Determinants of antenatal care utilization among refugees in Kampala district.

Abstract

Despite global advancements in Antenatal Care (ANC) utilization, UNICEF's 2015 report emphasizes a persistently low rate of ANC uptake in Uganda, posing a significant challenge, particularly for vulnerable populations like refugee women, where accurate statistics on ANC utilization in urban health centers are lacking. The main objective of this study was to investigate the factors associated with Ante Natal Care (ANC) attendance use among female urban refugees. The study was based on primary data obtained from a survey of 382 refugees recruited from urban areas like Katwe, Kisenyi, Old Kampala, Makindye and Kansanga where refugees are known to reside. A descriptive summary of the status of ANC attendance as well as refugee socio-demographic, economic and enabling factors was made using frequency distributions. The Pearson Chi-square test was used to identify the association between refugee characteristics and ANC attendance. At the multivariate level, a Multinomial Logistic Regression (MLR) was adopted in obtaining the determinants of ANC attendance among refugees. The regression was adopted because ANC attendance was evaluated using three outcomes namely, none (0 times), 1 - 3 (1 to 3 times) and ≥4 (4 and above times). The results revealed that majority of female refugees were married, employed, and had access to integrated services. Notably, those aged 20 to 29, with up to secondary education, identifying as Christians, originating from Congo, and having experienced violence constituted a significant proportion. The study delves into intermediate factors, including economic and healthcare decision- making, time taken to reach health facilities, perceived quality of ANC services, and challenges faced. It highlights the nuanced decision-making processes and challenges faced by female refugees in accessing ANC services. ANC attendance patterns indicate that the highest percentage attended four or more sessions, with bivariate analyses identifying influential factors such as country of origin, time taken to reach health facilities, and influences by church members or spouses. The multivariate analysis underscores the significance of certain predictors, notably the reduced risk of non-attendance for women refugees from Burundi compared to those from Congo. Factors like the time taken to reach the health facility and influence by church or other community members are identified as significant contributors to ANC attendance, enriching our understanding of the multifaceted dynamics involved in maternal healthcare utilization among refugees. Notably, tailored interventions are recommended for high-risk groups, including women from Congo and those with extended travel times, with a focus on transportation support and community outreach. Intensified communication and education efforts are advised to improve ANC perceptions and address poverty-related challenges. Clear informational materials and community engagement initiatives, especially with church and community leaders, are crucial for fostering a supportive environment and enhancing overall maternal healthcare utilization among female refugees.