title: Factors associated with late antenatal care booking: population based observations from the 2007 Zambia demographic and health survey.
abstract: BACKGROUND
  In spite of the extreme importance of an early antenatal care visit, more than 50% of Zambian pregnant women book for antenatal care late. We aimed to determine factors associated with late antenatal care booking in Zambia.
  
  
  METHODS
  Data stem from the 2007 Zambia Demographic and Health Survey where information on socio-demographic, social-economic, obstetrical characteristics and timing of the first antenatal visit were extracted on all women aged 15 to 49 years. A weighted survey analysis using STATA version 12 was applied. Firstly, we explored proportions of ANC booking at 0-3 months, 4-5 month and 6-9 months. Secondly, we investigated the association between predictor variables and late antenatal care booking using univariate and multivariate logistic regression.
  
  
  RESULTS
  Overall (n= 3979), the proportion of late ANC booking (booking between 4th to 9th month) was 81% disaggregated as 56% and 19% at 4 to 5 months and 6 to 9 months respectively. Women who wanted their last child later were more likely to book late than those with wanted pregnancies then (AOR: 1.35 95% CI 1.10-1.66). Women with higher education were 55% less likely to book for ANC late compared to women with no education (AOR: 0.45 95%CI: 0.27-0.74). Women aged 20-34 years were 30% more likely to book earlier than women younger than 20 years (AOR: 0.69 95% CI 0.50-0.97).
  
  
  CONCLUSIONS
  We found high proportion of late ANC booking associated with presence of unplanned or unwanted pregnancies in this population. The concentration of this problem in lower or no education groups may be an illustration of existing inequalities which might further explain limitations in health promotion messages meant to mitigate this challenge. There is thus urgent need to re-pack health promotion message to specifically target this and related poor groups.
authors.affiliation: School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia; Ministry of Health, Republic of Zambia.
authors.forename: Nyambe
authors.initials: N
authors.lastname: Sinyange
authors.affiliation: School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Lungowe
authors.initials: L
authors.lastname: Sitali
authors.affiliation: School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Choolwe
authors.initials: C
authors.lastname: Jacobs
authors.affiliation: School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Patrick
authors.initials: P
authors.lastname: Musonda
authors.affiliation: School of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia.
authors.forename: Charles
authors.initials: C
authors.lastname: Michelo
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D004522:Educational Status; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D049168:Pregnancy, Unplanned / Q000523:psychology; D011275:Pregnancy, Unwanted; D011295:Prenatal Care / Q000706:statistics & numerical data*; D013997:Time Factors; D055815:Young Adult; D015024:Zambia
keywords: Antenatal care; ZDHS; booking; factors; late