Prenatal Ultrasound Utilization and Associated Factors Among Pregnant Women Attending Antenatal Care in South Wollo Zone Public Hospitals, North East, Ethiopia,2023

Prenatal Ultrasound Utilization and Associated Factors Among Pregnant Women Attending Antenatal Care in South Wollo Zone Public Hospitals, North East, Ethiopia,2023 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prenatal Ultrasound Utilization and Associated Factors Among Pregnant Women Attending Antenatal Care in South Wollo Zone Public Hospitals, North East, Ethiopia,2023 Belay Susu, Kibir Temesgen, Sindu Ayalew, Selam Yibeltal, Tadele Emagneneh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5933006/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Ultrasound (US) is essential in antenatal care worldwide and offers significant benefits for maternal and neonatal health. It should be a standard procedure in low- income countries. However, its utilization remains poor in nations like Ethiopia. Objective This study aimed to assess the use of prenatal ultrasound and associated factors among pregnant women who attended antenatal care in South Wollo Zone Public Hospitals, Northeast Ethiopia, in 2023. Method An institution-based cross-sectional study was conducted among 590 pregnant women from December 30, 2022, to February 28, 2023, in selected South Wollo Zone Public Hospitals. The data were entered into Epi-Data version 4.6, cleaned, and exported to SPSS version 26 for analysis. The strength of the association between the dependent and independent variables was presented as odds ratios (OR) with 95% confidence intervals (CI), with statistical significance set at P < 0.05 in multivariable logistic regression. Results Among the 590 pregnant women studied, the prevalence of prenatal ultrasound utilization was 62.8% [95% CI: 58.7% − 66.8%]. Significant factors associated with utilization included urban residency (AOR = 4.82, 95% CI: 2.99–8.03), mothers' knowledge (AOR = 7.36, 95% CI: 4.06–13.32), educational status above primary (AOR = 2.10, 95% CI: 1.09–4.05), medical illness (AOR = 3.03, 95% CI: 1.64–5.59), government employment (AOR = 4.05, 95% CI: 1.70–9.64), and private employment (AOR = 2.34, 95% CI: 1.58–7.05). Conclusion The proportion of patients who underwent prenatal ultrasound was lower than the WHO recommendation. The factors most significantly associated with ultrasound utilization were women's knowledge, urban residency, educational status, medical illness, and occupation. Therefore, the author recommended for health care providers educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed Antenatal care Obstetric ultrasound Prenatal Pregnant women Figures Figure 1 Figure 2 1. Introduction Medical imaging is indispensable for medical practice today. Obstetric ultrasound is a harmless, inexpensive, and noninvasive imaging modality that helps to scan a pregnant mother’s abdominal and pelvic cavity with high-frequency sound waves and delivers a real-time images of the fetus to parents[ 1 ]. Diagnostic ultrasound is recognized as a safe, effective, and highly flexible imaging modality capable of providing clinically relevant information about most parts of the body rapidly and cost-effectively. Prenatal ultrasound utilization is an integral part of antenatal care worldwide[ 2 ] The International Federation of Gynecology and Obstetrics (FIGO) recommends two ultrasound examination services for all pregnant women[ 3 ]. Similarly, in 2016, the World Health Organization (WHO) recognized the benefits of offering at least one antenatal ultrasound scanning service, before 24 weeks of gestation for all pregnant women[ 4 ]. Ultrasound has been used to diagnose obstructed labor, non-cephalic presentation, single or multiple pregnancy, incomplete miscarriage, molar pregnancy, ectopic pregnancy, fetal abnormality, intrauterine growth restriction and placenta previa[ 5 , 6 ]. Although the degree of diagnostic accuracy may vary depending on when pregnant women present themselves for an ultrasound exam[ 7 ]. Applications of ultrasound also extend to abdominal, musculoskeletal, cardiac, renal, pulmonary, trauma and soft tissue and vascular conditions[ 7 , 8 ]. A study shown that a minimum of three screening tests should be performed during pregnancy. The first should be performed at the fetal age of 10–14 weeks to detect abnormalities and pathological conditions in early pregnancy. The second one has to be performed between the fetal ages of 18 and 22 weeks to assess detailed fetal anatomy and rate of development. The third should be performed between the fetal age of 30 and 34 weeks to assess fetal anatomy, rate of development, placentation and circulation[ 8 ] Ultrasound in antenatal care (ANC) is essential for monitoring maternal health, pregnancy progression, and fetal development[ 9 ]. In developed countries like Vietnam and India, ultrasound utilization is high, averaging 6.6 scans per 8 ANC visits[ 10 ]. In low- and middle-income countries (LMICs), the prevalence of ultrasound is approximately 24%[ 11 ]. However, in low- and middle-income countries (LMICs), ultrasound utilization remains low. In sub-Saharan Africa, rates are 30% in urban areas and only 6.9% in rural areas, far below WHO recommendations[ 5 ]. A study in Ethiopia reported first-trimester ultrasound rates of 5.2%, 3.7%, and 8.1% in the Amhara, Oromia, and SNNP regions, respectively, while second-trimester rates were 22.2%, 26.6%, and 48.6%. Overall, only one in six eligible women received an ultrasound, highlighting a significant gap in adherence to WHO recommendations for early pregnancy scans[ 12 ]. Maternal and neonatal morbidity and mortality are critical health indicators[ 10 ]. Globally, in 2017, an estimated 295,000 women died due to pregnancy and childbirth, 99% of whom died in LMICs where ANC quality is low [ 12 , 13 ]. It has also been reported that up to 37% of patients are potentially misdiagnosed. All the above could be reduced by incorporating U/S services in their care [ 10 – 12 ]. In the Philippines, providing ultrasound during prenatal visits reduced maternal and neonatal deaths by 6.3% and 26.1%, respectively, and was cost-effective[ 14 ]. The use of ultrasound in developing countries is limited by several factors, such as culture, religion, illiteracy, attitude, accessibility and the high cost of ultrasound equipment; the fee of using ultrasound in a private clinic; the lack of trained sonographers or physicians; and the skill required to perform the examinations[ 5 ]. Moreover, poor utilization of ultrasound has indicated a high prevalence of adverse perinatal outcomes, such as ectopic pregnancies, abortions, congenital anomalies, fetal death, and increased maternal and neonatal morbidity and mortality[ 15 ]. A systematic review in Ethiopia revealed a high incidence of neural tube defects (63.3% per 10,000), which contributing incresed abortion rates[ 6 , 16 ]. Ethiopia is working to improve maternal health care quality, reduce morbidity and mortality, and achieve sustainable development goals[ 12 ]. The Ethiopian Ministry of Health aims to provide at least one ultrasound scan for all pregnant women before 24 weeks of gestation[ 17 ]. The USAID Transform: Primary Health Care Activity provides 100 ultrasound machines to health centers and trains206 mid-level providers in ultrasound use[ 18 ]. Despite these efforts, maternal and neonatal morbidity and mortality remain high due to poor utilization of prenatal ultrasound scans[ 12 ]. This study addresses new variables, such as maternal knowledge and attitudes toward obstetric ultrasound utilization, which previous studies did not cover. As far as my search is concerned, no published studies have examined the proportion of prenatal ultrasound utilization in the South Wollo Zone. Therefore, this study aimed to determine the prevalence and associated factors of prenatal ultrasound among pregnant women attending ANC in South Wollo Zone Public Hospitals. 2. METHODS AND MATERIALS Study design, area and period A hospital based cross-sectional study was conducted at the South Wollo Zone Public Health Institution from December 30, 2022, to February 28, 2023. The town is found in the southern Wollo zone, southeastern Ethiopia, and is approximately 401 km away from Addis Ababa, the capital city of Ethiopia. The zone comprises 14 governmental hospitals (one comprehensive specialized hospital, four general hospitals, and nine primary hospitals) and four private hospitals. There are also 119 health centers and 450 health posts in the zone. All public and private hospitals provide all types of obstetric care including antenatal care, ultrasound services and outpatient and inpatient services. According to South Wollo Zone Health Bureau reports, the estimated number of antenatal admissions in South Wollo Zone Public Hospitals is 1800 women per month. The financial coverage of ANC services in Ethiopia is cost free and limited by the state. According to the 2017Central Statistical Agency(CSA) of Ethiopia, the total estimated population of the South Wollo Zone is 3,086,132 among which these women accounts for almost half of the entire population. The language spoken in the zone was mainly Amharic 2.1 Study Design An institution-based cross-sectional study was conducted 2.2 Source Population All pregnant women were receiving antenatal care in South Wollo Zone Public Hospitals. 2.2 Study Population All pregnant women were receiving antenatal care at selected South Wollo Zone Public Hospitals during the data collection period. 2.3 Inclusion Criteria All pregnant women who attended antenatal care and who had been living for at least 6 months in the southern Wollo zone were included. 2.4 Exclusion Criteria Pregnant women who were severely ill and unable to communicate during the data collection period. 2.5 Sample Size Determination The sample size was calculated based on a single population proportion formula using the following assumptions. The use of prenatal ultrasound Taken p = 50%. $$\:\varvec{n}=\frac{{\left({\varvec{z}}_{\varvec{\alpha\:}/2}\right)}^{2}\times\:\varvec{p}(1-\varvec{p})}{{\varvec{d}}^{2}}$$ where n is the minimum sample size needed, p is the estimated proportion of prenatal ultrasound utilization, z is the standard value of the confidence level of α = 95% and d = 0.05 is the margin of error between the sample and the population. For this study, p = 60.7%, since a study was performed in Jimma, Oromia Region, in Ethiopia on the proportion of prenatal ultrasound utilization (19). $$\:\text{p}=\:0.607,\:\:\frac{\text{z}{\alpha\:}}{2}=1.96,\text{d}=\:0.05\:\:\:\:\:\:\:\:\frac{{1.96\:}^{2}\times\:\:0.607\:\times\:\left(1-0.607\right)}{{\left(0.05\right)}^{2}}=357$$ . Since we used two-stage sampling procedures and then multiplied by deff or 1.5, which is almost equal to 536, by adding a 10% nonresponse rate, the final sample size became 590 . 2.6 Sampling Techniques and Procedure There are fourteen public hospitals in the South Wollo Zone. Of these, five public hospitals were selected randomly by the lottery method. The allocation of the samples to the hospitals was performed proportionally based on the average number of clients who received antenatal care at each hospital in the most recent 3-month report of each health facility. Study participants were selected at each facility by systematic random sampling techniques. The participants were selected in the order in which they came to health facilities. Participant card numbers were used to systematically select participants in every Kth, interval taking K = N/n = 974/590 = 1.65 ≈ 2. The first sample was selected randomly and then samples were taken every K th interval until the required sample size was obtained. (where N is the source population taken from the Zone Health Bureau Three-month Antenatal Care Report of five selected hospitals and n is the sample size for this study. 2.8. Dependent Variables Proportion of prenatal ultrasound utilization 2.9 Independent Variables Sociodemographic factors : Maternal age, residence, ethnicity, marital status, monthly income, religion, educational level of the mother, and husband's education The obstetric factors : included parity, gravidity, history of abortion, history of ectopic pregnanc y , history of recent congenital anomaly, illness experienced in recent pregnancy, and twin pregnancy Maternal factors : maternal knowledge of obstetric ultrasound findings and maternal attitudes toward obstetric ultrasound findings. 2.10. Operational Definitions Obstetric ultrasound utilization In this study, the utilization of ultrasound by pregnant women was defined as obtaining ultrasound services at least once during a recent pregnancy[ 19 ]. Knowledge of obstetric ultrasound Respondents who answered more than or equal to 6 questions (50%) of knowledge-related questions correctly provided were considered to have good knowledge. Those who answered fewer than 6 questions (< 50%) were considered to have poor knowledge of obstetric ultrasound utilization[ 20 ]. Attitude toward obstetric ultrasound The respondents who responded ‘agree’ to at least 50% of the questions on attitude were categorized as having a good attitude toward obstetric ultrasound, whereas those who responded ‘agree’ to < 50% of the questions were considered to have a poor attitude toward obstetric ultrasound.[ 20 , 21 ]. 4.7 Data collections Tool and Procedures The data were collected using semi structured interviewer-administered questionnaires. The questionnaire was prepared by reviewing different published literature and adapted to the objective of this study [ 17 , 22 – 24 ], but knowledge and attitude assessment questionnaires were adopted from one study[ 20 ]. The questionnaires were modified to suit the local conditions and it consisted of sections related to Socio-demographic characteristics, obstetric factors, maternal knowledge about obstetric ultrasound factors, and maternal attitudes towards obstetric ultrasound factors. Five data collectors with BSc degrees in midwifery with two supervisors were recruited. The data collectors undertook face-to-face interviews using a semi structured and pretested Amharic questionnaire. Internal consistency/reliability of the item was checked by computing Cronbach’s alpha. The value of Cronbach’s alpha for knowledge assessment was 0.96 and attitude was 0.82. 2.11. Data Quality Control The questionnaire was initially prepared in English. The English version was translated to the Amharic local language and translated back to English to ensure internal consistency by language experts. The quality of the data was ensured during collection, coding, entry, and analysis. Before the data were collected, one day of training and orientation were given to the data collectors and supervisors. Follow-up was also performed during the data collection. Moreover, the questionnaires were pretested on 29 participants (5% of the sample) at Woldia Hospital 15 days before the data collection to ensure the clarity, wording, and logical sequence of the questions. The necessary modifications were made. In addition, the supervisors and principal investigator supervised the whole activity of the data collection process and checked the completed questionnaires every day for completeness, and correctness, and necessary corrections were made in a timely manner. 2.12 Data Processing and Analysis The data were edited and cleaned for inconsistencies by using Epidemiologic Data (Epid-data) 4.6 version software and exported to Statistical Package for the Social Sciences (SPSS) version 26 (manufactured in April 2019; Armonk, Nework, United States) for data analysis. Descriptive statistics such as frequencies and cross-tabulations were performed. Graphical presentations such as pie charts were used to present the findings of the study. The information was presented in tables and figures. Bivariable and multivariable logistic regression analyses were performed to determine the associations between outcome and explanatory variables. A P-value of < 0.25 in the bivariate analysis was used as the selection criterion for including a variable in the multivariable logistic regression model. An effort was made to assess whether the necessary assumptions for the application of multivariable logistic regression were fulfilled. In this regard, the Hosmer and Lemeshow goodness-of-fit test yielded a large p value (p > 0.05) and the result was 0.589. Multicollinearity was checked to determine the linear correlation among the independent variables by using the variance inflation factor(VIF), Tolerance test and standard error. Variables with an inflation factor > 10, standard error > 2 and tolerance < 0.1 were excluded from the multivariable analysis. The confounding effect were also checked. Variables without collinearity were entered into a multivariable model. Only variables with a p value < 0.05 were included in the final model. Finally, the AOR and 95% CI were considered to indicate the level of association between each factor and the utilization of prenatal obstetric ultrasound. 3. RESULTS 3.1 Sociodemographic Characteristics of the Respondents A total of 562 pregnant women participated in this study, for a response rate of 95.3%. The mean age of the study participants was 29.93 (SD ± 5.53) years, with a minimum of 18 years and a maximum of 45 years. Three hundred twenty-four (56.2%) patients were living in urban areas. The majority of the respondents (70.3%) were married, and 296 (52.7%) of the respondents were housewives. The educational level of the respondents varied from illiterate to above a college diploma, with the majority (48.2%) being illiterate, as shown in Table 1. Table 1; Sociodemographic history of pregnant mothers who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023 (n=562). Variable Category Frequency Percentage Age Marital status Residence Education Husband education Religion Occupation Ethinicity Income per month (Ethiopian birr) 15-19 20-24 25-29 30-34 >35 Married Single Divorced Widowed Urban Rural College diploma And above Secondary Primary Illiterate College diploma and above Secondary Primary Illiterate Orthodox Muslim Catholics Protestant Other Housewife Student Government employee Private employee Others Oromo Amhara Tigrie Guragie Others 5000 7 101 156 177 121 395 24 61 82 316 246 107 77 107 271 122 145 146 149 283 205 26 47 1 296 58 116 85 7 76 382 65 35 4 168 197 197 1.4 19.6 30.2 25.4 23.4 70.3 4.3 10.9 14.6 56.2 43.8 19 13.7 19 48.2 21.7 25.8 26.0 26.5 50.4 36.5 4.6 8.4 0.2 52.7 10.3 20.6 15.1 1.2 13.5 68 11.6 6.2 0.7 29.8 35.1 35.1 Other religion : adventist, Others occupation: merchant, shopkeeper, designer, house painter, Other ethinicity : afar 3.2 Obstetric and maternal health service characteristics of pregnant women in selected South Wollo zone hospitals in Northeast Ethiopia, 2023. Four-hundred-ninety-nine (88.8%) of the respondents were multigravida, five hundred thirty nine (95.9%) initiated antenatal visits after six months, and 379 (67.4%) had four or more antenatal visits. One hundred seventy-four (31.0%) of the respondents had a pregnancy that experienced medical illness while one hundred fifty- four (27.4%) mothers had a pregnancy ended in abortion. Ninety-eight (17.4%) of the mothers delivered congenital anomalies (Table 2). Table 3 Knowledge component on obstetric ultrasound among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023. Variables Yes Percentage Knew the importance of ultrasound to confirm pregnancy 389 69.2 Knew the importance of ultrasound to determine fetal position 356 63.3 Knew the importance of ultrasound to determine cord and placental position 310 55.2 Knew the importance of ultrasound to determine the expected date of delivery 345 61.4 Knew the importance of ultrasound to detect any defect or Congenital abnormalities during pregnancy 350 62.3 Knew the importance of ultrasound to detect complications of pregnancy 351 62.5 Knew the importance of ultrasound to detect amniotic fluid 364 64.8 Knew the importance of ultrasound to detect any assess fetal wellbeing 366 65.1 Knew the importance of ultrasound helps to confirm The Presence of multiple pregnancy 378 67.3 Knew the importance of ultrasound to estimate fetal weight 397 70.6 Knew the importance of ultrasound to estimate gestational age 412 73.3 Knew the importance of at least one ultrasound before 24 weeks 392 69.8 Good knowledge Poor knowledge 368 194 65.5 34.5 The most reported component of knowledge reported by participants was helping to estimate gestational age which was reported by approximately 412 (73.3%) mothers. Estimating fetal weight was the second most reported importance of ultrasound, with 397 (70.6%) reporting it. The least common component of knowledge regarding obstetric ultrasound was determining the cord and placental position which was reported by only 310 (55.2%) particpants ( Table 3). In this study, of 562 pregnant women, 368 (65.5%) had good knowledge of obstetrics ultrasound, while the remaining (194,34.5%) had poor knowledge of obstetric ultrasound. This indicates that more than half of the respondents were knowledgeable about the actual importance and effectiveness of obstetric ultrasound. The remaining women may to have a low rate of use of obstetric ultrasound or hinder women from being examined by ultrasound even in an emergency even though prenatal scanning improves pregnancy outcomes (as shown in Fig. 1). Table 4 Attitudes of pregnant women on obstetric ultrasound among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023. Variables Yes Percentage Perceived that obstetric ultrasound safe for the mother 409 72.8 Perceived that USS safe for the fetus 431 76.7 Perceived that USS lead to the anomaly 178 31.7 Perceived that USS is an essential investigation during Px. 459 81.7 Perceived terminating pregnancy if the sex of the child's other than you prefer, is right 437 77.8 Perceived that educating others about USS is necessary 459 81.7 Perceived that USS offer routinely 363 64.9 Negative attitude Positive attitude 249 313 44.3 55.7 Note : USS = ultrasonography The most frequently mentioned component attitudes regarding obstetric ultrasound were “educating others about obstetric ultrasound is necessary”and“perceived that ultrasound is an essential investigation during pregnancy” (459; 81.7%). The second most mentioned component was “terminating a pregnancy if sex is other than you prefer,” where 437 (77.8%) respondents did not believe that terminating a pregnancy based on sex was the right decision (Table 4). Out of 562 pregnant women, more than half (313, 55.7%) had a positive attitude toward obstetric ultrasound, while the remaining (249, 44.3%) had a negative attitude toward obstetric ultrasound. This indicated that nearly half of the women had a negative attitude toward prenatal ultrasound scanning. A negative attitude toward prenatal ultrasound scanning indicated that she was not willing to be scanned by obstetric ultrasound, which may have had a negative impact on the outcomes of pregnancy and motherhood (Fig. 2). 3.5 Prenatal Ultrasound Utilization Three hundred fifty-three (62.8%) respondents used prenatal ultrasound at least once during pregnancy, of whom 221 (62.5%) utilized it before 24 weeks of gestation and the remaining 122 (34.6) utilized it after 24 weeks of gestation. Nearly half, (51.3%) of the women requested the scan by themselves whereas 145 (41.1%) of the respondents were requested by clinicians (Table 5). Table 5 Questions related to prenatal ultrasound utilization among pregnant women who attended ANC in the South Wollo Zone in the northeast region of Ethiopia, 2023. Category Frequency Percentage Prenatal OBS U/S utilization (n = 562) Yes 355 62.8 No 207 37.2 At what gestational age (n = 355) ≤ 24 weeks 223 62.6 > 24week 122 34.6 Don’t remember 10 2.8 Who requested (n = 355)? Clinician 145 40.8 Herself 183 51.5 Don’t remember 27 7.6 Reason not utilized Obs U/S (n = 207) I think it is not nescceray 19 9.1 I fear it would cause injury to me and my baby 62 30.6 I didn’t have the information 36 17.2 I cannot access it 26 12.4 Lack of money 64 30.7 3.6 Factor Associated with the Use of Prenatal Obstetric Ultrasound According to our bivariate logistic regression, fifteen variables were associated with the use of prenatal obstetric ultrasound: education status, husband's education status, residence, occupation, gravidity, parity, previous abortion, congenital anomaly delivery, the timing of ANC initiation, the frequency of ANC visits, recent delivery of baby, mode of delivery, recent birth weight delivery, knowledge of the woman and attitudes about the woman. Respondents whose educational status was above college and diploma were more than six times more likely to use prenatal ultrasound than did those with no formal education (crude odds ratio (COR) = 6.45; 95%CI: (3.56, 11.72)). Similarly, pregnant women whose occupation was a government employee were more likely to utilize obstetric ultrasound than were those whose occupation was a housewife (COR = 7.99; 95%CI: (4.22, 15.15)). However, according to our multivariate logistic regression analysis, only five variables were significantly associated with the use of obstetric ultrasound such as women's education status, women’s knowledge, residence, occupation, and medical illness during pregnancy. The odds of utilizing prenatal ultrasound among pregnant women who reside in urban areas were nearly five times greater than those who reside in rural areas, (adjusted odds ratio (AOR) = 4.82; 95%CI: 2.99, 8.03). Those respondents who encountered medical illness during pregnancy were nearly three times more likely to utilize prenatal ultrasound than were their counterparts (AOR = 3.03; 95%CI: 1.64, 5.59). Similarly, women who had good knowledge of prenatal obstetric ultrasound were nearly seven times more likely to utilize prenatal ultrasound than were those who had poor knowledge (AOR = 7.32; 95%CI: (4.07, 13.33)) (see details in Table 6). Table 6 Result of multivariate binary logistic regression analysis of factors associated with prenatal ultrasound utilization among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023. Variables Utilization Of OU COR (95% CI) AOR (95% CI) YES ( No.) NO ( No.) Residency Urban 260 56 7.63(5.19, 11.25) 4.82(2.99, 8.03)** Rural 93 153 1 Education College diploma above 92 15 6.46(3.56, 11.72) 2.41 (1.02, 5.70)* Secondary 53 24 2.33(1.36, 3.98) 3.55(1.62, 7.82)* Primary 76 31 2.58 (1.60, 4.18) 2.10(1.09, 4.05)* Unable to read and write 132 139 1 Husband Education College diploma above 96 26 2.10(1.21, 3.63) 1.29(0.56, 2.95) Secondary 95 50 1.08(0.67, 1.74) 1.08(0.67, 1.74) Primary 67 79 0.48(0.30, 0.77) 0.37(0.17, 0.68)* Unable to read and write 95 54 1 Occupation Housewife 35 22 1 Student 23 35 1.65(0.34, 1.08) 0.95 (0.34, 1.64) Government employee 104 12 7.99(4.22, 15.15) 4.05(1.70, 9.64)* Private employee 67 18 3.43(1.95, 6.06) 2.34(1.58, 7.05)* Other 5 2 2.30(0.44, 12.07) 2.74(0.28, 26.88) Gravidity Multigravida 326 173 2.51(1.47, 4.27) 1.77(0.54, 0.83) Prim gravida 27 36 1 Parity Multipara 296 162 1.51(0.98, 2.32) 0.47(0.12, 1.87) Prim para 57 47 1 Previous Abortion Yes 126 29 3.45(2.20, 5.40) 1.52(0.78, 2.92) No 227 180 1 Timing of ANC Intitition for current Px ≤ 6month 346 193 4.10(1.65, 10.13) 1.61 (0.48, 5.45) > 6month 20 161 1 Frequency of ANC visit for Current Px. One visit 24 39 1 Two to three visits 62 58 1.74(0.93, 3.24) 0.55(0.22, 1.37) Four visits and above 267 112 3.87(2.22, 6.74) 0 .88(0.46, 2.66) Gestational age for current Px. First TM 58 37 1 Second TM 237 145 1.04(0.65, 1.65) 1.35(0.69, 2.64) Third TM 58 27 1.37(0.74, 2.54) 1.50(0.61, 2.67) Mild to moderate Illness Experienced with this Px. Yes 148 26 5.08(3.20, 8.06) 3.03(1.64, 5.59)* No 205 183 1 Congenital anomaly delivery Yes 76 22 2.33(1.40, 3.88) 1.32(0.64, 2.72) No 277 187 1 Recent delivery of baby Yes 299 168 1.35(0.86, 2.12) 1.28(0.36, 1.28) No 54 41 Knowledge Good knowledge 295 73 9.48(6.35, 14.14) 7.36(4.06, 13.32)** Good knowledge 58 136 1 Attitude Negative attitude 210 103 1.51(1.07, 2.13) 0.81(0.46, 1.45) Positive attitude 143 106 1 Note : *Statistically significant at P < 0.05, **Statistically significant at p < 0.001, 1 = reference category 4. DISCUSSION This study was designed to assess the proportion of pregnant women utilizing prenatal ultrasound and associated factors mong those attending ANC in five public hospitals of South Wollo Zone. The proportion of prenatal ultrasound utilization in this study was 62.8% [95% CI: (58.7%, 66.8%)]. This result was in line with the findings of prenatal ultrasound utilization described in Jimma Zone public hospitals in Ethiopia, which reported a 60.7%[ 25 ]. This result was also consistent with the findings recorded in southeastern Nigeria, which were58.7%[ 26 ]. However, the result of the current study were lower than tthose obtained in Uganda[ 27 ] and in accordance with the local government Zaria, Kaduna State, northern Nigeria where the proportion of patients utilizing ultrasound was 83.5%[ 28 ]. These finding were also lower than those of a cluster rondomized study conducted in Eastern China (96.1%)[ 29 ]. This variation may be due to socioeconomic factors,the propensity to use services and geographical differences between Ethiopia and Eastern China. The next step might be to focuses on both urban and rural pregnant women as China’s study included only rural pregnant women. Moreover, the discrepancy might be due to variations in access to use services ,barriers to use services, health service systems, and health policy programs. In contrast, the percentages of patients utilizing prenatal ultrasound in the current study was greater than that in a study conducted in Kenya (49.7%).[ 30 ]. The difference may be atributed to variations in health policy strategies for child and maternal health care between Ethiopia and Kenya. The findings of this study showed that there was a strong association between women’s knowledge of prenatal obstetric ultrasound and prenatal ultrasound utilization. Pregnant women who had good knowledge were 7.36 times more likely to utilize prenatal ultrasound than pregnant women who had poor knowledge. This result was consistent with the findings recorded in Jimma, Ethiopia[ 21 , 25 ] and in different countries, e.g., a peri-urban health center in Uganda[ 27 ] and the main referral hospital, in Sokoto, Nigeria[ 19 ]. Pregnant women with good obstetric ultrasound knowledge have a positive attitude toward obstetric ultrasound scans. The findings of this study align with research conducted in Gedeo Zone, Ethiopia [ 31 ]. This indicates that increased awareness of obstetric ultrasound enhances its utilization. This, in turn, facilitates early detection and management of obstetric complications, ultimately contributing to reduced perinatal mortality. Greater knowledge fosters confidence in ultrasound's role in predicting pregnancy outcomes, whereas misconceptions may discourage its Obstetric ultrasound has become a critical tool in obstetrics, and its benefits have undeniably contributed to improved pregnancy outcomes[ 31 – 34 ] Therefore, ensuring that all antenatal women receive obstetric ultrasound scans is essential for the prevention and management of obstetric complications, ultimately leading to improved pregnancy outcomes, as recommended by the World Health Organization (WHO). To bridge gaps in knowledge and accessibility, obstetric care providers should integrate routine ultrasound assessments into maternity services while promoting education on its benefits, particularly for rural women with limited access. Strengthening maternal health policies and integrating educational interventions into antenatal care programs could further enhance uptake of ultrasound utilization, contributing to better maternal and neonatal outcomes across the countries. In this study, pregnant mothers who reside in urban areas were more likely to utilize obstetric ultrasound than mothers who reside in rural areas (AOR = 4.82; 95% at CI: (2.99, 8.03)). This is probably due to the greater accessibility of information and awareness about prenatal ultrasound in urban areas than in rural areas and the variation in the distance of health facilities. Multiple sources of information about prenatal ultrasound data are obtained through television (TV) programs, private clinics, etc., for urban women rather than for rural pregnant women. Another reason may be the limited expansion of infrastructure in the rural areas compared to urban areas. Therefore, in collaboration with nongovernmental organizations (NGOs), the South Wollo Zone Health Office should focus on addressing health infrastructures in rural areas. These findings are in line with, other findings conducted in Addis Abeba and Dilla[ 21 , 31 ] respectively. Therefore, the South Wollo Zone Health Office, in collaboration with nongovernmental organizations (NGOs), should prioritize the expansion and enhancement of healthcare services in rural areas through a multifaceted approach. This includes the construction of well-equipped health centers, the deployment of adequately trained healthcare professionals, the implementation of telemedicine services, and the introduction of mobile health units to extend services to remote communities. Furthermore, advocating for policies that ensure the equitable distribution of healthcare resources, including the provision of prenatal ultrasound services, across rural regions is essential for closing the urban-rural healthcare gap Medical illness during pregnancy was the third explanatory variable that was significantly associated with the use of prenatal ultrasound. Pregnant mothers who had medical illness during pregnancy were 3.03 times more likely to utilize prenatal ultrasound than were those who were free of illness during pregnancy. Similarly, a study from Canada, showed that medical illness during pregnancy was significantly associated with the use of prenatal ultrasound[ 34 ]. This might be because of the perceived fear of losing their pregnancy and the complications associated with it. The authors suggest that policymakers and guideline developer’s consider incorporating more frequent ultrasound scans into the antenatal care schedule for pregnant women with medical conditions, as this strategy can help mitigate concerns about pregnancy loss and related complications. Further more women with history of pregnancy loss or anomaly detection might feel that their pregnancy loss related to poor utiliztions of ultrasound services. Another study in India showed that medical conditions such as abdominal problems and urinary tract infections (UTIs) were among the most common conditions[ 10 , 34 ]. A possible explanation might be that abdominal pain and urinary tract infection during pregnancy may lead to frequent antenatal visits and subsequently greater opportunities for ultrasound scans. The more patients visit a health facility with complaints during pregnancy, the more scans they obtain. In this study, occupation was also a predictor variable that was significantly associated with the use of prenatal ultrasound. The pregnant women whose occupations were government or private were 4.06 and 3.34 times more likely to utilize obstetric ultrasound,respectively, than were those whose occupations were housewives respectively. Similarly, in China, occupation was significantly associated with the use of prenatal ultrasound [ 29 , 35 ]. In contrast to these findings, a study performed in Nigeria reported that occupation does not affect the utilization of prenatal ultrasound [ 19 ]. This may be explained by the differences in sociodemographic background and economic status the two countries. In this study, the educational level of the women was another predictor variable associated with the utilization of prenatal ultrasound. An education level above the primary level was significantly associated with prenatal ultrasound utilization with (OR = 2.10; 95% at CI: (1.09, 4.05)). This study proved that mothers with a high level of education had more requests for ultrasound scans, possibly because their awareness of pregnancy complications is greater than among those with only primary school education. Furthermore, families with high socioeconomic status had better access to sonography and did not mind financial factors, as previous studies have also supported these findings[ 21 , 36 ]. Similar findings were obtained in a study conducted in Jimma (Ethiopia), in which individuals whose educational level was above primary level were more likely to undergo obstetric ultrasound than their counterparts were[ 25 ]. This may be explained by the fact that the educational status of the pregnant mother increases, and exposure to pieces of information may also increase. Discussing and disseminating of this issue may become more common among educated pregnant women than among those younger primary school.The level of education tends to influence the methods by which women obtain and analyze information about ultrasound. 5. STRENGTHS AND LIMITATIONS OF THE STUDY This research addressed pregnant women in different areas, both urban and rural by considering hospitals where antenatal flow is highest in all areas. The first study area in particular is the major strength of this study. Regarding the limitations of the current study, the literature on prenatal ultrasound utilization was limited, so discussing the findings of the study was difficult. While the study was designed as an institution-based cross-sectional study, it did not include women who received antenatal care at a private clinic.Moreover, The limitation of this study is, it is impossible to make causal inferences due to the cross-sectional nature of the study. 6. CONCLUSIONS According to the current findings, the proportion of prenatal ultrasounds utilized was 62.8%, but the prevalence prenatal ultrasounds was still much lower than that recommended by FIGO and WHO, which suggest that all pregnancies should undergo a minimum of two scans throughout pregnancy. The educational status of the pregnant woman, occupations, knowledge, residency, and medical illness during pregnancy were significantly associated with the use of prenatal ultrasound. Therefore the authors recommended for health care providers to educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed. 7. RECOMMENDATION In light of these findings, the following recommendations are proposed: The authors recommended for health care providers to educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed. The authors suggest that policymakers and guideline developers consider incorporating more frequent ultrasound scans into the antenatal care schedule for pregnant women with medical conditions, as this strategy can help mitigate concerns about pregnancy loss and related complications Authors recommended strengthening maternal health policies and integrating educational interventions into antenatal care programs could further enhance uptake of ultrasound utilization, contributing to better maternal and neonatal outcomes across the countries. The south wollo zone health office, in collaboration with NGOs, should prioritize expanding rural healthcare services and task health extension workers with educating rural women about the importance of obstetric ultrasound as part of their routine duties. Abbreviations ANC: antenatal Care, AOR: adjusted odds ratio, CI: confidence interval, COR: crude odds ratio, LMIC: low and middle income country, O/U: obstetric ultrasound, OR: odds ratio U/S: ultrasound, USAID: united states agency for international development, WHO: world health organization Declarations Ethics approval and consent to participate Ethical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Wollo University College of Medicine and Health Sciences. An official letter was sent to South Wollo public hospitals from Southern Health Bearuea before data collection was started. After explaining the purpose and the possible benefit of the study Informed, voluntary, written, and signed consent was obtained from the head of Hospitals and each participant. The consent form of neonates was taken from the mothers. Based on the willingness of participants, they were interviewed for the questions. Confidentiality of information was maintained. Finally, neonates who fulfill the definition of sepsis were recommended to get treatment and care in collaboration with the hospital staff and those who cannot afford to pay; the Authors communicated with the responsible body to gate free treatment. Consent for Publication Not applicable Availability of Data and Materials The data is not available from the corresponding authors. Competing interests: The authors declare that no competing interests exist. Funding A grant was received for this study from Wollo University. Author Contribution(s) BS: conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing. KT: Reviewed and criticized the proposal, guided the statistical analysis, gave advice on the interpretation of the results, and provided intellectual input to the participants, involved in the writing of the final research and writing of the manuscript . SA: Reviewed and criticized the proposal, guided the statistical analysis, gave advice on the interpretation of the result and made intellectual inputs, involved in the write-up of the final research work, and contributed to the write-up of the manuscript. SY: critically reviewed and edited the proposal, reviewed the research, performed the statistical analysis, interpreted the results, and contributed to the writing of the manuscript. TE: guided the statistical analysis, gave advice on the interpretation of the results, and provided intellectual input, and were involved in the final research. AY: conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing. CM: Methodology; Resources; Software; Supervision; Validation; Visualization; Writing – original draft; Writing – review & editing. All the authors read and approved the final manuscript. Acknowledgments This study is part of the first author’s Master of Science in Clinical Midwifery thesis with the College of Medicine and Health Sciences at Wollo University, Ethiopia. First, we would like to express our gratefulness to Woldia University for providing us with full sponsorship for our research thesis. Second, we would like to acknowledge the staff of all South Wollo Public Hospitals for their cooperation by providing all the necessary baseline information which was important for this study. Finally, we would like to extend our appreciation to Wollo University, College of Medicine, and health science librarians and internet center coordinators for their support and assistance in obtaining important materials to develop this research proposal, data collectors, supervisors, and all the participants during data collection. Author Information 1 Lecturer at the College of Health Sciences Department of Midwifery Woldia University, Woldia Ethiopia. 2 Assistant Professor of Maternity and Reproductive Health, College of Health and Medical Sciences, Wollo University, Dessie, Ethiopia. 3 Lecturer at College of Medicine and Health Sciences School of Nursing and Midwifery, Wollo University, Dessie Ethiopia 4 Lecturer at College of Medicine and Health Sciences School of Nursing and Midwifery, Wollo University, Dessie Ethiopia. 5 Lecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia. 6 Lecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia. 7 Lecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia. References GILL, K.A., Ultrasound in Obstetrics and. Simó, S., et al., Effects of ultrasound on anxiety and psychosocial adaptation to pregnancy. Archives of women's mental health, 2019. 22 : p. 511-518. Practice, F.W.G.O.B. and I.F. of Gynecology, Best practice in maternal-fetal medicine. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2015. 128 (1): p. 80-82. Organization, W.H., WHO recommendations on intrapartum care for a positive childbirth experience . 2018: World Health Organization. Wanyonyi, S.Z., et al., Opportunities and challenges in realizing universal access to obstetric ultrasound in sub-Saharan Africa. Ultrasound international open, 2017. 3 (02): p. E52-E59. Stanton, K. and L. Mwanri, Global maternal and child health outcomes: the role of obstetric ultrasound in low resource settings. J Prev Med, 2013. 1 (3): p. 22-29. Asllanaj, H., Limitations of Ultrasound Examination in Trauma. Albanian Journal of Trauma and Emergency Surgery, 2024. 8 (2): p. 1525-1531. Papp, Z. and T. Fekete, The evolving role of ultrasound in obstetrics/gynecology practice. International Journal of Gynecology & Obstetrics, 2003. 82 (3): p. 339-346. Salomon, L.J., et al., Practice guidelines for performance of the routine mid-trimester fetal ultrasound scan. Ultrasound in Obstetrics & Gynecology, 2011. 37 (1). Phutke, G., et al., Ultrasound in rural India: A failure of the best intentions. Indian J Med Ethics, 2018. 18 : p. 1-7. Shah, S., et al., Development of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda. International journal of emergency medicine, 2008. 1 : p. 193-196. Abawollo, H.S., et al., Contribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study. BMC pregnancy and childbirth, 2022. 22 (1): p. 368. Organization, W.H., Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals. 2015. Dalmacion, G.V., et al., Handheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis® intervention study. BMC pregnancy and childbirth, 2018. 18 : p. 1-8. Ekott, M.I., et al., Acceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria. Research Journal of Women’s Health, 2017. 4 (1): p. 2. Bitew, Z.W., et al., Magnitude and associated factors of neural tube defects in Ethiopia: a systematic review and meta-analysis. Global pediatric health, 2020. 7 : p. 2333794X20939423. Argaw, M.D., et al., Experiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study. BMC Pregnancy and Childbirth, 2022. 22 (1): p. 196. Tilahun, Y., USAID Transform: Primary Health Care Activity. 2022. Oche, O.M., et al., Knowledge of the use and indications for obstetric ultrasound scan among women attending a main referral hospital, Sokoto, Nigeria. Res Obstet Gynecol, 2013. 2 (5): p. 55-62. Abduljabbar, H.S., et al., Knowledge, attitudes and practice about obstetric ultrasonography among women attending a university hospital: a cross-sectional study. Open Journal of Obstetrics and Gynecology, 2020. 10 (12): p. 1763-1775. Haile, Z.W. and A.G. Gurmu, Knowledge, attitude, barriers, and associated factors of obstetric ultrasound among pregnant women in public hospitals, Ethiopia, 2022: a cross-sectional study. Journal of Ultrasound, 2024. 27 (1): p. 31-40. Flores, A.H., et al., Frequency of utilisation of ultrasound in the diagnosis of ectopic pregnancy in Sub-Saharan Africa countries: A systematic review. African Journal of Emergency Medicine, 2015. 5 (1): p. 31-36. Adams, S.J., et al., Sociodemographic and geographic disparities in obstetrical ultrasound imaging utilization: a population-based study. Academic Radiology, 2022. 29 (5): p. 650-662. Jarahi, L., et al., Association of Sociodemographic, Obstetric, and Attitudinal Factors with Prenatal Ultrasound in Mashhad, Iran. Journal of Child Science, 2021. 11 (01): p. e222-e226. Yetwale, A., et al., Prenatal ultrasound utilization and its associated factors among pregnant women in Jimma town public health institutions, Ethiopia. Health services research and managerial epidemiology, 2022. 9 : p. 23333928221085881. Ikeako, L., et al., Attitude of expectant mothers on the use of ultrasound in pregnancy in a tertiary institution in South East of Nigeria. Annals of Medical and Health Sciences Research, 2014. 4 (6): p. 949-953. Gonzaga, M.A., et al., Utilisation of obstetric sonography at a peri-urban health centre in Uganda. The Pan African Medical Journal, 2010. 7 . Galadanci, H., et al., Obstetric quality assurance to reduce maternal and fetal mortality in Kano and Kaduna State hospitals in Nigeria. International Journal of Gynecology & Obstetrics, 2011. 114 (1): p. 23-28. Huang, K., et al., Utilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China. BMC Health Services Research, 2012. 12 : p. 1-10. Matiang’i, M., et al., Barriers and enablers that influence utilization of ultrasound screening services among antenatal women in Kajiado and Kisii counties Kenya. Open Journal of Clinical Diagnostics, 2021. 11 (1): p. 1-17. Molla, W., N. Mengistu, and A. Wudneh, Pregnant women’s knowledge, attitude, and associated factors toward obstetric ultrasound in public hospitals, Ethiopia, 2021: Multi-centered cross-sectional study. Women's Health, 2022. 18 : p. 17455057221091357. Tunçalp, Ӧ., et al., WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival. Bjog, 2017. 124 (6): p. 860-862. Shidhaye, P.R., et al., Study of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai. Journal of education and health promotion, 2012. 1 (1): p. 36. Abdullah, P., et al., Factors associated with the timing of the first prenatal ultrasound in Canada. BMC pregnancy and childbirth, 2019. 19 : p. 1-14. Organization, W.H., Health in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals , in Health in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals . 2015. Haile, Z.W., et al., Attitude, Practice, and Associated factors of pregnant women towards prenatal ultrasound in Addis Ababa, Ethiopia. A cross-sectional study. 2022. Table 2 Table 2 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table2.docx suplementaryfiles.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5933006","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":437446614,"identity":"3d49d120-dd4b-47c2-9957-ee75905f2004","order_by":0,"name":"Belay 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00:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5933006/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5933006/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":79907904,"identity":"1d383073-0afa-4ac8-aa07-2d9b698c098c","added_by":"auto","created_at":"2025-04-04 11:15:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":19087,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge of obstetric ultrasound finding among pregnant women attending ANC in selected South Wollo Zone Public Hospitals, 2023.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5933006/v1/8773f1ff048ebe9da01ade0f.png"},{"id":79907906,"identity":"4b04628d-81ef-4959-add4-c4ab41844802","added_by":"auto","created_at":"2025-04-04 11:15:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13660,"visible":true,"origin":"","legend":"\u003cp\u003eOverall attitudes among women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5933006/v1/95ce37d01bd32c12d1673c47.png"},{"id":80607407,"identity":"ef725b9f-500a-4bce-9671-c6871d532c41","added_by":"auto","created_at":"2025-04-15 07:01:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1554731,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5933006/v1/328f2bd1-c670-4432-b6e5-31453eb1e0d2.pdf"},{"id":79909137,"identity":"4eb6975b-70af-4d9a-a62e-62ea95d3bb16","added_by":"auto","created_at":"2025-04-04 11:23:30","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":30880,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-5933006/v1/635d305ff712be1cbd2cde6c.docx"},{"id":79907911,"identity":"26b127a2-e47a-4aa5-b77a-8716666a56ba","added_by":"auto","created_at":"2025-04-04 11:15:30","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":24738,"visible":true,"origin":"","legend":"","description":"","filename":"suplementaryfiles.docx","url":"https://assets-eu.researchsquare.com/files/rs-5933006/v1/736ae676e00f97ca7a5a7adb.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePrenatal Ultrasound Utilization and Associated Factors Among Pregnant Women Attending Antenatal Care in South Wollo Zone Public Hospitals, North East, Ethiopia,2023\u003c/p\u003e","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMedical imaging is indispensable for medical practice today. Obstetric ultrasound is a harmless, inexpensive, and noninvasive imaging modality that helps to scan a pregnant mother\u0026rsquo;s abdominal and pelvic cavity with high-frequency sound waves and delivers a real-time images of the fetus to parents[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Diagnostic ultrasound is recognized as a safe, effective, and highly flexible imaging modality capable of providing clinically relevant information about most parts of the body rapidly and cost-effectively. Prenatal ultrasound utilization is an integral part of antenatal care worldwide[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe International Federation of Gynecology and Obstetrics (FIGO) recommends two ultrasound examination services for all pregnant women[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similarly, in 2016, the World Health Organization (WHO) recognized the benefits of offering at least one antenatal ultrasound scanning service, before 24 weeks of gestation for all pregnant women[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUltrasound has been used to diagnose obstructed labor, non-cephalic presentation, single or multiple pregnancy, incomplete miscarriage, molar pregnancy, ectopic pregnancy, fetal abnormality, intrauterine growth restriction and placenta previa[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Although the degree of diagnostic accuracy may vary depending on when pregnant women present themselves for an ultrasound exam[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Applications of ultrasound also extend to abdominal, musculoskeletal, cardiac, renal, pulmonary, trauma and soft tissue and vascular conditions[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA study shown that a minimum of three screening tests should be performed during pregnancy. The first should be performed at the fetal age of 10\u0026ndash;14 weeks to detect abnormalities and pathological conditions in early pregnancy. The second one has to be performed between the fetal ages of 18 and 22 weeks to assess detailed fetal anatomy and rate of development. The third should be performed between the fetal age of 30 and 34 weeks to assess fetal anatomy, rate of development, placentation and circulation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eUltrasound in antenatal care (ANC) is essential for monitoring maternal health, pregnancy progression, and fetal development[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In developed countries like Vietnam and India, ultrasound utilization is high, averaging 6.6 scans per 8 ANC visits[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In low- and middle-income countries (LMICs), the prevalence of ultrasound is approximately 24%[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. However, in low- and middle-income countries (LMICs), ultrasound utilization remains low. In sub-Saharan Africa, rates are 30% in urban areas and only 6.9% in rural areas, far below WHO recommendations[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. A study in Ethiopia reported first-trimester ultrasound rates of 5.2%, 3.7%, and 8.1% in the Amhara, Oromia, and SNNP regions, respectively, while second-trimester rates were 22.2%, 26.6%, and 48.6%. Overall, only one in six eligible women received an ultrasound, highlighting a significant gap in adherence to WHO recommendations for early pregnancy scans[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMaternal and neonatal morbidity and mortality are critical health indicators[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Globally, in 2017, an estimated 295,000 women died due to pregnancy and childbirth, 99% of whom died in LMICs where ANC quality is low [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It has also been reported that up to 37% of patients are potentially misdiagnosed. All the above could be reduced by incorporating U/S services in their care [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In the Philippines, providing ultrasound during prenatal visits reduced maternal and neonatal deaths by 6.3% and 26.1%, respectively, and was cost-effective[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe use of ultrasound in developing countries is limited by several factors, such as culture, religion, illiteracy, attitude, accessibility and the high cost of ultrasound equipment; the fee of using ultrasound in a private clinic; the lack of trained sonographers or physicians; and the skill required to perform the examinations[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, poor utilization of ultrasound has indicated a high prevalence of adverse perinatal outcomes, such as ectopic pregnancies, abortions, congenital anomalies, fetal death, and increased maternal and neonatal morbidity and mortality[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A systematic review in Ethiopia revealed a high incidence of neural tube defects (63.3% per 10,000), which contributing incresed abortion rates[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eEthiopia is working to improve maternal health care quality, reduce morbidity and mortality, and achieve sustainable development goals[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The Ethiopian Ministry of Health aims to provide at least one ultrasound scan for all pregnant women before 24 weeks of gestation[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The USAID Transform: Primary Health Care Activity provides 100 ultrasound machines to health centers and trains206 mid-level providers in ultrasound use[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these efforts, maternal and neonatal morbidity and mortality remain high due to poor utilization of prenatal ultrasound scans[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This study addresses new variables, such as maternal knowledge and attitudes toward obstetric ultrasound utilization, which previous studies did not cover. As far as my search is concerned, no published studies have examined the proportion of prenatal ultrasound utilization in the South Wollo Zone. Therefore, this study aimed to determine the prevalence and associated factors of prenatal ultrasound among pregnant women attending ANC in South Wollo Zone Public Hospitals.\u003c/p\u003e"},{"header":"2. METHODS AND MATERIALS","content":"\u003cp\u003e \u003cb\u003eStudy design, area and period\u003c/b\u003e \u003c/p\u003e \u003cp\u003eA hospital based cross-sectional study was conducted at the South Wollo Zone Public Health Institution from December 30, 2022, to February 28, 2023. The town is found in the southern Wollo zone, southeastern Ethiopia, and is approximately 401 km away from Addis Ababa, the capital city of Ethiopia. The zone comprises 14 governmental hospitals (one comprehensive specialized hospital, four general hospitals, and nine primary hospitals) and four private hospitals. There are also 119 health centers and 450 health posts in the zone. All public and private hospitals provide all types of obstetric care including antenatal care, ultrasound services and outpatient and inpatient services. According to South Wollo Zone Health Bureau reports, the estimated number of antenatal admissions in South Wollo Zone Public Hospitals is 1800 women per month. The financial coverage of ANC services in Ethiopia is cost free and limited by the state. According to the 2017Central Statistical Agency(CSA) of Ethiopia, the total estimated population of the South Wollo Zone is 3,086,132 among which these women accounts for almost half of the entire population. The language spoken in the zone was mainly Amharic\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Source Population\u003c/h2\u003e \u003cp\u003eAll pregnant women were receiving antenatal care in South Wollo Zone Public Hospitals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Population\u003c/h2\u003e \u003cp\u003eAll pregnant women were receiving antenatal care at selected South Wollo Zone Public Hospitals during the data collection period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Inclusion Criteria\u003c/h2\u003e \u003cp\u003eAll pregnant women who attended antenatal care and who had been living for at least 6 months in the southern Wollo zone were included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Exclusion Criteria\u003c/h2\u003e \u003cp\u003ePregnant women who were severely ill and unable to communicate during the data collection period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Sample Size Determination\u003c/h2\u003e \u003cp\u003eThe sample size was calculated based on a single population proportion formula using the following assumptions. The use of prenatal ultrasound\u003c/p\u003e \u003cp\u003eTaken p\u0026thinsp;=\u0026thinsp;50%.\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:\\varvec{n}=\\frac{{\\left({\\varvec{z}}_{\\varvec{\\alpha\\:}/2}\\right)}^{2}\\times\\:\\varvec{p}(1-\\varvec{p})}{{\\varvec{d}}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003ewhere \u003cem\u003en\u003c/em\u003e is the minimum sample size needed, \u003cem\u003ep\u003c/em\u003e is the estimated proportion of prenatal ultrasound utilization, \u003cem\u003ez\u003c/em\u003e is the standard value of the confidence level of \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;95% and \u003cem\u003ed\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05 is the margin of error between the sample and the population.\u003c/p\u003e \u003cp\u003eFor this study, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;60.7%, since a study was performed in Jimma, Oromia Region, in Ethiopia on the proportion of prenatal ultrasound utilization (19).\u003cdiv id=\"Equb\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equb\" name=\"EquationSource\"\u003e\n$$\\:\\text{p}=\\:0.607,\\:\\:\\frac{\\text{z}{\\alpha\\:}}{2}=1.96,\\text{d}=\\:0.05\\:\\:\\:\\:\\:\\:\\:\\:\\frac{{1.96\\:}^{2}\\times\\:\\:0.607\\:\\times\\:\\left(1-0.607\\right)}{{\\left(0.05\\right)}^{2}}=357$$\u003c/div\u003e\u003c/div\u003e.\u003c/p\u003e \u003cp\u003eSince we used two-stage sampling procedures and then multiplied by deff or 1.5, which is almost equal to 536, by adding a 10% nonresponse rate, the final sample size became \u003cb\u003e590\u003c/b\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Sampling Techniques and Procedure\u003c/h2\u003e \u003cp\u003eThere are fourteen public hospitals in the South Wollo Zone. Of these, five public hospitals were selected randomly by the lottery method. The allocation of the samples to the hospitals was performed proportionally based on the average number of clients who received antenatal care at each hospital in the most recent 3-month report of each health facility. Study participants were selected at each facility by systematic random sampling techniques. The participants were selected in the order in which they came to health facilities. Participant card numbers were used to systematically select participants in every Kth, interval taking K\u0026thinsp;=\u0026thinsp;N/n\u0026thinsp;=\u0026thinsp;974/590\u0026thinsp;=\u0026thinsp;1.65\u0026thinsp;\u0026asymp;\u0026thinsp;2. The first sample was selected randomly and then samples were taken every K\u003csup\u003eth\u003c/sup\u003e interval until the required sample size was obtained. (where N is the source population taken from the Zone Health Bureau Three-month Antenatal Care Report of five selected hospitals and \u003cb\u003en\u003c/b\u003e is the sample size for this study.\u003c/p\u003e \u003cp\u003e \u003cb\u003e2.8. Dependent Variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eProportion of prenatal ultrasound utilization\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e2.9 Independent Variables\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eSociodemographic factors\u003c/b\u003e: Maternal age, residence, ethnicity, marital status, monthly income, religion, educational level of the mother, and husband's education\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eThe obstetric factors\u003c/b\u003e: included parity, gravidity, history of abortion, history of ectopic pregnanc\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ey\u003c/span\u003e, history of recent congenital anomaly, illness experienced in recent pregnancy, and twin pregnancy\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eMaternal factors\u003c/b\u003e: maternal knowledge of obstetric ultrasound findings and maternal attitudes toward obstetric ultrasound findings.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.10. Operational Definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eObstetric ultrasound utilization\u003c/strong\u003e \u003cp\u003eIn this study, the utilization of ultrasound by pregnant women was defined as obtaining ultrasound services at least once during a recent pregnancy[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eKnowledge of obstetric ultrasound\u003c/strong\u003e \u003cp\u003eRespondents who answered more than or equal to 6 questions (50%) of knowledge-related questions correctly provided were considered to have good knowledge. Those who answered fewer than 6 questions (\u0026lt;\u0026thinsp;50%) were considered to have poor knowledge of obstetric ultrasound utilization[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAttitude toward obstetric ultrasound\u003c/strong\u003e \u003cp\u003eThe respondents who responded \u0026lsquo;agree\u0026rsquo; to at least 50% of the questions on attitude were categorized as having a good attitude toward obstetric ultrasound, whereas those who responded \u0026lsquo;agree\u0026rsquo; to \u0026lt;\u0026thinsp;50% of the questions were considered to have a poor attitude toward obstetric ultrasound.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Data collections Tool and Procedures\u003c/h2\u003e \u003cp\u003eThe data were collected using semi structured interviewer-administered questionnaires. The questionnaire was prepared by reviewing different published literature and adapted to the objective of this study [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan additionalcitationids=\"CR23\" citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], but knowledge and attitude assessment questionnaires were adopted from one study[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The questionnaires were modified to suit the local conditions and it consisted of sections related to Socio-demographic characteristics, obstetric factors, maternal knowledge about obstetric ultrasound factors, and maternal attitudes towards obstetric ultrasound factors.\u003c/p\u003e \u003cp\u003eFive data collectors with BSc degrees in midwifery with two supervisors were recruited. The data collectors undertook face-to-face interviews using a semi structured and pretested Amharic questionnaire. Internal consistency/reliability of the item was checked by computing Cronbach\u0026rsquo;s alpha. The value of Cronbach\u0026rsquo;s alpha for knowledge assessment was 0.96 and attitude was 0.82.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.11. Data Quality Control\u003c/h2\u003e \u003cp\u003eThe questionnaire was initially prepared in English. The English version was translated to the Amharic local language and translated back to English to ensure internal consistency by language experts. The quality of the data was ensured during collection, coding, entry, and analysis. Before the data were collected, one day of training and orientation were given to the data collectors and supervisors. Follow-up was also performed during the data collection. Moreover, the questionnaires were pretested on 29 participants (5% of the sample) at Woldia Hospital 15 days before the data collection to ensure the clarity, wording, and logical sequence of the questions. The necessary modifications were made. In addition, the supervisors and principal investigator supervised the whole activity of the data collection process and checked the completed questionnaires every day for completeness, and correctness, and necessary corrections were made in a timely manner.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.12 Data Processing and Analysis\u003c/h2\u003e \u003cp\u003eThe data were edited and cleaned for inconsistencies by using Epidemiologic Data (Epid-data) 4.6 version software and exported to Statistical Package for the Social Sciences (SPSS) version 26 (manufactured in April 2019; Armonk, Nework, United States) for data analysis. Descriptive statistics such as frequencies and cross-tabulations were performed. Graphical presentations such as pie charts were used to present the findings of the study. The information was presented in tables and figures. Bivariable and multivariable logistic regression analyses were performed to determine the associations between outcome and explanatory variables. A P-value of \u0026lt;\u0026thinsp;0.25 in the bivariate analysis was used as the selection criterion for including a variable in the multivariable logistic regression model.\u003c/p\u003e \u003cp\u003eAn effort was made to assess whether the necessary assumptions for the application of multivariable logistic regression were fulfilled. In this regard, the Hosmer and Lemeshow goodness-of-fit test yielded a large p value (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and the result was 0.589. Multicollinearity was checked to determine the linear correlation among the independent variables by using the variance inflation factor(VIF), Tolerance test and standard error. Variables with an inflation factor\u0026thinsp;\u0026gt;\u0026thinsp;10, standard error\u0026thinsp;\u0026gt;\u0026thinsp;2 and tolerance\u0026thinsp;\u0026lt;\u0026thinsp;0.1 were excluded from the multivariable analysis. The confounding effect were also checked.\u003c/p\u003e \u003cp\u003eVariables without collinearity were entered into a multivariable model. Only variables with a p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were included in the final model. Finally, the AOR and 95% CI were considered to indicate the level of association between each factor and the utilization of prenatal obstetric ultrasound.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec15\"\u003e\n \u003ch2\u003e3.1 Sociodemographic Characteristics of the Respondents\u003c/h2\u003e\n \u003cp\u003eA total of 562 pregnant women participated in this study, for a response rate of 95.3%. The mean age of the study participants was 29.93 (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;5.53) years, with a minimum of 18 years and a maximum of 45 years.\u003c/p\u003e\n \u003cp\u003eThree hundred twenty-four (56.2%) patients were living in urban areas. The majority of the respondents (70.3%) were married, and 296 (52.7%) of the respondents were housewives. The educational level of the respondents varied from illiterate to above a college diploma, with the majority (48.2%) being illiterate, as shown in Table 1.\u003c/p\u003e\n \u003cdiv\u003e\n \u003cp\u003eTable 1; Sociodemographic history of pregnant mothers \u0026nbsp;who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023 (n=562).\u003c/p\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"534\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eResidence\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEducation\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eHusband education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEthinicity\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIncome per month\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(Ethiopian birr)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003cp\u003e\u0026gt;35\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003cp\u003eRural\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCollege diploma\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAnd above\u003c/p\u003e\n \u003cp\u003eSecondary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePrimary\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIlliterate \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCollege diploma\u003c/p\u003e\n \u003cp\u003eand above\u003c/p\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003cp\u003eIlliterate\u003c/p\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eCatholics\u003c/p\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eHousewife\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003cp\u003ePrivate employee\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003cp\u003eTigrie\u003c/p\u003e\n \u003cp\u003eGuragie\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026lt;3000\u003c/p\u003e\n \u003cp\u003e3000-5000\u003c/p\u003e\n \u003cp\u003e\u0026gt;5000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 7\u003c/p\u003e\n \u003cp\u003e101\u003c/p\u003e\n \u003cp\u003e156\u003c/p\u003e\n \u003cp\u003e177\u003c/p\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e395\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;24\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;61\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;82\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003cp\u003e246\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;77\u003c/p\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003cp\u003e271\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003cp\u003e149\u003c/p\u003e\n \u003cp\u003e283\u003c/p\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003cp\u003e116\u003c/p\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003cp\u003e382\u003c/p\u003e\n \u003cp\u003e65\u003c/p\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; 4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003cp\u003e197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 103px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003cp\u003e19.6\u003c/p\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003cp\u003e25.4\u003c/p\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003cp\u003e10.9\u003c/p\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e56.2\u003c/p\u003e\n \u003cp\u003e43.8\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e13.7\u003c/p\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003cp\u003e48.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e21.7\u003c/p\u003e\n \u003cp\u003e25.8\u003c/p\u003e\n \u003cp\u003e26.0\u003c/p\u003e\n \u003cp\u003e26.5\u003c/p\u003e\n \u003cp\u003e50.4\u003c/p\u003e\n \u003cp\u003e36.5\u003c/p\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003cp\u003e8.4\u003c/p\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e52.7\u003c/p\u003e\n \u003cp\u003e10.3\u003c/p\u003e\n \u003cp\u003e20.6\u003c/p\u003e\n \u003cp\u003e15.1\u003c/p\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.5\u003c/p\u003e\n \u003cp\u003e68\u003c/p\u003e\n \u003cp\u003e11.6\u003c/p\u003e\n \u003cp\u003e6.2\u003c/p\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e29.8\u003c/p\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003cp\u003e35.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003eOther religion\u003c/strong\u003e: \u0026nbsp;adventist, \u003cstrong\u003eOthers occupation:\u0026nbsp;\u003c/strong\u003emerchant, shopkeeper, designer, house painter, \u003cstrong\u003eOther ethinicity\u003c/strong\u003e: afar\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\u003cstrong\u003e3.2 Obstetric and maternal health service characteristics of pregnant women in selected South Wollo zone hospitals in Northeast Ethiopia, 2023.\u003c/strong\u003e\u003c/div\u003e\n \u003cp\u003eFour-hundred-ninety-nine (88.8%) of the respondents were multigravida, five hundred thirty nine (95.9%) initiated antenatal visits after six months, and 379 (67.4%) had four or more antenatal visits. One hundred seventy-four (31.0%) of the respondents had a pregnancy that experienced medical illness while one hundred fifty- four (27.4%) mothers had a pregnancy ended in abortion. Ninety-eight (17.4%) of the mothers delivered congenital anomalies (Table 2).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 3\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003e\u003cstrong\u003eKnowledge component on obstetric ultrasound among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023.\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to confirm pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e389\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to determine fetal position\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e356\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e63.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to determine cord and placental position\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to determine the expected date of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to detect any defect or Congenital abnormalities during pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to detect complications of pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e351\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to detect amniotic fluid\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e364\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to detect any assess fetal wellbeing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound helps to confirm\u003c/p\u003e\n \u003cp\u003eThe Presence of multiple pregnancy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to estimate fetal weight\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e397\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of ultrasound to estimate gestational age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eKnew the importance of at least one ultrasound before 24 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood knowledge\u003c/p\u003e\n \u003cp\u003ePoor knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.5\u003c/p\u003e\n \u003cp\u003e34.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe most reported component of knowledge reported by participants was helping to estimate gestational age which was reported by approximately 412 (73.3%) mothers. Estimating fetal weight was the second most reported importance of ultrasound, with 397 (70.6%) reporting it. The least common component of knowledge regarding obstetric ultrasound was determining the cord and placental position which was reported by only 310 (55.2%) particpants ( Table 3).\u003c/p\u003e\n \u003cdiv\u003eIn this study, of 562 pregnant women, 368 (65.5%) had good knowledge of obstetrics ultrasound, while the remaining (194,34.5%) had poor knowledge of obstetric ultrasound. This indicates that more than half of the respondents were knowledgeable about the actual importance and effectiveness of obstetric ultrasound. The remaining women may to have a low rate of use of obstetric ultrasound or hinder women from being examined by ultrasound even in an emergency even though prenatal scanning improves pregnancy outcomes (as shown in Fig. 1).\u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab6\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 4\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eAttitudes of pregnant women on obstetric ultrasound among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that obstetric ultrasound safe for the mother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that USS safe for the fetus\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that USS lead to the anomaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that USS is an essential investigation during Px.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived terminating pregnancy if the sex of the child\u0026apos;s other\u003c/p\u003e\n \u003cp\u003ethan you prefer, is right\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e437\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that educating others about USS is necessary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePerceived that USS offer routinely\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative attitude\u003c/p\u003e\n \u003cp\u003ePositive attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e249\u003c/p\u003e\n \u003cp\u003e313\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.3\u003c/p\u003e\n \u003cp\u003e55.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\"\u003eNote : USS\u0026thinsp;=\u0026thinsp;ultrasonography\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eThe most frequently mentioned component attitudes regarding obstetric ultrasound were \u0026ldquo;educating others about obstetric ultrasound is necessary\u0026rdquo;and\u0026ldquo;perceived that ultrasound is an essential investigation during pregnancy\u0026rdquo; (459; 81.7%). The second most mentioned component was \u0026ldquo;terminating a pregnancy if sex is other than you prefer,\u0026rdquo; where 437 (77.8%) respondents did not believe that terminating a pregnancy based on sex was the right decision (Table 4).\u003c/p\u003e\n \u003cdiv\u003eOut of 562 pregnant women, more than half (313, 55.7%) had a positive attitude toward obstetric ultrasound, while the remaining (249, 44.3%) had a negative attitude toward obstetric ultrasound. This indicated that nearly half of the women had a negative attitude toward prenatal ultrasound scanning. A negative attitude toward prenatal ultrasound scanning indicated that she was not willing to be scanned by obstetric ultrasound, which may have had a negative impact on the outcomes of pregnancy and motherhood (Fig. 2).\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\"\u003e\n \u003ch2\u003e3.5 Prenatal Ultrasound Utilization\u003c/h2\u003e\n \u003cp\u003eThree hundred fifty-three (62.8%) respondents used prenatal ultrasound at least once during pregnancy, of whom 221 (62.5%) utilized it before 24 weeks of gestation and the remaining 122 (34.6) utilized it after 24 weeks of gestation. Nearly half, (51.3%) of the women requested the scan by themselves whereas 145 (41.1%) of the respondents were requested by clinicians (Table 5).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab8\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 5\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eQuestions related to prenatal ultrasound utilization among pregnant women who attended ANC in the South Wollo Zone in the northeast region of Ethiopia, 2023.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePrenatal OBS U/S utilization (n\u0026thinsp;=\u0026thinsp;562)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e207\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eAt what gestational age (n\u0026thinsp;=\u0026thinsp;355)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;24 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt; 24week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eWho requested (n\u0026thinsp;=\u0026thinsp;355)?\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eClinician\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHerself\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e51.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDon\u0026rsquo;t remember\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eReason not utilized\u003c/p\u003e\n \u003cp\u003eObs U/S (n\u0026thinsp;=\u0026thinsp;207)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI think it is not nescceray\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI fear it would cause injury to me and my baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI didn\u0026rsquo;t have the information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eI cannot access it\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLack of money\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab9\" border=\"1\"\u003e\u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\"\u003e\n \u003ch2\u003e3.6 Factor Associated with the Use of Prenatal Obstetric Ultrasound\u003c/h2\u003e\n \u003cp\u003eAccording to our bivariate logistic regression, fifteen variables were associated with the use of prenatal obstetric ultrasound: education status, husband\u0026apos;s education status, residence, occupation, gravidity, parity, previous abortion, congenital anomaly delivery, the timing of ANC initiation, the frequency of ANC visits, recent delivery of baby, mode of delivery, recent birth weight delivery, knowledge of the woman and attitudes about the woman.\u003c/p\u003e\n \u003cp\u003eRespondents whose educational status was above college and diploma were more than six times more likely to use prenatal ultrasound than did those with no formal education (crude odds ratio (COR)\u0026thinsp;=\u0026thinsp;6.45; 95%CI: (3.56, 11.72)). Similarly, pregnant women whose occupation was a government employee were more likely to utilize obstetric ultrasound than were those whose occupation was a housewife (COR\u0026thinsp;=\u0026thinsp;7.99; 95%CI: (4.22, 15.15)).\u003c/p\u003e\n \u003cp\u003eHowever, according to our multivariate logistic regression analysis, only five variables were significantly associated with the use of obstetric ultrasound such as women\u0026apos;s education status, women\u0026rsquo;s knowledge, residence, occupation, and medical illness during pregnancy.\u003c/p\u003e\n \u003cp\u003eThe odds of utilizing prenatal ultrasound among pregnant women who reside in urban areas were nearly five times greater than those who reside in rural areas, (adjusted odds ratio (AOR)\u0026thinsp;=\u0026thinsp;4.82; 95%CI: 2.99, 8.03). Those respondents who encountered medical illness during pregnancy were nearly three times more likely to utilize prenatal ultrasound than were their counterparts (AOR\u0026thinsp;=\u0026thinsp;3.03; 95%CI: 1.64, 5.59). Similarly, women who had good knowledge of prenatal obstetric ultrasound were nearly seven times more likely to utilize prenatal ultrasound than were those who had poor knowledge (AOR\u0026thinsp;=\u0026thinsp;7.32; 95%CI: (4.07, 13.33)) (see details in Table 6).\u003c/p\u003e\n \u003cdiv\u003e\n \u003ctable id=\"Tab10\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 6\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eResult of multivariate binary logistic regression analysis of factors associated with prenatal ultrasound utilization among pregnant women who attended ANC in selected South Wollo Zone Public Hospitals, Ethiopia, 2023.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eUtilization\u003c/p\u003e\n \u003cp\u003eOf OU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYES (\u003cstrong\u003eNo.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNO (\u003cstrong\u003eNo.)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eResidency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e260\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.63(5.19, 11.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.82(2.99, 8.03)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eEducation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege diploma above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.46(3.56, 11.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.41 (1.02, 5.70)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.33(1.36, 3.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.55(1.62, 7.82)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.58 (1.60, 4.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10(1.09, 4.05)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e139\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eHusband Education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCollege diploma above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.10(1.21, 3.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.29(0.56, 2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08(0.67, 1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.08(0.67, 1.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.48(0.30, 0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.37(0.17, 0.68)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"5\"\u003e\n \u003cp\u003eOccupation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.65(0.34, 1.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.95 (0.34, 1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGovernment employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e104\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.99(4.22, 15.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.05(1.70, 9.64)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrivate employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.43(1.95, 6.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.34(1.58, 7.05)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.30(0.44, 12.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.74(0.28, 26.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eGravidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultigravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e326\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.51(1.47, 4.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.77(0.54, 0.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrim gravida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eParity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMultipara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.51(0.98, 2.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.47(0.12, 1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePrim para\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePrevious Abortion\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e126\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45(2.20, 5.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.52(0.78, 2.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTiming of ANC Intitition for current Px\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026le;\u0026thinsp;6month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.10(1.65, 10.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.61 (0.48, 5.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026gt;\u0026thinsp;6month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eFrequency of ANC visit for Current Px.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOne visit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTwo to three visits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.74(0.93, 3.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.55(0.22, 1.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFour visits and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.87(2.22, 6.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 .88(0.46, 2.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003eGestational age for current Px.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFirst TM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSecond TM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e237\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.04(0.65, 1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35(0.69, 2.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eThird TM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.37(0.74, 2.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.50(0.61, 2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eMild to moderate Illness Experienced with this Px.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.08(3.20, 8.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.03(1.64, 5.59)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e183\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCongenital anomaly delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.33(1.40, 3.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.32(0.64, 2.72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e277\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eRecent delivery of baby\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.35(0.86, 2.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.28(0.36, 1.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eKnowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e295\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.48(6.35, 14.14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.36(4.06, 13.32)**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e136\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAttitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.51(1.07, 2.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.81(0.46, 1.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"6\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: *Statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **Statistically significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 1\u0026thinsp;=\u0026thinsp;reference category\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cdiv\u003e\u003c/div\u003e\n\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis study was designed to assess the proportion of pregnant women utilizing prenatal ultrasound and associated factors mong those attending ANC in five public hospitals of South Wollo Zone. The proportion of prenatal ultrasound utilization in this study was 62.8% [95% CI: (58.7%, 66.8%)]. This result was in line with the findings of prenatal ultrasound utilization described in Jimma Zone public hospitals in Ethiopia, which reported a 60.7%[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This result was also consistent with the findings recorded in southeastern Nigeria, which were58.7%[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. However, the result of the current study were lower than tthose obtained in Uganda[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and in accordance with the local government Zaria, Kaduna State, northern Nigeria where the proportion of patients utilizing ultrasound was 83.5%[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese finding were also lower than those of a cluster rondomized study conducted in Eastern China (96.1%)[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This variation may be due to socioeconomic factors,the propensity to use services and geographical differences between Ethiopia and Eastern China. The next step might be to focuses on both urban and rural pregnant women as China\u0026rsquo;s study included only rural pregnant women. Moreover, the discrepancy might be due to variations in access to use services ,barriers to use services, health service systems, and health policy programs.\u003c/p\u003e \u003cp\u003eIn contrast, the percentages of patients utilizing prenatal ultrasound in the current study was greater than that in a study conducted in Kenya (49.7%).[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The difference may be atributed to variations in health policy strategies for child and maternal health care between Ethiopia and Kenya.\u003c/p\u003e \u003cp\u003eThe findings of this study showed that there was a strong association between women\u0026rsquo;s knowledge of prenatal obstetric ultrasound and prenatal ultrasound utilization. Pregnant women who had good knowledge were 7.36 times more likely to utilize prenatal ultrasound than pregnant women who had poor knowledge. This result was consistent with the findings recorded in Jimma, Ethiopia[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] and in different countries, e.g., a peri-urban health center in Uganda[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and the main referral hospital, in Sokoto, Nigeria[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Pregnant women with good obstetric ultrasound knowledge have a positive attitude toward obstetric ultrasound scans. The findings of this study align with research conducted in Gedeo Zone, Ethiopia [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This indicates that increased awareness of obstetric ultrasound enhances its utilization. This, in turn, facilitates early detection and management of obstetric complications, ultimately contributing to reduced perinatal mortality. Greater knowledge fosters confidence in ultrasound's role in predicting pregnancy outcomes, whereas misconceptions may discourage its Obstetric ultrasound has become a critical tool in obstetrics, and its benefits have undeniably contributed to improved pregnancy outcomes[\u003cspan additionalcitationids=\"CR32 CR33\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] Therefore, ensuring that all antenatal women receive obstetric ultrasound scans is essential for the prevention and management of obstetric complications, ultimately leading to improved pregnancy outcomes, as recommended by the World Health Organization (WHO). To bridge gaps in knowledge and accessibility, obstetric care providers should integrate routine ultrasound assessments into maternity services while promoting education on its benefits, particularly for rural women with limited access. Strengthening maternal health policies and integrating educational interventions into antenatal care programs could further enhance uptake of ultrasound utilization, contributing to better maternal and neonatal outcomes across the countries.\u003c/p\u003e \u003cp\u003eIn this study, pregnant mothers who reside in urban areas were more likely to utilize obstetric ultrasound than mothers who reside in rural areas (AOR\u0026thinsp;=\u0026thinsp;4.82; 95% at CI: (2.99, 8.03)). This is probably due to the greater accessibility of information and awareness about prenatal ultrasound in urban areas than in rural areas and the variation in the distance of health facilities. Multiple sources of information about prenatal ultrasound data are obtained through television (TV) programs, private clinics, etc., for urban women rather than for rural pregnant women. Another reason may be the limited expansion of infrastructure in the rural areas compared to urban areas. Therefore, in collaboration with nongovernmental organizations (NGOs), the South Wollo Zone Health Office should focus on addressing health infrastructures in rural areas. These findings are in line with, other findings conducted in Addis Abeba and Dilla[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] respectively. Therefore, the South Wollo Zone Health Office, in collaboration with nongovernmental organizations (NGOs), should prioritize the expansion and enhancement of healthcare services in rural areas through a multifaceted approach. This includes the construction of well-equipped health centers, the deployment of adequately trained healthcare professionals, the implementation of telemedicine services, and the introduction of mobile health units to extend services to remote communities. Furthermore, advocating for policies that ensure the equitable distribution of healthcare resources, including the provision of prenatal ultrasound services, across rural regions is essential for closing the urban-rural healthcare gap\u003c/p\u003e \u003cp\u003eMedical illness during pregnancy was the third explanatory variable that was significantly associated with the use of prenatal ultrasound. Pregnant mothers who had medical illness during pregnancy were 3.03 times more likely to utilize prenatal ultrasound than were those who were free of illness during pregnancy. Similarly, a study from Canada, showed that medical illness during pregnancy was significantly associated with the use of prenatal ultrasound[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This might be because of the perceived fear of losing their pregnancy and the complications associated with it. The authors suggest that policymakers and guideline developer\u0026rsquo;s consider incorporating more frequent ultrasound scans into the antenatal care schedule for pregnant women with medical conditions, as this strategy can help mitigate concerns about pregnancy loss and related complications. Further more women with history of pregnancy loss or anomaly detection might feel that their pregnancy loss related to poor utiliztions of ultrasound services.\u003c/p\u003e \u003cp\u003eAnother study in India showed that medical conditions such as abdominal problems and urinary tract infections (UTIs) were among the most common conditions[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. A possible explanation might be that abdominal pain and urinary tract infection during pregnancy may lead to frequent antenatal visits and subsequently greater opportunities for ultrasound scans. The more patients visit a health facility with complaints during pregnancy, the more scans they obtain.\u003c/p\u003e \u003cp\u003eIn this study, occupation was also a predictor variable that was significantly associated with the use of prenatal ultrasound. The pregnant women whose occupations were government or private were 4.06 and 3.34 times more likely to utilize obstetric ultrasound,respectively, than were those whose occupations were housewives respectively. Similarly, in China, occupation was significantly associated with the use of prenatal ultrasound [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. In contrast to these findings, a study performed in Nigeria reported that occupation does not affect the utilization of prenatal ultrasound [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This may be explained by the differences in sociodemographic background and economic status the two countries.\u003c/p\u003e \u003cp\u003eIn this study, the educational level of the women was another predictor variable associated with the utilization of prenatal ultrasound. An education level above the primary level was significantly associated with prenatal ultrasound utilization with (OR\u0026thinsp;=\u0026thinsp;2.10; 95% at CI: (1.09, 4.05)). This study proved that mothers with a high level of education had more requests for ultrasound scans, possibly because their awareness of pregnancy complications is greater than among those with only primary school education. Furthermore, families with high socioeconomic status had better access to sonography and did not mind financial factors, as previous studies have also supported these findings[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSimilar findings were obtained in a study conducted in Jimma (Ethiopia), in which individuals whose educational level was above primary level were more likely to undergo obstetric ultrasound than their counterparts were[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This may be explained by the fact that the educational status of the pregnant mother increases, and exposure to pieces of information may also increase. Discussing and disseminating of this issue may become more common among educated pregnant women than among those younger primary school.The level of education tends to influence the methods by which women obtain and analyze information about ultrasound.\u003c/p\u003e"},{"header":"5. STRENGTHS AND LIMITATIONS OF THE STUDY","content":"\u003cp\u003eThis research addressed pregnant women in different areas, both urban and rural by considering hospitals where antenatal flow is highest in all areas. The first study area in particular is the major strength of this study. Regarding the limitations of the current study, the literature on prenatal ultrasound utilization was limited, so discussing the findings of the study was difficult. While the study was designed as an institution-based cross-sectional study, it did not include women who received antenatal care at a private clinic.Moreover, The limitation of this study is, it is impossible to make causal inferences due to the cross-sectional nature of the study.\u003c/p\u003e"},{"header":"6. CONCLUSIONS","content":"\u003cp\u003eAccording to the current findings, the proportion of prenatal ultrasounds utilized was 62.8%, but the prevalence prenatal ultrasounds was still much lower than that recommended by FIGO and WHO, which suggest that all pregnancies should undergo a minimum of two scans throughout pregnancy. The educational status of the pregnant woman, occupations, knowledge, residency, and medical illness during pregnancy were significantly associated with the use of prenatal ultrasound. Therefore the authors recommended for health care providers to educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed.\u003c/p\u003e"},{"header":"7. RECOMMENDATION","content":"\u003cp\u003eIn light of these findings, the following recommendations are proposed:\u003c/p\u003e \u003cp\u003eThe authors recommended for health care providers to educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed.\u003c/p\u003e \u003cp\u003eThe authors suggest that policymakers and guideline developers consider incorporating more frequent ultrasound scans into the antenatal care schedule for pregnant women with medical conditions, as this strategy can help mitigate concerns about pregnancy loss and related complications\u003c/p\u003e \u003cp\u003eAuthors recommended strengthening maternal health policies and integrating educational interventions into antenatal care programs could further enhance uptake of ultrasound utilization, contributing to better maternal and neonatal outcomes across the countries.\u003c/p\u003e \u003cp\u003eThe south wollo zone health office, in collaboration with NGOs, should prioritize expanding rural healthcare services and task health extension workers with educating rural women about the importance of obstetric ultrasound as part of their routine duties.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eANC: antenatal Care, AOR: adjusted odds ratio, CI: confidence interval, COR: crude odds ratio, LMIC: low and middle income country, O/U: obstetric ultrasound, OR: odds ratio U/S: ultrasound, USAID: united states agency for international development, WHO: world health organization\u003c/p\u003e\n"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eEthical clearance was obtained from the Institutional Health Research Ethics Review Committee (IHRERC) of Wollo University College of Medicine and Health Sciences. An official letter was sent to South Wollo public hospitals from Southern Health Bearuea before data collection was started. After explaining the purpose and the possible benefit of the study Informed, voluntary, written, and signed consent was obtained from the head of Hospitals and each participant. The consent form of neonates was taken from the mothers. Based on the willingness of participants, they were interviewed for the questions. Confidentiality of information was maintained. Finally, neonates who fulfill the definition of sepsis were recommended to get treatment and care in collaboration with the hospital staff and those who cannot afford to pay; the Authors communicated with the responsible body to gate free treatment.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for Publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of Data and Materials\u003c/h2\u003e\n\u003cp\u003e\u0026nbsp;The data is not available from the corresponding authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003eThe authors declare that no competing interests exist.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eA grant was received for this study from Wollo University.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contribution(s)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBS:\u0026nbsp;\u003c/strong\u003econceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editing.\u003cstrong\u003e\u0026nbsp;KT:\u0026nbsp;\u003c/strong\u003eReviewed and criticized the proposal, guided the statistical analysis, gave advice on the interpretation of the results, and provided intellectual input to the participants, involved in the writing of the final research and writing of the manuscript\u003cstrong\u003e. SA:\u0026nbsp;\u003c/strong\u003eReviewed and criticized the proposal, guided the statistical analysis, gave advice on the interpretation of the result and made intellectual inputs, involved in the write-up of the final research work, and contributed to the write-up of the manuscript. \u003cstrong\u003eSY:\u003c/strong\u003e critically reviewed and edited the proposal, reviewed the research, performed the statistical analysis, interpreted the results, and contributed to the writing of the manuscript. \u003cstrong\u003eTE:\u003c/strong\u003e guided the statistical analysis, gave advice on the interpretation of the results, and provided intellectual input, and were involved in the final research. \u003cstrong\u003eAY:\u003c/strong\u003e conceptualization; Data curation; Formal analysis; Investigation; Methodology; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editing. \u003cstrong\u003eCM:\u003c/strong\u003e Methodology; Resources; Software; Supervision; Validation; Visualization; Writing \u0026ndash; original draft; Writing \u0026ndash; review \u0026amp; editing.\u0026nbsp;All the authors read and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAcknowledgments\u003c/h2\u003e\n\u003cp\u003eThis study is part of the first author\u0026rsquo;s Master of Science in Clinical Midwifery thesis with the College of Medicine and Health Sciences at Wollo University, Ethiopia. First, we would like to express our gratefulness to Woldia University for providing us with full sponsorship for our research thesis. Second, we would like to acknowledge the staff of all South Wollo Public Hospitals for their cooperation by providing all the necessary baseline information which was important for this study. Finally, we would like to extend our appreciation to Wollo University, College of Medicine, and health science librarians and internet center coordinators for their support and assistance in obtaining important materials to develop this research proposal, data collectors, supervisors, and all the participants during data collection.\u003c/p\u003e\n\u003ch2\u003eAuthor Information\u003c/h2\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003eLecturer at the College of Health Sciences Department of Midwifery Woldia University, Woldia Ethiopia.\u0026nbsp;\u003csup\u003e2\u003c/sup\u003eAssistant Professor of Maternity and Reproductive Health, College of Health and Medical Sciences, Wollo University, Dessie, Ethiopia.\u0026nbsp;\u003csup\u003e3\u003c/sup\u003eLecturer at College of Medicine and Health Sciences School of Nursing and Midwifery, Wollo University, Dessie Ethiopia\u0026nbsp;\u003csup\u003e4\u003c/sup\u003eLecturer at College of Medicine and Health Sciences School of Nursing and Midwifery, Wollo University, Dessie Ethiopia.\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e5\u003c/sup\u003eLecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia.\u0026nbsp;\u003csup\u003e6\u003c/sup\u003eLecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia.\u0026nbsp;\u003csup\u003e7\u003c/sup\u003eLecturer at College of Health Sciences Department of Midwifery, Woldia University, Woldia, Ethiopia.\u0026nbsp;\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGILL, K.A., \u003cem\u003eUltrasound in Obstetrics and.\u003c/em\u003e\u003c/li\u003e\n\u003cli\u003eSim\u0026oacute;, S., et al., \u003cem\u003eEffects of ultrasound on anxiety and psychosocial adaptation to pregnancy.\u003c/em\u003e Archives of women\u0026apos;s mental health, 2019. \u003cstrong\u003e22\u003c/strong\u003e: p. 511-518.\u003c/li\u003e\n\u003cli\u003ePractice, F.W.G.O.B. and I.F. of Gynecology, \u003cem\u003eBest practice in maternal-fetal medicine.\u003c/em\u003e International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2015. \u003cstrong\u003e128\u003c/strong\u003e(1): p. 80-82.\u003c/li\u003e\n\u003cli\u003eOrganization, W.H., \u003cem\u003eWHO recommendations on intrapartum care for a positive childbirth experience\u003c/em\u003e. 2018: World Health Organization.\u003c/li\u003e\n\u003cli\u003eWanyonyi, S.Z., et al., \u003cem\u003eOpportunities and challenges in realizing universal access to obstetric ultrasound in sub-Saharan Africa.\u003c/em\u003e Ultrasound international open, 2017. \u003cstrong\u003e3\u003c/strong\u003e(02): p. 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Fekete, \u003cem\u003eThe evolving role of ultrasound in obstetrics/gynecology practice.\u003c/em\u003e International Journal of Gynecology \u0026amp; Obstetrics, 2003. \u003cstrong\u003e82\u003c/strong\u003e(3): p. 339-346.\u003c/li\u003e\n\u003cli\u003eSalomon, L.J., et al., \u003cem\u003ePractice guidelines for performance of the routine mid-trimester fetal ultrasound scan.\u003c/em\u003e Ultrasound in Obstetrics \u0026amp; Gynecology, 2011. \u003cstrong\u003e37\u003c/strong\u003e(1).\u003c/li\u003e\n\u003cli\u003ePhutke, G., et al., \u003cem\u003eUltrasound in rural India: A failure of the best intentions.\u003c/em\u003e Indian J Med Ethics, 2018. \u003cstrong\u003e18\u003c/strong\u003e: p. 1-7.\u003c/li\u003e\n\u003cli\u003eShah, S., et al., \u003cem\u003eDevelopment of an ultrasound training curriculum in a limited resource international setting: successes and challenges of ultrasound training in rural Rwanda.\u003c/em\u003e International journal of emergency medicine, 2008. \u003cstrong\u003e1\u003c/strong\u003e: p. 193-196.\u003c/li\u003e\n\u003cli\u003eAbawollo, H.S., et al., \u003cem\u003eContribution of portable obstetric ultrasound service innovation in averting maternal and neonatal morbidities and mortalities at semi-urban health centers of Ethiopia: a retrospective facility-based study.\u003c/em\u003e BMC pregnancy and childbirth, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 368.\u003c/li\u003e\n\u003cli\u003eOrganization, W.H., \u003cem\u003eHealth in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals.\u003c/em\u003e 2015.\u003c/li\u003e\n\u003cli\u003eDalmacion, G.V., et al., \u003cem\u003eHandheld ultrasound to avert maternal and neonatal deaths in 2 regions of the Philippines: an iBuntis\u0026reg; intervention study.\u003c/em\u003e BMC pregnancy and childbirth, 2018. \u003cstrong\u003e18\u003c/strong\u003e: p. 1-8.\u003c/li\u003e\n\u003cli\u003eEkott, M.I., et al., \u003cem\u003eAcceptability of focused antenatal care by antenatal clinic attendees in Obio Cottage Hospital, Port Harcourt, Nigeria.\u003c/em\u003e Research Journal of Women\u0026rsquo;s Health, 2017. \u003cstrong\u003e4\u003c/strong\u003e(1): p. 2.\u003c/li\u003e\n\u003cli\u003eBitew, Z.W., et al., \u003cem\u003eMagnitude and associated factors of neural tube defects in Ethiopia: a systematic review and meta-analysis.\u003c/em\u003e Global pediatric health, 2020. \u003cstrong\u003e7\u003c/strong\u003e: p. 2333794X20939423.\u003c/li\u003e\n\u003cli\u003eArgaw, M.D., et al., \u003cem\u003eExperiences of midwives on Vscan limited obstetric ultrasound use: a qualitative exploratory study.\u003c/em\u003e BMC Pregnancy and Childbirth, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 196.\u003c/li\u003e\n\u003cli\u003eTilahun, Y., \u003cem\u003eUSAID Transform: Primary Health Care Activity.\u003c/em\u003e 2022.\u003c/li\u003e\n\u003cli\u003eOche, O.M., et al., \u003cem\u003eKnowledge of the use and indications for obstetric ultrasound scan among women attending a main referral hospital, Sokoto, Nigeria.\u003c/em\u003e Res Obstet Gynecol, 2013. \u003cstrong\u003e2\u003c/strong\u003e(5): p. 55-62.\u003c/li\u003e\n\u003cli\u003eAbduljabbar, H.S., et al., \u003cem\u003eKnowledge, attitudes and practice about obstetric ultrasonography among women attending a university hospital: a cross-sectional study.\u003c/em\u003e Open Journal of Obstetrics and Gynecology, 2020. \u003cstrong\u003e10\u003c/strong\u003e(12): p. 1763-1775.\u003c/li\u003e\n\u003cli\u003eHaile, Z.W. and A.G. Gurmu, \u003cem\u003eKnowledge, attitude, barriers, and associated factors of obstetric ultrasound among pregnant women in public hospitals, Ethiopia, 2022: a cross-sectional study.\u003c/em\u003e Journal of Ultrasound, 2024. \u003cstrong\u003e27\u003c/strong\u003e(1): p. 31-40.\u003c/li\u003e\n\u003cli\u003eFlores, A.H., et al., \u003cem\u003eFrequency of utilisation of ultrasound in the diagnosis of ectopic pregnancy in Sub-Saharan Africa countries: A systematic review.\u003c/em\u003e African Journal of Emergency Medicine, 2015. \u003cstrong\u003e5\u003c/strong\u003e(1): p. 31-36.\u003c/li\u003e\n\u003cli\u003eAdams, S.J., et al., \u003cem\u003eSociodemographic and geographic disparities in obstetrical ultrasound imaging utilization: a population-based study.\u003c/em\u003e Academic Radiology, 2022. \u003cstrong\u003e29\u003c/strong\u003e(5): p. 650-662.\u003c/li\u003e\n\u003cli\u003eJarahi, L., et al., \u003cem\u003eAssociation of Sociodemographic, Obstetric, and Attitudinal Factors with Prenatal Ultrasound in Mashhad, Iran.\u003c/em\u003e Journal of Child Science, 2021. \u003cstrong\u003e11\u003c/strong\u003e(01): p. e222-e226.\u003c/li\u003e\n\u003cli\u003eYetwale, A., et al., \u003cem\u003ePrenatal ultrasound utilization and its associated factors among pregnant women in Jimma town public health institutions, Ethiopia.\u003c/em\u003e Health services research and managerial epidemiology, 2022. \u003cstrong\u003e9\u003c/strong\u003e: p. 23333928221085881.\u003c/li\u003e\n\u003cli\u003eIkeako, L., et al., \u003cem\u003eAttitude of expectant mothers on the use of ultrasound in pregnancy in a tertiary institution in South East of Nigeria.\u003c/em\u003e Annals of Medical and Health Sciences Research, 2014. \u003cstrong\u003e4\u003c/strong\u003e(6): p. 949-953.\u003c/li\u003e\n\u003cli\u003eGonzaga, M.A., et al., \u003cem\u003eUtilisation of obstetric sonography at a peri-urban health centre in Uganda.\u003c/em\u003e The Pan African Medical Journal, 2010. \u003cstrong\u003e7\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eGaladanci, H., et al., \u003cem\u003eObstetric quality assurance to reduce maternal and fetal mortality in Kano and Kaduna State hospitals in Nigeria.\u003c/em\u003e International Journal of Gynecology \u0026amp; Obstetrics, 2011. \u003cstrong\u003e114\u003c/strong\u003e(1): p. 23-28.\u003c/li\u003e\n\u003cli\u003eHuang, K., et al., \u003cem\u003eUtilization of antenatal ultrasound scan and implications for caesarean section: a cross-sectional study in rural Eastern China.\u003c/em\u003e BMC Health Services Research, 2012. \u003cstrong\u003e12\u003c/strong\u003e: p. 1-10.\u003c/li\u003e\n\u003cli\u003eMatiang\u0026rsquo;i, M., et al., \u003cem\u003eBarriers and enablers that influence utilization of ultrasound screening services among antenatal women in Kajiado and Kisii counties Kenya.\u003c/em\u003e Open Journal of Clinical Diagnostics, 2021. \u003cstrong\u003e11\u003c/strong\u003e(1): p. 1-17.\u003c/li\u003e\n\u003cli\u003eMolla, W., N. Mengistu, and A. Wudneh, \u003cem\u003ePregnant women\u0026rsquo;s knowledge, attitude, and associated factors toward obstetric ultrasound in public hospitals, Ethiopia, 2021: Multi-centered cross-sectional study.\u003c/em\u003e Women\u0026apos;s Health, 2022. \u003cstrong\u003e18\u003c/strong\u003e: p. 17455057221091357.\u003c/li\u003e\n\u003cli\u003eTun\u0026ccedil;alp, Ӧ., et al., \u003cem\u003eWHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival.\u003c/em\u003e Bjog, 2017. \u003cstrong\u003e124\u003c/strong\u003e(6): p. 860-862.\u003c/li\u003e\n\u003cli\u003eShidhaye, P.R., et al., \u003cem\u003eStudy of knowledge and attitude regarding prenatal diagnostic techniques act among the pregnant women at a tertiary care teaching hospital in Mumbai.\u003c/em\u003e Journal of education and health promotion, 2012. \u003cstrong\u003e1\u003c/strong\u003e(1): p. 36.\u003c/li\u003e\n\u003cli\u003eAbdullah, P., et al., \u003cem\u003eFactors associated with the timing of the first prenatal ultrasound in Canada.\u003c/em\u003e BMC pregnancy and childbirth, 2019. \u003cstrong\u003e19\u003c/strong\u003e: p. 1-14.\u003c/li\u003e\n\u003cli\u003eOrganization, W.H., \u003cem\u003eHealth in 2015: from MDGs, millennium development goals to SDGs, sustainable development goals\u003c/em\u003e, in \u003cem\u003eHealth in 2015: from MDGs, Millennium Development Goals to SDGs, Sustainable Development Goals\u003c/em\u003e. 2015.\u003c/li\u003e\n\u003cli\u003eHaile, Z.W., et al., \u003cem\u003eAttitude, Practice, and Associated factors of pregnant women towards prenatal ultrasound in Addis Ababa, Ethiopia. A cross-sectional study.\u003c/em\u003e 2022.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is available in the Supplementary Files section.\u003c/p\u003e\n"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Antenatal care, Obstetric ultrasound, Prenatal, Pregnant women","lastPublishedDoi":"10.21203/rs.3.rs-5933006/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5933006/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eUltrasound (US) is essential in antenatal care worldwide and offers significant benefits for maternal and neonatal health. It should be a standard procedure in low- income countries. However, its utilization remains poor in nations like Ethiopia.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to assess the use of prenatal ultrasound and associated factors among pregnant women who attended antenatal care in South Wollo Zone Public Hospitals, Northeast Ethiopia, in 2023.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was conducted among 590 pregnant women from December 30, 2022, to February 28, 2023, in selected South Wollo Zone Public Hospitals. The data were entered into Epi-Data version 4.6, cleaned, and exported to SPSS version 26 for analysis. The strength of the association between the dependent and independent variables was presented as odds ratios (OR) with 95% confidence intervals (CI), with statistical significance set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in multivariable logistic regression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong the 590 pregnant women studied, the prevalence of prenatal ultrasound utilization was 62.8% [95% CI: 58.7% \u0026minus;\u0026thinsp;66.8%]. Significant factors associated with utilization included urban residency (AOR\u0026thinsp;=\u0026thinsp;4.82, 95% CI: 2.99\u0026ndash;8.03), mothers' knowledge (AOR\u0026thinsp;=\u0026thinsp;7.36, 95% CI: 4.06\u0026ndash;13.32), educational status above primary (AOR\u0026thinsp;=\u0026thinsp;2.10, 95% CI: 1.09\u0026ndash;4.05), medical illness (AOR\u0026thinsp;=\u0026thinsp;3.03, 95% CI: 1.64\u0026ndash;5.59), government employment (AOR\u0026thinsp;=\u0026thinsp;4.05, 95% CI: 1.70\u0026ndash;9.64), and private employment (AOR\u0026thinsp;=\u0026thinsp;2.34, 95% CI: 1.58\u0026ndash;7.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe proportion of patients who underwent prenatal ultrasound was lower than the WHO recommendation. The factors most significantly associated with ultrasound utilization were women's knowledge, urban residency, educational status, medical illness, and occupation. Therefore, the author recommended for health care providers educating mothers on the purposes of obstetric ultrasound and including a prenatal ultrasound screening as part of antenatal care is needed\u003c/p\u003e","manuscriptTitle":"Prenatal Ultrasound Utilization and Associated Factors Among Pregnant Women Attending Antenatal Care in South Wollo Zone Public Hospitals, North East, Ethiopia,2023","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-04 11:15:25","doi":"10.21203/rs.3.rs-5933006/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"559466e9-61e5-472f-9a03-ae5b262bd67c","owner":[],"postedDate":"April 4th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-04-15T06:53:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-04 11:15:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5933006","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5933006","identity":"rs-5933006","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}