Early registration for antenatal care was associated with improved birth outcomes in a low-income community in Harare

Abstract Background : The World Health Organization (WHO) recommends early registration, regular and consistent attendance of antenatal care (ANC) sessions for all pregnant women. Specifically, if ANC services promote evidence-based practices this improves pregnancy outcomes and reduce maternal mortality. Yet there are worrying gaps in knowledge of antenatal care services in Zimbabwe. Objectives: To determine the relationship between early registration and frequency of ANC visits on birth weight, birth length, head circumference, Apgar score, birth complications, delivery mode, preterm birth and duration of labour among women aged 15-49 from Hatcliffe Polyclinic, Harare. Methods: This was a health facility based analytical cross-sectional study. An interviewer administered questionnaire was used to collect data. Data was entered and analysed using SPSS version 20. Descriptive statistics, and associations between dependent and independent variables were determined using Pearson’s Chi-square and Fisher’s exact test. Ethical approval was granted from the Medical Research Council of Zimbabwe (MRCZ/B/1438). Results: A total of 75 mother child pairs were interviewed. Most (77.3%) had more than four ANC visits. Only 36% registered early (during first trimester). Most of the children had normal birth weight ≥2500g (80.3%), birth length ≥47cm, (76%), head circumference ≥33cm (80%), and Apgar score ≥7 (96%). A positive association was observed between number of ANC visits and birth weight [Odds ratio (OR) 7.6; 95% Confidence Interval (CI) 1.6, 36.4 (p=0.013)], birth length [OR 6.1; 95%CI 1.8, 20.1 (p=0.010)], and head circumference [OR 4.3; 95% CI 1.3, 14.8 (p=0.013)]. Positive associations were also observed between timing of registration and birth weight [OR 1.2; 95% 1.05, 1.36 (p=0.045)], birth length [OR 0.16; 95% CI 0.03, 0.76 (p=0.012)]. Conclusions: In this study increased frequency and early registration for ANC visits had a positive relationship with birth weight, birth length and head circumference. These findings show the need for improving the uptake of ANC services, early registration for ANC in the first trimester and adoption of community wide strategies to ensure that pregnant women attend all recommended visits for improved birth outcomes in this and related settings.