Utilization of Antenatal Care Services Within the Context of COVID-19, Security Challenges, and an Unstable Healthcare System at Primary Health Care Centers

Figures & data

Figure 1 Integrating conceptual theoretical model.

Table 1 Utilization of Antenatal Care Services According to the Characteristics and Issues Leaded to ANC Services Interruption (n=536)

Other Variables		Regularly Attend ANC	Not Regularly Attend ANC	Total (%)	P value
Age	< 20	4 (0.8)	0 (0)	4 (0.8)	0.10
	20–29	136 (25.4)	4 (0.8)	140 (26.2)
	30–39	289 (53.9)	11 (2.1)	300 (56)
	40–49	78 (14.5)	14 (2.6)	92 (17.1)
	Total	507 (94.6)	29 (5.4)	536 (100)
Educational level	Illiterate	0 (0)	8 (1.5)	8 (1.5)	0.00
	Primary	8 (1.5)	9 (1.6)	17 (3.1)
	Secondary	93 (17.3)	12 (2.3)	105 (19.6)
	University	319 (59.6)	0 (0)	319 (59.6)
	post-graduate	86 (16.1)	0 (0)	86 (16.1)
	Total	507 (94.6)	29 (5.4)	536 (100)
Parity	Para-1	97 (18.1)	0 (0)	97 (18.1)	0.01
	Multiparous	251 (47)	16 (3)	267 (50)
	Grand multipara	158 (29.5)	13 (2.4)	171 (31.9)
	Total	507 (94.6)	29 (5.4)	536 (100)
Occupation	Unemployed	340 (63.5)	25 (4.6)	365 (68.1)	0.01
	Employed	167 (31.1)	4 (0.8)	171 (31.9)
	Total	507 (94.6)	29 (5.4)	536 (100)
Marital status	Married	507 (94.6)	13 (2.4)	520 (97)	0.20
	Divorced	0 (0)	5 (1)	5 (1)
	widow	0 (0)	0 (0)	0 (0)
	others	0 (0)	11 (2)	11 (2)
	Total	507 (94.6)	29 (5.4)	536 (100)
COVID issues	Yes	142 (26.5)	21 (3.9)	163 (30.4)	0.03
	No	365 (68.1)	8 (1.5)	573 (69.6)
Fear of infection	Yes	126 (23.5)	20 (3.7)	146 (27.2)	0.01
	No	381 (71.1)	9 (1.7)	390 (72.8)
Transport issues	Yes	243 (45.3)	19 (3.5)	262 (48.9)	0.01
	No	264 (49.3)	10 (1.9)	274 (51.1)
Security issue	Yes	241 (45)	17 (3.2)	258 (48.2)	0.00
	No	266 (49.6)	12 (2.2)	278 (51.9)
Total		507 (95.6)	29 (5.4)	536 (100)

Table 2 Logistic Regression Analysis to Examine the Factor Influence Antenatal Care Utilization (n=536)

Variable	Category	OR	95% CI	p-value
Age	20–29 (Reference)	-	-	-
	30–39	0.87	0.63–1.21	0.372
	40–49	0.56	0.37–0.85	0.004
Educational Level	Illiterate (Reference)	-	-	-
	Primary	0.89	0.55–1.43	0.656
	Secondary	1.12	0.74–1.70	0.586
	University	1.28	0.83–1.98	0.260
	Post-graduate	1.45	0.85–2.46	0.176
Parity	Multiparous (Reference)	-	-	-
	Grand Multipara	0.76	0.53–1.10	0.141
Occupation	Employed (Reference)	-	-	-
	Unemployed	0.91	0.65–1.29	0.614
COVID-19 Perception	Yes	0.72	0.53–0.98	0.037
Security Concerns	Yes	0.82	0.58–1.16	0.266

Table 3 Summary of Qualitative Result

Theme	Code	Summary of the Result
1.Access barriers and security challenges	Security-related fear and constraints and limited transportation options	In unsafe areas, transportation to healthcare was a problem, with women worried about travel safety. Delays and missed appointments were common.
2.Impact of COVID-19 on service delivery	Disruptions in services due to COVID-19 and concerns about infection.	Pregnant women worried about catching COVID-19 at healthcare centers, especially due to crowded waiting areas and shared facilities. This made some hesitant to seek medical care.
3.Coping strategies and adaptations	Healthcare initiatives rooted in the community, which encompass telehealth and virtual consultations.	Healthcare providers introduced telehealth and virtual consultations to tackle COVID-19 and security challenges. These services allowed pregnant women to receive guidance and support from home.
4.Recommendations for Improvement	Enhancing security protocols. Building robust healthcare systems.	Participants emphasized the need for healthcare systems to be more resilient, with better contingency planning and resource allocation for continuous antenatal care services during unexpected events like pandemics and security issues.