Antenatal care (ANC) is one of the strategies aimed at addressing maternal mortality as it facilitates the identification and mitigation of risk factors early in pregnancy [1]. Timely and frequent use of a package ANC enables delivery of essential services include: identification and management of obstetric complications such as preeclampsia, tetanus toxoid immunization, intermittent preventive treatment for malaria during pregnancy (IPTp), and identification and management of infections including HIV, syphilis and other sexually transmitted infections (STIs). ANC is also an opportunity to promote the use of skilled attendance at birth and healthy behaviours such as breastfeeding, early postnatal care, and planning for optimal pregnancy spacing [2].

Every year about 6 million women become pregnant; 5 million of these pregnancies lead to the birth of the child. An adequate use of antenatal health services is associated with improved maternal and neonatal health status. Pregnancy care expected to affect the development of the fetus and the baby as well as the mother [3].

Approximately 810 women die every day from preventable causes related to pregnancy and childbirth around the world. Global maternal deaths estimated about 295,000 women died during and following pregnancy and childbirth. The vast majority of these deaths (94%) occurred in low-resource settings, and most could have been prevented. The Sub-Saharan Africa alone accounted for roughly two-thirds (196,000) of maternal deaths [4].

Antenatal Care act as a key entry-point for implementing nutrition and health educational interventions that promote preventive health behaviors to improve maternal and neonatal health through better knowledge, attitudes and practices [5].

Globally scientific evidence has shown that low utilization of FANC services is influenced by some factors such as low maternal education, teenage pregnancies, multiparty, unplanned pregnancies and cultural factors [6].

Knowledge of pregnant mothers may be major factor in determining the extent of antenatal services use. Reports from various parts of the world have shown that increased levels of a wariness of pregnant mothers in terms of antenatal care have an impact on their utilization [7].

A lot of initiatives are in place to encourage adequate FANC utilization, these include: capacity building of health care providers towards ANC Guideline and intensive information, education and communication (IEC) on maternal health services offered in all health facilities. It is worrying that despite availability of the reproductive health policy and initiatives promoting adequate utilization of FANC services, very few pregnant women utilize these services [8].

Therefore, this study aimed to assess the aimed knowledge attitude and practice towards antenatal care among pregnant women attending for antenatal care in SOS Hospital, Hiliwa District, Benadir region, Somalia 2021.

Table 2 indicated that the majority of the respondents 45 (70%) were aged between (25 - 34) years while 10 (17%) were aged between (15 - 24) years followed by 5 (8%) were aged between (35 - 44) years, the majority illustrated that 22 (37%) were illiterate, followed by 17 (28%) were primary education level, 14 (23%) were secondary level While only 7 (12%) were university level.

In Table 2 showed that 26 (43%) said more than four times, followed by 19 (32%) said three times, 14 (28%) said two times, while only 1 (2%) said one time.Lastly the respondents mentioned that 33 (55%) said more than four children, followed by 20 (33%) said three children, 6 (10%) said two children, while only 1 (2%) said one child respectively.

Table 3 revealed that the majority of the respondents 45 (75%) said yes while 15 (25%) said no when asked their Awareness on Antenatal care ANC.

Also the respondents illustrated that 31 (52%) said its care given to pregnant women during pregnancy, followed by 9 (15%) said Its Maternal health & maternal nutritional towards pregnant women, while only 5 (8%) said it’s WHO recommendation; that pregnant women in developing countries to get at least

four ANC visits. While 15 (25%) said I don’t know.

In Table 3 mentioned the sources of the information and pointed out that 23 (38%) said that the source of their awareness towards antenatal care were from health care providers at health centers while 10 (17%) from my husband, followed by 8 (13%) from friends/relatives/neighbors; 3 (7%) from traditional birth attendants; While 15 (25%) said I don’t know.

In Table 4 showed that the majority of the respondents 48 (80%) said yes while 12 (20%) said no when asked about Convenience to go for antenatal check-up. Another revealed that the majority of the respondents 51 (85%) were taking permission from their husbands for ANC clinic visit during their pregnancies, while the rest of respondents 9 (15%) did not.

The result in Table 4 showed that the majority of the respondents 42 (70%) were said yes while 18 (30%) were said no when asked about their Satisfaction current ANC service.

Table 5 demonstrated that 35 (58%) were said yes while 25 (42%) said no when asked if they conducted Previous ANC visit. also showed that the majority of respondents 22 (36%) were said Mother and child health center (MCH), followed by 10 (16%) said public hospitals. while only 2 (5%) said private hospital. Lastly showed that 21 (35%) were said one time followed by 10 (16%) were said two times, 3 (5%) were said three timed, 1 (2%) were said Four and more times when asked how many Number of ANC visits of current pregnancy respectively.

Table 6 showed when the parity of the respondents were cross tabulated with their ANC visit the result showed significant difference was strongly observed (P < 0.000).

Table 7 showed that when the respondent’s Awareness toward ANC were cross tabulated with their ANC visit result showed significant difference was strongly observed (P < 0.000).

Table 8 showed that when the respondent’s seeking for permission to the ANC visit were cross tabulated with their ANC visit result showed significant difference was strongly observed (P < 0.000).

Table 9 showed that When the respondent’s spouse (husband) accompany to the ANC center were cross tabulated with their ANC visit result showed significant

difference was strongly observed (P < 0.000).

Table 10 When the respondent’s gestational months of their current pregnant were cross tabulated with their ANC visit result showed significant difference was strongly observed (P < 0.000).

As shown in Table 6 mainly related the independent study variables and methods to be collected those variables from study participants. In Table 2 showed

that this study illustrated that the majority of the respondents 45 (70%) were aged between 25 - 34 years while 54 (90%) were married while 4 (7%) and 22 (37%) were illiterate, followed by 17 (28%) were primary education level, also 46 (77%) were Housewives, while 9 (15%) were employed and`33 (55%) were had more than four children.

ANC utilization can be influenced by demographic and socio-cultural factors. Maternal age has been shown to be both negatively and positively influence utilization of FANC and ANC in general. A study conducted in Turkey demonstrated that teenage mothers were statistically less likely to use FANC service [6]. However, in other studies teenage mothers were more likely to start utilizing ANC services earlier than their older counter parts [17].

In Table 2 Maternal education has also been shown to influence utilization of ANC [18]. In study conducted in Nepal demonstrated that women with higher education were more likely to utilize FANC than those with lower education [19]. A study conducted in Ecuador and Nepal found that demographic factors such as marital status, occupation, religion, family size and ethnicity also statistically significantly influence utilization of ANC, also Place of residence has also been shown to influence ANC utilization, and women in urban areas were more likely to use ANC more than rural women in Ecuador [20].

In Table 2, in the multivariable analysis, maternal education was found to be significantly associated with timely attendance of ANC; mothers whose educational status was secondary school and above were two times more likely to attend their ANC timely compared to the mothers who took primary school or who had no formal education. This study is similar to the studies conducted in Vietnam, Benin, Uganda, Ambo and Adigrat [21]. This might be due to, educated mothers might be knowledgeable about what is necessary during pregnancy, the importance of ANC and early booking and they might book timely.

In Table 6, Maternal level of knowledge was found to be significantly associated with timely beginning of ANC; respondents who had good knowledge about the importance of ANC and early booking were about three times more likely to book timely as compared to those respondents who had poor knowledge about the importance of ANC and early booking. This is equivalent with the study findings in Benin, Zambia, Tanzania, Rwanda, Ambo, Debre brhan, Mekelle and Adigrat in which mothers who lack knowledge about ANC were more likely to book late [22].

In Table 6 addition many other studies showed woman’s residence, age, educational status, employment status, parity, intention to get pregnant, economic status, health insurance, and traveling time are among the most cited factors which are related to late ANC visit [23].

As shown in Table 2, total numbers of 60 respondents were pregnant women who attended antenatal center SOS hospital Hiliwa district, Benadir region, Somalia during the period of the study from April 2021-July 2021.

Almost about 45 (70%) were aged between 25 - 34 years while 54 (90%) were married, 4 (7%) and 22 (37%) were illiterate, followed by 17 (28%) were primary education level, also 46 (77%) were Housewives, while 9 (15%) were employed and 33 (55%) were had more than four children.

Among the study respondents, 45 (75%) had awareness towards antenatal care while the source information was 23 (38%) from health care providers at health centers while 10 (17%) from their husband, and 48 (80%) have convenience and accepted utilization of antenatal care, while 51 (85%) were taking permission for antenatal care clinic visit also 56 (93%) had a spouse accompany during their ANC clinic visit.

As show in Table 5, total 35 (58%) utilized antenatal care ANC visit during their pregnancies while 22 (36%) were preferred to go Mother and child health center (MCH) for antenatal care visit, followed by 10 (16%) public hospitals. while only 2 (5%) private hospital.

And 26 (43%) were they started ANC visit during the period 7 - 9 months (25 - 36 weeks) of their gestational period of their current pregnancy followed by 6 (10%) were started ANC visit in 4 - 6 months (13 - 24 weeks) of their gestational period while 21 (35%) were made one time of ANC visit followed by 10 (16%) two times of ANC visit regarding their main reason of not ANC clinic visit of their previous pregnancy.

A total of 13 (22%) were responded due to: not satisfied with the services offered at the health facilities, followed by 9 (15%) responded not knew that they was supposed to attend ANC, while 2 (3%) responded due to long waiting hours while 1 (2%) responded Bad health worker attitude.

Furthermore, when the respondent’s multigravida, gestational months of their current pregnant, seeking permission and a spouse (Husband) accompany to the ANC clinic visit and level of their awareness were cross tabulated with their ANC visit result showed significant difference was strongly observed (P = 0.000) as mentioned in Table 9.

The study recommended the flowing:

1) The Federal ministry of health incorporation with Federal member states ministry of health should intensify national health education programmers aimed at promoting utilization of ANC services by increase the knowledge of mothers about importance of antenatal care and timely antenatal care booking.

2) To train all health workers especially (doctors, nurse and midwives) in the health facility level across the country on the national Antenatal care guideline, policies and strategies to ultimately improve quality of health care services in the maternal and child health services

3) To increased awareness and behavioral change and improve male involvement of maternal and reproductive health services.

4) However, due to the scarcity of published data regarding the antenatal care in Somalia and the important of antenatal care ANC services. The study recommended further studies on Knowledge Attitude and Practice towards Antenatal Care among Pregnant Women should be conducted in Somalia.

The authors declare no conflicts of interest regarding the publication of this paper.

Mohamoud, A.M., Mohamed, S.M., Hussein, A.M., Omar, M.A., Ismail, B.M., Mohamed, R.A., Ahmed, M.I. and Ibrahim, S.D. (2022) Knowledge Attitude and Practice towards Antenatal Care among Pregnant Women Attending for Antenatal Care in SOS Hospital at Hiliwa District, Benadir Region, Somalia. Health, 14, 377-391. https://doi.org/10.4236/health.2022.144030