Late Initiation of Antenatal Care and Its Associated Factors among Pregnant Women in Dire Dawa, Eastern Ethiopia

Background: The timing of the first antenatal care visit is paramount for optimal health outcomes for women and newborns. The World Health Organization recommends a minimum of four antenatal care visits for any pregnancy to promote the health of the fetus and the mother, and then improve the birth outcome. However, there is a paucity of data on the time of initiation of antenatal care among pregnant women in this study setting. Hence, this study aimed to assess the magnitude and factors associated with late initiation of antenatal care among pregnant women in Dire Dawa City, eastern Ethiopia. Methods: An institutional-based cross-sectional study was conducted on 406 pregnant women selected using a sys­tematic sampling method in Dire Dawa City from February 1-30, 2017. Data were collected using a pre-tested face-to-face interviewer-administered questionnaire. Data were analyzed using Statistical Package for Social Science Version 22.0. Logistic regression was used to examine the factors associated with late initiation of antenatal care. P-value<0.05 was considered statistically significant. Results: The magnitude of late initiation of antenatal care was 55.9% (95% CL: 51.1, 60.8%). Women  aged 25 years and above (AOR=1.77; 95% CL: 1.12, 2.78), unemployment (AOR=2.07; 95% CL:1.3, 3.27), poor knowledge about antenatal care (AOR=2.47; 95% CL: 1.54, 3.96), advised to start ANC visits (AOR=1.87; 95% CL:1.20,2.91), decision-making power to initiate antenatal care (AOR=0.36;95% CI:0.16, 0.78) and history of still­birth (AOR=0.37; 95% CI: 0.17,0.78) were factors associated with late initiation of antenatal care. Conclusion: More than half of the pregnant women initiated antenatal care late. Those factors associated with late initiation of antenatal care visits were maternal age, employment status, decision-making power, knowledge about antenatal care, received counseling on time of antenatal care, and history of stillbirth. Therefore, the concerned body should give due attention to strengthening the promotion of health education, empowering women, and giving ap­propriate advice on pregnancy. In addition, intervention strategies aimed at reducing the late initiation of antenatal care should target on the identified factors. Keywords: Antenatal care, late initiation, pregnant women, Dire Dawa, Ethiopia