Declining Antenatal Clinic Attendance at A Tertiary Hospital in Lagos, Nigeria: A Cross-Sectional Study Evaluating Its Determinants and Pregnant Women’s Experiences

Abstract

Objectives: This study determined the attrition rate from antenatal care (ANC) and delivery in Lagos University Teaching Hospital (LUTH), Idi-Araba, Lagos, and established the reasons for poor patient retention.

Methods: A cross-sectional survey of 403 pregnant women receiving ANC in LUTH. An interviewer-administered questionnaire was used to collect information on their sociodemographic characteristics and experiences with ANC services in LUTH. Level of satisfaction with ANC was assessed using a numerical rating scale. In addition, data on the number of pregnant women registered for ANC and delivered yearly were retrieved from the hospital’s records. Descriptive analysis was conducted on Stata version 18.0.

Results: From 2014 to 2021, 8,620 pregnant women registered for ANC in LUTH, but only 4,072 of these delivered in the facility, making the overall attrition rate 52.8%, with the highest attrition of 71.0% in 2021. The mean age of the respondents was 31.6±5.5 years, and 112(27.8%) were first timers at the clinics. ANC was considered important by 401(99.5%). The commonest self-reported reasons why the women would decide to discontinue ANC in LUTH included problems with e-payment 118(29.3%), complex registration processes 109(27.1%), long waiting time 107(26.6%), disregard/abuse by healthcare workers 74(18.4%) and missing laboratory results 71(17.6%). Problems already being encountered by some women included e-payment issues 114(28.3%), long waiting time 106(26.3%) and long registration processes 52(12.9%); and 7(1.7%) of the women expressed readiness to stop ANC at the facility. The median satisfaction score of the women for ANC received was 7(IQR:6-8), with 215(53.4%) having an above median satisfaction score.

Conclusion: Attrition from ANC in LUTH is high due to suboptimal satisfaction with ANC services, hinged on reasons related to the e-payment process, complex registration processes and delay in receiving consultation. There is an urgent need to upscale services and adopt seamless processes to improve pregnant women’s retention for ANC.