Introduction: Low attendance of ANC visits among women in Nigeria stimulated the antenatal care medication compliance. The new model was implemented and tested in Eastern province, Nigeria. Despite the well documented benefits of the model and huge investment by the government and donors, there is limited data on the impact of the new WHO ANC in Delta state, and Nigeria in particular. Hence, the need to conduct this study. The objective was to assess the antenatal care medication compliance among pregnant women presenting at primary health care centres in Delta state, Nigeria.

Methodology: This study adopted a non-experimental descriptive cross sectional study design. Participants were drawn from four facilities across Delta state. Purposive sampling to select clients that meet the inclusion criteria and later simple random sampling was conducted. data was analysed using SPSS v.23. Pearson’s Chi-Square (X2) and/or Fisher’s Exact test was used to determine whether there is an association between socio-demographic traits and uptake of new ANC model.

Results: A total of N = 200 participants were enrolled in the study. Most of the women, 61.5% had their 1st ANC booking within the first 12 weeks, majority, 86% (172) clients did not complete the recommended number of ANC visits. Similarly, Age and Employment status were associated with uptake of new ANC model with p-values of; .000 and .000, respectively. And were therefore, had a negative effect on ANC uptake among the women.

Conclusion: The study sought to assess the antenatal care medication compliance among pregnant women presenting at primary health care centres in Delta state, Nigeria. The study provides evidence that Age and employment status of participants affect uptake of antenatal care medication. In addition, good knowledge and attitude does not always translate into uptake of a health intervention.

• Background of study
The quality of antenatal care accessed by women during pregnancy is key not only to the mother but also to the child. As a country, Nigeria acknowledges that antenatal period is a critical period for the provision of life saving interventions such as the new World Health Organization (WHO) Antenatal Care (ANC) which provides an ideal platform for the provision of integrated, quality services for pregnant women and adolescents.

Globally, approximately 303,000 women and adolescent girls died from pregnancy and childbirth related complications in 2015 and 2.6 million babies were stillborn (Alkema, et al., 2016). Almost all of the maternal deaths (99%) and child deaths (98%) occurred in low- and middle-income countries and Nigeria is not an exception. These maternal deaths could have been prevented if the pregnant women or adolescent girls had been able to access quality ANC (WHO, 2016).

To address this gap on low access to quality ANC, Nigeria has adopted the new WHO ANC guidelines in 2018. This new model addresses the issue of frequency of visits or contacts by pregnant mothers. Unlike the earlier 4-visit ANC model (also known as Focused Antenatal Care – FANC), antenatal care medication has an increased frequency on contact from 4 to minimum of 8 contacts between a pregnant woman and a respectful, knowledgeable health care worker leading to positive pregnancy experience. On the other hand, FANC model was found to have a challenge of underutilization of ANC services by pregnant mothers. It was observed that most pregnant mothers referred to Delta state Central Hospital (LCH) exhibited poor uptake of the new model. As evidenced by a report that women in Delta state do not attend antenatal care clinics, and that the majority of those who seek routine care often do so in late pregnancy resulting in increased pregnancy complications (Libingi, et al., 2019). Given that antenatal care medication was introduced in Nigeria in 2018, no previous research work was found related to poor uptake of this model in Delta state. This therefore presents an opportunity for a study specifically to address the issue of uptake of the new WHO ANC model by pregnant women.

This study, therefore, aims at finding out factors leading to poor uptake of the new model including quality of service in areas such as knowledge of the model content. Findings from this study will be used to feedback to the participating primary care health centres to help improve the knowledge base and uptake levels. The health staff will benefit from this information in that future clients will benefit through contact with them.

Since 2002, many low- and middle-income countries have adopted FANC into national policies, guidelines, and institutional protocols. However, in 2012, only 52% of pregnant women had four or more ANC visits during pregnancy, an absolute increase of only 15% in 22 years (Hodgins & D’Agostino, 2014). Therefore, WHO now recommends a minimum of eight contacts compared to the four visits from the old model as shown in Figure 1: five contacts in the third trimester, one contact in the first trimester, and two contacts in the second trimester. By using the word ‘contact’ rather than ‘visit’, the new WHO ANC model promotes a more active connection between ANC clients and their healthcare providers. To provide guidance to countries and health facilities and to enable consistent monitoring and assessing progress towards implementation of the new model, a monitoring framework is required. Monitoring the implementation and impact of routine ANC, as described in the guideline, requires monitoring ANC content and care processes that are not captured in the global benchmark indicator of four or more ANC visits (Hodgins & D’Agostino, 2014). The W.H.O’s 2016 ANC recommendations span five categories: routine antenatal nutrition, maternal and fetal assessment, preventive measures, interventions for management of common physiologic symptoms in pregnancy, and health system-level interventions to improve the utilization and quality of ANC. The 2016 WHO ANC model aims to provide pregnant women with respectful, individualized, person centered care at every contact and to ensure that each contact delivers effective, integrated clinical practices (interventions and tests), provides relevant and timely information, and offers psychosocial and emotional support (WHO, 2016).

1.2 Statement of the problem
A myriad of ANC models proposed by WHO have been over the past years implemented in low- and middle-income countries. One such model proposed by the organisation in 2001 was the Focused Antenatal Care (FANC) programme, which recommended at least those women with uncomplicated pregnancies should at least make 4 ANC visits.

Despite FANC benefits, it’s been noted that monitoring the impact of routine ANC, requires indicators that go beyond the previously used global benchmark indicator of four (4) visits (Lattof, et al., 2020). An increase in the number of visits would enable consistent monitoring of ANC content and care processes, and this led to a new model.

Nigeria implemented the new model in 2018 against a backdrop of low ANC visits (ZDHS, 2018), and high maternal mortality rates standing at 183 deaths per 100, 000 live births (ZNPHI, 2020).

Despite the well documented benefits of the model and huge investment by the government and donors, there is limited data on the impact of the new WHO ANC in Southern Province, and Nigeria in particular (Muloongo, 2019).

• Research Objectives
To assess the antenatal care medication compliance among pregnant women presenting at primary health care centres as well as Delta state Central Hospital.

Specific Objectives
• To determine the level of knowledge of antenatal care medication among pregnant women.

• To identify the gestational age (ANC Timing) of pregnancy at ANC booking.

• To determine average number of ANC visits completed by women at term.

• To determine the factors influencing the poor adoption of antenatal care medication among pregnant women.

• Research questions
• What is the level of knowledge of antenatal care medication among pregnant women attending at primary care health centres in Delta state?

• What is the average gestational age at booking among pregnant women presenting at the primary health care centres?

• How many antenatal care visits are completed by the pregnant women at term?

• What factors are associated with poor uptake of antenatal care medication?

1.5 Significance of study
Currently, there is no data relating to the outcomes of the new model in Delta state, Nigeria. In view of this background, there is need to determine the factors influencing the uptake of antenatal care medication primary health care centres in Delta state. As similar study performed by Muloongo at military primary care health centres determined that social, economic, and demographic factors such as education level, income, employment status, age, parity and male partner involvement, social and traditional norms, timing of visits, and attitude of women and decision making affected the successful implementation of antenatal care medication (Muloongo, 2019). It is likely that these factors may also be factors affecting the uptake of the new model. Nonetheless, it is worth performing this study as it can highlight these and other factors that negatively affect the uptake of antenatal care medication; it can help improve the level of attendance to ensure the good health of both mothers and infants in Delta state and other areas.

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