
20 - 24 88 18.9
25 - 29 185 39.8
30 - 34 139 29.5
≥ 35 40 8.6
Tribes   
Yoruba 443 92.5
Ibo 24 5.1
Hausa 3 0.6
Other tribes 8 1.7
Religion   
Christianity 243 52.0
Islam 221 47.3
Others 3 0.6
Educational Status   
None 50 0.8
Primary 139 29.9
Secondary 215 46.2
Tertiary 61 13.1
Employment Status   
Government employed 86 18.5
Private employed 47 10.1
Self-employed 207 44.6
Unemployed 63 13.6
Students 61 13.1
Husband’s Educational Status   
None 18 3.9
Primary 22 4.8
Secondary 144 31.6
Tertiary 272 59.6
Parity   
Para 0 139 29.6
Para 1 and above 331 70.4
On bivariate  analysis,  those  who earned  lesser  income 
were more likely to book late compared to those who 
earned more,(p < 0.01). So also, those were less than 25 
years,  91(91.1%) were significantly likely to register late 
compared to those that were older, 276(78.9%), p < 0.01.
Those  who  had  no  previous  caesarean  delivery, 
262(81.9%)  would  more  likely  book  late  compared  to 
those  with  previous  caesarean  section,  33(75.0%),  p  > 
0.05. Those who had no complaints in index pregnancy, 
321(82.1%) booked later than those who had complaints, 
28(73.7%), p > 0.05. Those who had no problems in the 
last  delivery,  246(81.7%) were more likely to book late 
compared to those who had problems,  50(75.8%),  p > 
0.05. Those in polygamous union, 107(78.7%) were more 
likely  to register  late  compared to those  who were in 
monogamous  union,  307(80.8%),  p > 0.05.  Multiparous 
women were more likely book late compared to Nulli-
parous women, 107(78.7%), p > 0.05. Those who had pri-
mary school education or none, 152(85.4%) were more 
likely to register late compared to those who had sec-
ondary  school  education  and  above,  215(79.3%),  p  > 
0.05.  Pregnant  women  whose  husband  had  primary 
school education or none, 33(86.8%) would more likely 
book late compared to those whose husband had sec-
ondary school education and above, 325(81.0%), p > 0.05 
(Table 2).
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OJHAS  Vol 7 Issue 1(4) Adekanle DA et al. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria
Table 2. Factors influencing late entry into antenatal care.
Variables
Gestational Age ≤ 13 weeks Gestational Age > 13 weeks
Number(%) Number(%)
χ2 df P value
Problems in last delivery 
Yes 16(24.2) 50(75.8)    
No 55(18.3) 246(81.7) 1.24 1 0.266
Previous Caesarean sec-
tion
     
Yes 11(25.0) 33(75.0)    
No 58(18.1) 262(81.9) 1.19 1 0.275
Problems in index preg-
nancy
     
Yes 10(26.3) 28(73.7)    
No 70(17.9) 321(82.1) 1.62 1 0.204
Income per month(US dollars)
   <  40 10(10.5) 85(89.5)    
40 - 80 18(17.5) 85(82.5)    
80 - 120 15(21.4) 55(78.6)    
     > 120 25(35.2) 46(64.8) 16.06 3 0.007
Type of Family      
Monogamy 73(19.2) 307(80.8)    
Polygamy 7(11.5) 54(88.5) 2.12 1 0.146
Parity      
Para 0 29(21.3) 107(78.7)    
Para  ≥ 1 55(17.3) 263(82.7) 1.03 1 0.311
Educational Status      
Primary and below 26(14.6) 152(85.4)    
Secondary and above 56(20.7) 215(79.3) 2.64 1 0.104
Husband’s Educational Status
Primary and below 5(13.2) 33(86.8)    
Secondary and above 76(19.0) 325(81.0) 0.775 1 0.379
Age(years)      
< 25 8(8.1) 91(91.9)    
≥ 25 74(21.1) 276(78.9) 8.82 1 0.003
χ2  = Chi-square; df = degree of freedom
After adjusting for other factors, pregnant women who had primary school education or none were more likely to book late 
compared to  those who had secondary school education and above (OR = 2.6, 95% CI, 1.28 – 5.38). Those women who were 
aged less than 25 years were more likely to register late compared to those who were older (OR = 8.3, 95% CI, 1.10 – 62.65)
(Table 3).
Table 3. Multivariate analyses of factors associated with late booking.
Variables Crude OR(95% CI) Adjusted OR(95% CI)
Problems in last delivery
Yes 1 1
No 1.431(0.759 – 2.699) 2.042(0.933 – 4.472)
Educational Status   
Secondary and above 1 1
Primary and below 1.522(0.915 – 2.533) 2.631(1.287 – 5.378)**
Maternal age(years)
< 25 1 1
≥ 25 3.050(1.416 – 6.5.66)** 8.306(1.101 – 62. 653)*
* p < 0.05; ** p < 0.01; OR = Odd ratio; CI = Confidence interval
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OJHAS  Vol 7 Issue 1(4) Adekanle DA et al. Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria
Discussion:
The study attempted to assess the prevalence of women 
who entered antenatal care (ANC) late in South Western 
Nigeria in 2006 and identify related factors. Eighty one 
percent of women entered ANC after 12 weeks of gesta-
tion. This was double the Australian study in 2004,20 but 
similar  to studies reported in other parts  of the coun-
try.19 The mean gestational age at booking was still very 
high but slightly lower than reports from studies in other 
parts the country.17,19 This is far away from the recom-
mendation of World Health Organization thus the bene-
fits of early booking is not yet well appreciated.
Our results were similar to the findings from other stud-
ies  on  significance  of  age10,  and  maternal  education.11 
Women that were less than 25 years old, were less edu-
cated, earning lesser income and more unemployed than 
the older women and were more likely to register late; 
though after adjusting for other factors, income became 
insignificant, this may still be due to traditional practice 
of late booking in this environment due to the belief that 
since pregnancy is not a diseased condition, thus reason 
for indifference to early booking. Women that had lower 
education or none booked later than those with higher 
education,  this  agrees with studies in developed coun-
tries11,13,14 better educated women would likely appreci-
ate the importance of early booking more than the less 
educated ones. This emphasizes the importance of edu-
cation  on  antenatal  care.  Previous  obstetric  complica-
tions  such  as  still  birth,  eclampsia,  intrauterine  fetal 
death; and caesarean section have no influence on gesta-
tional age at booking which were also reported in anoth-
er study in the country.19 This might be due to the nega-
tive effect of ignorance which had been demonstrated in 
vicious circle of disease, ignorance and poverty. 
In contrast to other studies in the country, illness in in-
dex pregnancy and nulliparity that were found to be sig-
nificantly associated with early booking had no influence 
on gestational age at booking in this study,17,19  this might 
be due to poor counseling of those who had illness in 
the index pregnancy by the health workers they first had 
contact with which were usually in low cadres that may 
not necessarily  have midwifery skill.  Traditionally,  nulli-
parous  women  in  our  environment  would  first  seek 
counseling from multiparous women who were consid-
ered to be more experienced and would eventually  in 
most instances discourage early booking as seen in this 
study.
In conclusion, late booking still remain significantly high 
in  our  environment  indicating  that  the  importance  of 
early booking is yet to be appreciated. Maternal educa-
tion and age which had been associated with better in-
come earning had been found to improve booking sta-
tus. There is need for public enlightenment and incorpo-
ration of the benefits of early booking in the routine an-
tenatal health education. Women empowerment through 
qualitative education and gainful employment were also 
major factors that would contribute significantly to early 
booking.
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Antenatal care: some characteristics of the booking visit in a major teaching hospital in the developing world.

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Gestation age at first antenatal clinic booking in Sokoto,

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The effectiveness of current antenatal

The influence of antenatal care on pregnancy outcome.

Use of a Western theoretical model to investigate the relationships among characteristics of pregnant women, utilization, and satisfaction with prenatal care services in St.

Utilization of maternal health care services in Southern India.

Late Antenatal Care Booking And Its Predictors Among Pregnant Women In South Western Nigeria

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