Antenatal Care in Sudan: A Qualitative Study Into Accessibility and Quality of Maternal Health Services in Khartoum

Antenatal care is shown to be a cost-effective intervention for reducing rates of maternal mortality. However, utilization of maternal health services in Sudan remains low and maternal deaths high. This study aims to investigate why Sudanese women do not attend antenatal care, satisfaction with services and views on improving uptake. Focus group discussions took place, with 30 women who had delivered in the past year, in five areas in Khartoum. Themes in transcripts were identified. Factors that can affect a woman’s choice to attend antenatal care extend beyond physical barriers and include misconceptions of it’s use, conflict between faith and modern medicine and dissatisfaction with previously used services. The care provider’s perceived lack of empathy, unpunctuality and lack of health promotion can also contribute to underutilization.

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Predictors of the Timing and Number of Antenatal Care Visits among Unmarried Compared To Married Youth in Uganda Between 1995 And 2011

10.21203/rs.3.rs-33567/v1 ◽

2020 ◽

Author(s):

Peninah Agaba ◽

Cyprian Misinde

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

First Trimester ◽

Maternal Health Services ◽

Demographic And Health Surveys ◽

Enabling Factors ◽

Maternal Deaths ◽

Early Use ◽

Late Start

Abstract Introduction Inadequate use of maternal health services among the youth remains a serious health challenge in Uganda. The low use of maternal health services among youth partly explains the persistence high maternal mortality rate in the country. Yet, improved use of maternal health services by the youth would help reduce maternal deaths in the country. Therefore, this study examines predisposing and enabling factors associated with the timing and the number of antenatal care visits among unmarried compared to married youth aged 15-24 years between 1995 and 2011 in Uganda. Methodology Two-level binary logistic and linear regression models with district as a second level of analysis were conducted on pooled data of the 1995, 2000/01, 2006 and 2011 Uganda Demographic and Health Surveys. This analysis was among 581 unmarried, compared to 5,437 married youth, aged 15-24 years. Results Only 16% of unmarried youth and 18% of married youth had ANC in the first trimester. Education was the only factor that was significantly associated with early use of antenatal care among unmarried youth. Whereas high education was associated with higher odds of using antenatal care in the first trimester among married youth (OR=1.30, 95%CI=1.08-1.57), it was associated with late start among unmarried youth (OR=0.56, 95%CI=0.31-0.98). Higher parity, protestant membership and residence in eastern region were associated with late start of antenatal care, while access to radio and television, and education level of the husband were associated with higher odds of early use of antenatal care among married youth. Overall, married youth were more likely to have more frequent antenatal care visits than unmarried youth. Among both groups, higher educational attainment and greater access to radio were associated with frequent antenatal care use. Residing in western region was associated with fewer antenatal care visits among both married and unmarried youth. Access to newspaper was associated with more antenatal care visits among married youth only. Conclusion This study presents the individual level predisposing and enabling factors that are important predictors of the use of antenatal health care services among youth that will guide policy to reduce maternal deaths among youth in Uganda.

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Maternal Health Care Among Refugees and Host Communities in Northern Uganda: Access, Quality, and Discrimination

Frontiers in Global Women's Health ◽

10.3389/fgwh.2021.626002 ◽

2021 ◽

Vol 2 ◽

Author(s):

Siri Aas Rustad ◽

Helga Malmin Binningsbø ◽

Haakon Gjerløw ◽

Francis Mwesigye ◽

Tony Odokonyero ◽

...

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Maternal Health Services ◽

Maternal Health Care ◽

Host Community ◽

Northern Uganda

Introduction: Uganda is one of the largest refugee-hosting nations in the world, with the majority of the refugees having fled South Sudan. In the early 2000's the local government and refugee health systems were merged to create a more equal and integrated system for refugees and the host population. Our aim is to investigate whether mothers from the two groups experience the same access to and quality of maternal health services, and whether refugee- and host-community mothers perceive the maternal health services differently.Methods: In November–December 2019, we conducted a household survey of 1,004 Ugandan nationals and South Sudanese refugee mothers aged 15–49 in the West Nile region covering the districts of Arua, Yumbe, and Adjumani, and elicited information on access to maternal health care services, perceptions of the quality of services, and feelings of discrimination. The data was then analyzed using Ordinary Least Squares and logistic regression.Results: Our analyses do not reveal large differences between refugees and the host community in terms of access to and the quality of maternal health services. Results from bivariate models indicate that refugee mothers are 6% points less likely to receive antenatal care (p-value < 0.05) but are 8% points more likely to give birth at a health facility (p-value < 0.05). Refugee mothers are generally less satisfied with how they were treated during antenatal care (0.132 lower average value on a Likert scale, p-value < 0.01). Refugee mothers are also 4% points more likely to feel discriminated against during ANC compared to their counterparts in the host community (p-value < 0.05).Discussion: The way women feel treated at the health facility during maternal health care is an important aspect of quality care. While there seems to be equal access to resources between refugees and host community mothers in Northern Uganda in terms of access to and quality of care, there is still a discrepancy between the two groups in terms of how the women feel treated. Policymakers and practitioners in the health sector should pay attention to these perceived inequalities between refugees and women from the host communities to ensure equally inclusive treatment across groups.

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Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

Public Health Reviews ◽

10.1186/s40985-020-00147-0 ◽

2020 ◽

Vol 41 (1) ◽

Author(s):

Adweeti Nepal ◽

Santa Kumar Dangol ◽

Anke van der Kwaak

Keyword(s):

Maternal Health ◽

Health Services ◽

Health System ◽

Maternal Health Services ◽

Policy Formulation ◽

Social Accountability ◽

The Social ◽

The Government ◽

The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

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Interrelationships Between Maternal Health Services in Uganda: A Structural Equation Analysis

10.21203/rs.2.17266/v1 ◽

2019 ◽

Author(s):

Ruth Atuhaire

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Health Facility ◽

Structural Equation ◽

First Trimester ◽

Maternal Health Services ◽

Facility Delivery ◽

Health Facility Delivery ◽

Mediating Factor

Abstract Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

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Association between male involvement during antenatal care and use of maternal health services in Mwanza City, Northwestern Tanzania: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-036211 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036211

Author(s):

Clara C Natai ◽

Neema Gervas ◽

Frybert M Sikira ◽

Beatrice J Leyaro ◽

Juma Mfanga ◽

...

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Male Involvement ◽

Maternal Health Services ◽

Cross Sectional Study ◽

Growth Monitoring ◽

Sectional Study ◽

Cross Sectional ◽

Mwanza City

BackgroundMale involvement in antenatal care (ANC) is among interventions to improve maternal health. Globally male involvement in ANC is low and varies in low-income and middle-income countries including Tanzania where most maternal deaths occur. In Sub-Sahara, men are chief decision makers and highly influence maternal health. In Tanzania information is limited regarding influence of male involvement during ANC on utilisation of maternal health services.ObjectivesTo determine the effect of male involvement during ANC on use of maternal health services in Mwanza, Tanzania.DesignA cross-sectional study conducted from June to July 2019.SettingThis study was conducted at seven randomly selected health facilities providing reproductive, maternal and child health (RCH) services in Mwanza City.ParticipantsIncluded 430 postpartum women who delivered 1 year prior to the study and attending for RCH services (growth monitoring, vaccination, postpartum care).Outcome measures4 or more ANC visits, skilled birth attendant (SBA) use during childbirth and postnatal care (PNC) utilisation 48 hours after delivery.MethodsInterviews and observation of the women’s ANC card were used to collect data. Data was entered, cleaned and analysed by SPSS.ResultsThe mean age of participants was 25.7 years. Of 430 women, 54.4% reported their partners attended ANC at least once, 69.7% reported they attended for four or more ANC visits during last pregnancy, 95% used SBAs during childbirth and 9.2% attended PNC within 48 hours after delivery. Male involvement during ANC was significantly associated with four or more ANC visits (Crude Odds Ratio (COR): 1.90; 95% CI: 1.08–3.35) but not with SBA use or PNC utilisation.ConclusionMale involvement in ANC is still low in Mwanza, as 46% of the partners had not attended with partners at ANC. Alternative strategies are needed to improve participation. Studies among men are required to explore the barriers of participation in overall RCH services.

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PELAYANAN PEMERIKSAAN KEHAMILAN BERKUALITAS YANG DIMANFAATKAN IBU HAMIL UNTUK PERSIAPAN PERSALINAN DI INDONESIA

Jurnal Ekologi Kesehatan ◽

10.22435/jek.18.1.1777.60-69 ◽

2019 ◽

Vol 18 (1) ◽

pp. 60-69

Author(s):

Ika Dharmayanti ◽

Khadijah Azhar ◽

Dwi Hapsari Tjandrarini ◽

Puti Sari Hidayangsih

Keyword(s):

Maternal Health ◽

Antenatal Care ◽

Social Environment ◽

Maternal Health Services ◽

Living Environment ◽

Health Centers ◽

Safe Delivery ◽

Highly Educated ◽

Analysis Technique

ABSTRACT Antenatal care (ANC) is a prevention healthcare for maternal health and their babies. In order to fulfill the needs of them, an accessible health facility that provides ANC with qualified services for the community is needed. This study aims to determine the utilization of maternal health services as preparation for safe delivery. Analysis of this study used the data from National Health Indicator Survey (Sirkesnas) 2016 and Village Potential Census (Podes) 2014. The analysis technique was multivariable logistic regression. The results showed that the use of qualified ANC tended to be used by mothers who were examined by midwives in health centers, highly educated mothers, those who were living in moderate and good neighborhoods, not living in slums (social environment) and residing in Java-Bali region. It can be concluded that midwives and location of ANC provided important role to improve the utilization of ANC services as an ideal preparation for safe delivery. Keywords: Quality of ANC, maternal health, living environment, social environment ABSTRAK Pemeriksaan kehamilan atau antenatal care (ANC) merupakan upaya untuk menjaga kesehatan ibu hamil dan bayinya. Dalam memenuhi kebutuhan tersebut, diperlukan fasilitas kesehatan yang mudah diakses oleh masyarakat serta pelayanan pemeriksaan ANC yang berkualitas. Penelitian ini bertujuan untuk mengetahui pemanfaatan pelayanan kesehatan ibu hamil sebagai persiapan persalinan yang aman. Analisis menggunakan data Survei Indikator Kesehatan Nasional (Sirkesnas) tahun 2016 dan Potensi Desa (Podes) tahun 2014. Teknik analisis yang digunakan adalah regresi logistik multivariabel. Hasil uji regresi logistik multivariabel menunjukkan bahwa pemanfaatan ANC berkualitas cenderung digunakan oleh ibu yang diperiksa bidan di puskesmas, ibu berpendidikan tinggi, tinggal di lingkungan permukiman sedang dan baik, tidak tinggal di wilayah kumuh (lingkungan sosial) serta bertempat tinggal di Regional Jawa-Bali. Dapat disimpulkan bahwa bidan dan tempat ANC mempunyai peran sangat penting untuk meningkatkan pemanfaatan pelayanan ANC ideal sebagai persiapan persalinan yang aman. Kata kunci: Pelayanan kehamilan berkualitas, kesehatan ibu hamil, lingkungan permukiman, lingkungan sosial

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Predictors of skilled maternal health services utilizations: A case of rural women in Ethiopia

PLoS ONE ◽

10.1371/journal.pone.0246237 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0246237

Author(s):

Berhan Tsegaye ◽

Elsabet Shudura ◽

Amanuel Yoseph ◽

Alemu Tamiso

Keyword(s):

Regression Analysis ◽

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Postnatal Care ◽

Institutional Delivery ◽

Care Service ◽

Maternal Health Services ◽

P Value ◽

Services Utilization

Background Maternal health services are affected by complex factors from one setting to another. Consequently, health planners should prioritize different interventions and design appropriate programs to enhance maternal health services utilization. Results of prior studies are conflicting. Furthermore, only few studies were done from antenatal to postnatal continuum of care in Ethiopia. Objectives This study aimed to assess prevalence and predictors of skilled maternal health services utilization at Dale-Wonsho health and demographic surveillance site of the Hawassa University, South Ethiopia, in 2019. Methods A community based cross sectional study was conducted from January 1–30; 2019. A total of 682 women who gave birth in the last twelve months were selected by using a two stage sampling technique. Data were collected through face to face interview. Data were entered into Epidata version 3.1. Then, they were exported and analyzed by SPSS version 22. Bi-variable logistic regression analysis was done and variables with p-value less than 0.05 were considered as candidate for multivariable logistic regression analysis. Adjusted Odds Ratios (AOR) with 95% CI were computed, and p-value less than 0.01 was computed to determine the level of significance. Result Prevalence of antenatal care, institutional delivery and postnatal care utilizations were 69.1%, 52.1% and 32.7% respectively. Educated women (AOR = 4.72, 95%CI,2.82,7.9), household training (AOR = 8.52,95%CI = 5.5,13.1), middle wealth quantile(AOR = 0.8,95%CI,0.4–0.7), being richest wealth quantile (AOR = 0.16;95%CI = 0.06,0.41) and pregnancy plan (AOR = 3.65,95%CI,1.67–8.0) were factors positively associated with antenatal care utilization. Husband education (AOR = 4.96,95CI,3.08–8.0), and antenatal care (AOR = 5.9; 95%CI,3.87,9.1) were factors associated with institutional delivery. Maternal education (AOR = 2.5,95CI,1.4–4.4), information about postnatal care service utilization (AOR = 3.6,95CI,2.1,6.2) and women autonomy(AOR = 6.1,95CI,3.8,9.7) were positively associated with postnatal care service. Conclusion Prevalence of antenatal care, institutional delivery and postnatal care services were lower than the targeted plan. Policy makers should focus on capacity building of women both economically and academically. So, women should be more autonomous to utilize health services effectively. Moreover, awareness creation among women should be enhanced about maternal health service.

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Knowledge on Intrapartum Danger Sign Influences Place of Delivery: The Case of Raya Kobo District, Northeastern Ethiopia

International Journal of Child Health and Nutrition ◽

10.6000/1929-4247.2021.10.02.1 ◽

2021 ◽

Vol 10 (2) ◽

pp. 44-50

Author(s):

Nigus Bililign Yimer ◽

◽

Misgan Legesse Liben

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Institutional Delivery ◽

Maternal Health Services ◽

District Health ◽

Delivery Service ◽

Danger Signs ◽

Study Participants ◽

Institutional Delivery Service

Background: A skilled birth attendance for every pregnant woman during childbirth is the most crucial intervention for improving maternal health. This study aimed to assess institutional delivery service utilization and associated factors among mothers who gave birth in the last 12 months in Raya Kobo district, Ethiopia. Methods: A community-based cross-sectional study was carried out in the Raya Kobo district of Amhara Regional State during March 2016. Logistic regression analysis was performed to assess the association between each independent variable and the outcome variable. Variables with a p-value <0.05 were considered significant. Results: A total of 493 mothers were included in the study, with a response rate of 95.4%. The mean (+SD) age of the study participants was 29.13 (±6.93) years. About 73% of the study participants had attended at least one antenatal care follow up for their last pregnancy, and 56.6% (95% CI: 52.0, 61.0%) gave birth at health institutions. Travelling for 30 minutes and less [AOR=2.95(1.89, 4.58)], attending antenatal care [AOR=6.0(3.55, 10.13)], having knowledge about intrapartum danger signs [AOR=2.48(1.44, 4.24)] and getting information from health extension workers (HEWs) regarding maternal health services were positively associated. Conclusion: The district health office should strengthen its effort to provide free ambulance accessibility and provide information on danger signs of intrapartum complications and the importance of using institutional delivery service to every mother who came to the antenatal clinic. Furthermore, the district health officials should focus on strengthening the capacity of HEWs in relation to maternal health services.

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Traditional practices influencing the use of maternal health care services in Indonesia

PLoS ONE ◽

10.1371/journal.pone.0257032 ◽

2021 ◽

Vol 16 (9) ◽

pp. e0257032

Author(s):

Ni Ketut Aryastami ◽

Rofingatul Mubasyiroh

Keyword(s):

Health Care ◽

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Maternal Health Services ◽

Community Empowerment ◽

Maternal Health Care ◽

Health Care Facilities ◽

Traditional Practices ◽

Birth Attendance

Background Maternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia. Methods We used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates. Results Traditional practices and high TBA density have significantly inhibited the mother’s access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24–0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17–1.52; p<0.01) of using maternal health services. Discussion Not all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

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Health Extension Workers Involvement in the Utilization of Focused Antenatal Care Service in Rural Sidama Zone, Southern Ethiopia: A Cross-Sectional Study

Health Services Research and Managerial Epidemiology ◽

10.1177/2333392819835138 ◽

2019 ◽

Vol 6 ◽

pp. 233339281983513 ◽

Cited By ~ 1

Author(s):

Achamyelesh Gebretsadik ◽

Million Teshome ◽

Mekdes Mekonnen ◽

Akalewold Alemayehu ◽

Yusuf Haji

Keyword(s):

Maternal Health ◽

Health Services ◽

Antenatal Care ◽

Multivariate Logistic Regression Analysis ◽

Maternal Health Services ◽

Child Health Services ◽

Outcome Variable ◽

Health Extension Workers ◽

Cross Sectional ◽

Focused Antenatal Care

Background: Health extension workers (HEWs) are primarily been assigned in rural areas of Ethiopia to provide maternal and child health services. Few studies have been done to investigate HEWs’ contributions towards maternal health services. This study describes HEWs involvement in the utilization of focused antenatal care (FANC). Methods: A population-based cross-sectional survey was conducted between January 21 and February 4, 2017. Mothers (2300) who gave birth in the last 6 months (0-6 months) in randomly selected 30 kebeles in the rural Sidama zone, participated in the study. A face-to-face interview was done using a structured questionnaire adapted from the Saving Newborn Lives Program. The main outcome variable was FANC utilization. Descriptive statistics and multivariate logistic regression analysis were used using SPSS statistical software. Results: The FANC was used by 525 (24.36%; 95% confidence interval [CI]: 22.5%-26.2%) women. Health extension workers accounted for 244 (46.47%; 95% CI: 43.5-47.7%) of mothers. The FANC utilization was less likely among those who were illiterate (adjusted odds ratio [AOR]: .32; 95% CI: .18-.57) and those who attended first cycle (AOR: .41; 95% CI: .23-.74), those who attended secondary cycle (AOR: .47; 95% CI: .27-.82), primipara (AOR: 0.53; 95% CI: .35-.83), and those who gave birth at home (AOR: .66; 95% CI: .51-.84). Mothers who had knowledge of pregnancy danger signs (AOR: 1.42; 95% CI: 1.2-1.7) and exposure to mass media (AOR: 1.35; 95% CI: 1.1-1.66) were more likely to utilize FANC. Conclusions: FANC utilization in this study was low compared to other studies. The HEWs had a major contribution to the services. However, it is low when compared to the plan set by the state ministry of health. The existing health extension program could be strengthened by increasing the number of HEWs. Empowering rural mothers through continuous education program to enhance the utilization of maternal health services.

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