1. Washington D.C., USA, 22-27 July 2012www.aids2012.org Factors associated with non-utilisation of antenatal care services by women delivering with an unbooked status at the four polyclinics in Chitungwiza. V.Makani 1, S.Rusakaniko¹,W. Chandisarewa 1, A.Mushavi², B.Makunike-Chikwinya³, A.Shetty 4 ¹Zimbabwe AIDS Prevention Project-University of Zimbabwe, Department of Community Medicine, Harare, Zimbabwe ²Ministry of Health and Child Welfare, Harare, Zimbabwe ³Elizabeth Glaser Paediatric AIDS Foundation Zimbabwe Country Office ⁴ Wake Forest University Health Sciences, North Carolina, USA

2. Washington D.C., USA, 22-27 July 2012www.aids2012.org Statement of the problem The number of women presenting in labour without prior ANC and unknown HIV status continued to increase in Chitungwiza despite: Community awareness through the ZAPP-UZ drama group National programmes on maternal and child health. Little was known regarding the factors associated with non- utilisation of antenatal care services by pregnant women Distribution of women delivering with an unbooked status at Chitungwiza municipal clinics by year

3. Washington D.C., USA, 22-27 July 2012www.aids2012.org Demographics VariableCases (N=232) % Controls (N=232) % P-value Marital status <0.01 Married21391.820789.2 Single, Divorced 198.22510.8 Parity 0.03 1 or 214462.116470.7 3 or more8837.96829.3 Employment <0.01 Employed3916.86327.2 Unemployed19383.216972.8 Median age in yrs. 25Q1:22; Q3: 29.5 0.97

4. Washington D.C., USA, 22-27 July 2012www.aids2012.org Risk Factors VariableUnbookedBookedOR 95%CI N=232% % Unaffordability of user fees Y 2510.8733.8 (1.39-10.46) N20789.222597.0 Seek TBA ANC with current pregnancy Y 6929.72711.63.2(1.16-8.85) N16370.320588.4 Religion Apostolic/Pentecostal 17173.714160.81.5 (1.22-2.68) Catholic / Protestants/Other 6126.39139.2

5. Washington D.C., USA, 22-27 July 2012www.aids2012.org Protective factors VariableUnbooked N=232 % Booked N=232 % OR 95%CI HIV test before booking Y 104.72611.20.4 (0.25-0.76) N20195.3 20688.8 Death of a child Y114.72510.80.4 (0.19-0.86) N22195.320789.2

6. Washington D.C., USA, 22-27 July 2012www.aids2012.org Multivariate Analysis on Antenatal care utilisation VariableAOR95% CI Unaffordability of ANC fees3.01.15-7.69 Religion1.81.09-2.98 Testing for HIV before pregnancy0.390.23-0.64 Received information on ANC with previous pregnancy 0.160.10-0.26 Death of a child0.40.19-0.93

7. Washington D.C., USA, 22-27 July 2012www.aids2012.org Conclusion and recommendation Cost of antenatal care services was the main reason for non utilisation of antenatal care services Municipality of Chitungwiza and Ministry of Health and child should ensure that pregnant women access antenatal care services through affordable ANC fees.

8. Washington D.C., USA, 22-27 July 2012www.aids2012.org ACKNOWLWDGEMENTS Zimbabwe Ministry of Health and Child Welfare Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) United States Agency for International Development (USAID) Chitungwiza Municipality Health Department Chitungwiza Central Hospital. Community Mobilisers and the nurses at the health institutions