Uptake of ≥8 Antenatal Care Contacts Among Multigravida Women in Hard-to-Reach Islands of Buvuma District, Uganda: A Community- Based Study

Crispus Nkoyoyo,1 Rebecca Nekaka,2 Yovani Moses Lubaale,1 Julius Nteziyaremye31Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 2Department of Health Professionals Education, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 3Department of Obstetrics and Gynaecology, Faculty of Health Sciences, Busitema University, Mbale, UgandaCorrespondence: Julius Nteziyaremye, +256706614213, Email jntezi@gmail.comBackground: Globally, inadequate antenatal care (ANC) utilization is associated with poor pregnancy outcomes. In Uganda, only 68% attain 4+ contacts despite 99% attending ANC 1. It is envisaged that compliance with the recommended 8+ contacts may be lower especially in hard-to-reach areas with unique geographical and health-system barriers, and amongst multigravidas due to complacence. We assessed compliance with 8+ ANC contacts and associated factors among multigravidas residing on islands of Buvuma district.Methods: Quantitative and qualitative study designs were use. 371 multiparous women aged 15– 49 years, selected through multistage sampling were recruited for quantitative study and data analysed using Stata version 17.0 with 95% confidence intervals (CIs) and statistical significance set at p < 0.05. For qualitative study, 8 health workers, 7 multigravidas and their partners were purposively recruited and data was transcribed, analyzed thematically with deductive content analysis used with a priori themes using Atlas ti24.Results: Majority 89.2% (331/371) were married and 69.8% (259/371) had attained primary-level education. The mean number of pregnancies and live births were 4.2 (± 2.03) and 3.3 (± 1.98) respectively. Overall, only 4.3% (16/371) attended 8+ ANC contacts. Furthermore only, 37.6% (135/359) had initiated ANC in the first trimester. Factors significantly associated with reduced compliance of ≥ 8contacts included travel time of > 1hour (p=0.001, AOR=0.07, 95% CI 0.033– 0.129), somewhat confident to recognize danger signs (p=0.001, AOR=0.13, 95% CI 0.018– 0.871), distance to facility > 5km (p=0.033, AOR=0.34, 95% CI 0.127– 0.928,) while tertiary education (p=0.006, AOR=2.6, 95% CI1.102-6.112) and knowledge of 8+ ANC contacts (p=0.031, AOR=11.15, 95% CI 1.254– 99.111) enhanced attendance. Qualitatively, male involvement, health systems strengthening and tackling cultural, religious and inaccessibility barriers facilitated compliance while complacence seemed to dampen attendance.Conclusion: Compliance with 8+ contacts among multigravidas living on Buvuma islands was markedly low. There is need to further girl child education, promote health education, male involvement, breaking religious and cultural impediments, and strengthen health systems through investments to reduce ANC inequity.Keywords: eight antenatal contacts, hard to reach islands, Uganda