Determinants of compliance with the World Health Organisation recommendations for pregnant women in an urban health centre in The Gambia

Susan P Laing, John M Guzek, David M Rassam, Isatou Sey Ceesay, James M O N’Dow


In 2001 the World Health Organization drew up recommendations for pregnant women in order to reduce maternal mortality: the first visit to the antenatal clinic to be in the first trimester, at least four visits in total and delivery with a trained birth attendant.  This study reports the extent to which pregnant women attending a health centre in The Gambia complied with the recommendations.  A cohort of 1611 consecutive pregnant women was recruited. Only 384 (23.9%) women first attended in the first trimester and 568 (41.6%) attended at least four times. Only 15.8% of the women complied with all recommendations.  Following multivariate analysis the educational level of the partner was the sole factor associated with both recommendations regarding attendance. This level of compliance reflects widespread ignorance of the value of early antenatal care and frequent visits. Public health programmes require a basic level of education to be effective. (Afr J Reprod Health 2020; 24[3]: 24-32).

Full Text:



World Health Organisation. WHO antenatal care

randomized trial: manual for the implementation of the new model, WHO document WHO/RHR/01.30. Geneva: WHO; 2002.

Mchenga M, Burger R and von Fintel D. Examining the

impact of WHO’s Focused Antenatal Care policy on services in Malawi: a retrospective study. BMC Health Serv Res. 2019; 19(1):295-308.

Verney A, Reed BA, Lumumba JB and Kung’u JK.

Factors associated with socio-demographic characteristics and antenatal care and iron supplement use in Ethiopia, Kenya, and Senegal. Matern Child Nutr. 2018;14 Suppl 1. doi: 10.1111/mcn.12565.

Anchang-Kimbi JK, Achidi EA, Apinjoh TO, Mugri RN,

Chi HF, Tata RB, Nkegoum B, Mendimi JM, Sverremark-Ekstrom E and Troye-Blomberg M. Antenatal care visit attendance, intermittent preventive treatment during pregnancy (IPTp) and malaria parasitaemia at delivery. Malar J. 2014; 13:162-170.

Gudayu TW. Proportion and factors associated with late

antenatal care booking among pregnant mothers in Gondar Town, North West Ethiopia. Afr J Reprod Health. 2015; 19(2):94-100.

Laing SP, Smruti SV, Rafique K, Smith HE and Cooper

M. Barriers to antenatal care in an urban community in the Gambia: An in-depth qualitative interview study. Afr J Reprod Health. 2017; 21(3): 62-69.

Anya SE, Hydara A and Jaiteh LES. Antenatal care in

the Gambia: Missed opportunity for information, education and communication. BMC Pregnancy and Childbirth. 2008; 8:9-15.

Kisuule I, Kaye DK, Najjuka f, Ssematimba SK, Arinda

A, Nakitende G and Otim L. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala, Uganda. BMC Pregnancy Childbirth. 2013; 13:121-127.

Gudayu TW, Woldeyohannes SM and Abdo AA. Timing

and factors associated with first antenatal care booking among pregnant mothers in Gondar Town; North West Ethiopia. BMC Pregnancy Childbirth. 2014; 14:287-293.

Muchie KF. Quality of antenatal care services and

completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey. 2017; 17(1):300-307.

Sakeah E, Olawa S, Oduro AR, Shibanuma A, Ansah E,

Kikuchi K, Gyapong M, Owusu-Agyei S, Williams J, Debpuur C, Yeji F, Kukula VA, Enuameh Y, Asare GQ, Agyekum EO, Addai S, Sarpong S, Adjei K, Tawiah C, Yasuoka J, Nanishi K, Jimba M, Hodgson A and the Ghana EMBRACE Team. Determinants of attending antenatal care at least four times in rural Ghana: analysis of a cross-sectional survey. Glob Health Action.2017; 10(1):1291879.

Carvajal-Aguirre L, Amouzou A, Mehra V, Zigi M, Zaka

N and Newby H. Gap between contact and content in maternal and newborn care: An analysis of data from 20 countries in sub-Saharan Africa. J Glob Health. 2017; 792:020501.

Ebeigbe PN and Igberase GO. Reasons given by

pregnant women for late initiation of antenatal care in the niger delta, Nigeria. Ghana Med J. 2010; 44(2):47-51.

Wolde F, Mulaw Z, Zena T, Biadgo B and Limenih MA.

Determinants of late initiation for antenatal care follow up: the case of northern Ethiopian pregnant women. BMC Res Notes. 2018; 11(1):837-843.

Gulema H and Berhane Y. Timing of first antenatal care

visit and its associated factors among pregnant women attending public health facilities in Addis Ababa, Ethiopia. Ethiop J Health Sci. 2017; 27(2):139-146.

Tesfaye G, Loxton D, Chojenta C, Semahegn A and

Smith R. Delayed initiation of antenatal care and associated factors in Ethiopa: a systematic review and meta-analysis. Reproductive Health. 2017; 14(1):150-166.

Chama-Chiliba CM and Koch SF. Utilization of focused

antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis. Health Policy Plan. 2015; 30(1):78-87.

Forbes F, Wynter K, Wade C, Zeleke BM and Fisher J.

Male partner attendance at antenatal care and adherence to antenatal care guidelines: secondary analysis of 2011 Ethiopian demographic and health survey data. BMC Pregnancy Childbirth. 2018; 18(1):145-155.

Abekah-Nkrumah G and Abor P. Socioeconomic

determinants of use of reproductive health services in Ghana. Health Econ Rev. 2016; 6(1):9-23.

Chimatiro CS, Hajison P, Chipeta E and Muula AS.

Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District - Malawi. Reprod Health. 2018; 15(1):158-164.

Some DT, Sombie I and Meda N. How decision for

seeking maternal care is made - a qualitative study in two rural medical districts of Burkina Faso. Reprod Health. 2013; 10:8-13.

Adjiwanou V, Bougma M and LeGrand T. The effect of

partners’ education on women’s reproductive nd maternal health in developing countries. Soc Sci Med. 2018; 197:104-115.


  • There are currently no refbacks.