title: Determinants of first trimester attendance at antenatal care clinics in the Amazon region of Peru: A case-control study.
abstract: OBJECTIVE
  To identify determinants which influence the timing of the first antenatal care (ANC) visit in pregnant women.
  
  
  METHODS
  Retrospective matched nested case-control study.
  
  
  METHODS
  Two health centres, Belén and 6 de Octubre, in the Peruvian Amazon.
  
  
  METHODS
  All pregnant women who had attended ANC during the years 2010, 2011, and 2012.
  
  
  METHODS
  All cases (819 women initiating ANC in their first trimester) were selected from ANC registries from 2010 to 2012. A random sample of controls (819 women initiating ANC in their second or third trimester) was matched 1:1 to cases on health centre and date of first ANC visit. Data were obtained from ANC registries. Conditional logistic regression analyses were performed.
  
  
  METHODS
  Case-control status of each woman determined by the gestational age at first ANC visit.
  
  
  RESULTS
  Cases had higher odds of: 1) being married or cohabiting (aOR = 1.69; 95% CI: 1.19, 2.41); 2) completing secondary school or attending post-secondary school (aOR = 1.45; 95% CI: 1.02, 2.06); 3) living in an urban environment (aOR = 1.79; 95% CI: 1.04, 3.10) and 4) having had a previous miscarriage (aOR = 1.56; 95% CI: 1.13, 2.15), compared to controls. No statistically significant difference in odds was found for parity (aOR = 1.08; 95% CI: 0.85, 1.36).
  
  
  CONCLUSIONS
  This study provides empirical evidence of determinants of first ANC attendance. These findings are crucial to the planning and timing of local interventions, like deworming, aimed at pregnant women so that they can access and benefit fully from all government-provided ANC services.
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.|Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Canada.
authors.forename: Nora
authors.initials: N
authors.lastname: Moore
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.|Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Canada.
authors.forename: Brittany
authors.initials: B
authors.lastname: Blouin
authors.affiliation: Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Canada.
authors.forename: Hugo
authors.initials: H
authors.lastname: Razuri
authors.affiliation: Asociación Civil Selva Amazónica, Iquitos, Peru.
authors.forename: Martin
authors.initials: M
authors.lastname: Casapia
authors.affiliation: Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada.|Division of Clinical Epidemiology, McGill University Health Centre, Montréal, Canada.
authors.forename: Theresa W
authors.initials: TW
authors.lastname: Gyorkos
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006801:Humans; D010298:Parity; D010342:Patient Acceptance of Health Care; D010568:Peru; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D037841:Pregnant People; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult