title: Health and nutrition knowledge, attitudes and practices of pregnant women attending and not-attending ANC clinics in Western Kenya: a cross-sectional analysis.
abstract: BACKGROUND
  Antenatal care (ANC) is a key strategy to decreasing maternal mortality in low-resource settings. ANC clinics provide resources to improve nutrition and health knowledge and promote preventive health practices. We sought to compare the knowledge, attitude and practices (KAP) among women seeking and not-seeking ANC in rural Kenya.
  
  
  METHODS
  Data from a community-based cross-sectional survey conducted in Western Province, Kenya were used. Nutrition knowledge (NKS), health knowledge (HKS), attitude score (AS), and dietary diversity score (DDS) were constructed indices. χ2 test and Student's t-test were used to compare proportions and means, respectively, to assess the difference in KAP among pregnant women attending and not-attending ANC clinics. Multiple regression analyses were used to assess the impact of the number of ANC visits (none, <4, ≥4) on knowledge and practice scores, adjusting for maternal socio-demographic confounders, such as age, gestational age, education level and household wealth index.
  
  
  RESULTS
  Among the 979 pregnant women in the survey, 59% had attended ANC clinics while 39% had not. The mean (±SD) NKS was 4.6 (1.9) out of 11, HKS was 6.2 (1.7) out of 12, DDS was 4.9 (1.4) out of 12, and AS was 7.4 (2.2) out of 10. Nutrition knowledge, attitudes, and DDS were not significantly different between ANC clinic attending and non-attending women. Among women who attended ANC clinics, 82.6% received malaria and/or antihelmintic treatment, compared to 29.6% of ANC clinic non-attendees. Higher number of ANC clinic visits and higher maternal education level were significantly positively associated with maternal health knowledge.
  
  
  CONCLUSIONS
  Substantial opportunities exist for antenatal KAP improvement among women in Western Kenya, some of which could occur with greater ANC attendance. Further research is needed to understand multi-level factors that may affect maternal knowledge and practices.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto, Ontario, Canada. nandita.perumal@utoronto.ca
authors.forename: Nandita
authors.initials: N
authors.lastname: Perumal
authors.forename: Donald C
authors.initials: DC
authors.lastname: Cole
authors.forename: Hermann Z
authors.initials: HZ
authors.lastname: Ouédraogo
authors.forename: Kirimi
authors.initials: K
authors.lastname: Sindi
authors.forename: Cornelia
authors.initials: C
authors.lastname: Loechl
authors.forename: Jan
authors.initials: J
authors.lastname: Low
authors.forename: Carol
authors.initials: C
authors.lastname: Levin
authors.forename: Christine
authors.initials: C
authors.lastname: Kiria
authors.forename: Jaameeta
authors.initials: J
authors.lastname: Kurji
authors.forename: Mary
authors.initials: M
authors.lastname: Oyunga
mesh_terms: D000328:Adult; D000871:Anthelmintics / Q000008:administration & dosage; D000962:Antimalarials / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D004032:Diet; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007630:Kenya; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009819:Office Visits; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D011247:Pregnancy; D011295:Prenatal Care; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000871:Anthelmintics; D000962:Antimalarials