WOLLO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF MIDWIFERY

A STUDY TO ASSESS KNOWLEDGE, ATTITUDE AND PRACTICE

TOWARD ANTENATAL CARE UTILIZATION AMONG PREGNANT
MOTHERS IN TACH AKESTA KEBELE ,LEGAMBO
WOREDA ,SOUTH WOLLO ZONE,NORTH PART OF ETHIOPIA.

BY: -MANDEFRO ASSEFAW

AZEZEW TSEGAY

GEBRU GEBRESLASE

ZEMENE AYELGN

AMELEWORK WUBIYE

A PROPOSAL SUBMITTED TO DEPARTMENT OF MIDWIFERY IN

WOLLO UNIVERSITY FOR PARTIAL FULFILLMENT OF THE
DEGREE BACHLORE OF SCIENCE IN MIDWIFERY.

DEC, 2015 G, C

WOLLO, ETHIOPIA

i
 WOLLO UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF MIDWIFERY

A STUDY TO ASSESS OF KNOWLEDGE, ATTITUDE AND PRACTICE

TOWARD ANTENATAL CARE UTILIZATION AMONG PREGNANT
MOTHERS IN TACH AKESTA KEBELE, LEGAMBO WORDA, AND
SOUTH WOLLO NORTH PART OF ETHIOPIA.

BY: - MANDEFRO ASSEFAW

AZEZEW TSEGAY

GEBRU GEBRESLASE

ZEMENE AYELGN

AMELEWORK WUBIYE

ADVISOR:-A.INFANT RANI (MSC)

SAMSON NIGUSSIE (BSC)

A PROPOSAL SUBMITTED TO DEPARTMENT OF MIDWIFERY IN

WOLLO UNIVERSITY FOR PARTIAL FULFILLMENT OF THE
DEGREE BACHLORE OF SCIENCE IN MIDWIFERY.

DEC, 2015 G, C

WOLLO, ETHIOPIA

ii
ACKNEWLEDGEMENT

First of all we would like to express our heart full gratitude to almighty god who
helped us to accomplish this proposal successfully
.We are also extended our gratitude to the Department of Midwifery, college of
Medicine and Health Science, Wollo University for assigning advisors and giving
chance to develop this proposal.
We will like to give grateful attitude to our advisor A.InfantRani(Msc) andSamson
Nigussie (Bsc) for their unreserved guidance and constructive suggestions and
comments while we develop this research proposal.
Finally, we wish to express our gratitude and deep respect to TachAkestakebele
community and administrator who have share their view on knowledge,
attitude and practice towards ANC.

i
ACRONYMS
AIDS............Acquired Immune Deficiency Syndrome

KAP............Knowledge Attitude Practice

ii
ABBREVIATIONS

ANC…..Antenatal Care
DM……Diabetes Mellitus
HIV.......Human Immune Deficiency syndrome
HTN…..Hypertension
NIH …..National Institute of Health
MDG…...Millennium Development Goal

MMR…..Maternal Mortality Rate

U5MR….Under 5 Mortality Rate

WHO…...World Health Organization

iii
TABLE OF CONTENTS

Acknowledgments………………………………………………………………………………………………………………………..…………I
Acronyms………………………………………………………………………………………………………………………………………...…….II

Abbreviations…………………………………………………………………………………………………………………………….….………III

Table of Contents……………………………………………………………………………………………………………………………......IV

List of Tables……………………………………………………………………………………………………………………………….….…..VII

List of Figures……………………………………………………………………………………………………………………………………..VIII

Summary……………………………………………………………………………………………………………………………………….……..IX
CHAPTER ONE

Introduction …………………………………………………………………………………………………………………….………………...…1
1.1.Back ground information ………………………………………………..……………………………………….…...………..………1
1.2.Statement of the problem…………………………………………………………………………………………….………..……….2

1.3. Justification and significance of study……………………………………………………………………………..…….….…….3

CHAPTER TWO

.Literature review……………………………………………………….………………………………………………….………..……………5
.2.1. Knowledge………………………………………………………………………………………….………………………………………...5
2.2. Attitude…………………………………………………………………………………………………………………………….…………...5

2.3. Practice………………………………………………………………………………………………………………………….…….…..…...6

2.4.Conceptual frame work………………………………………………………………………………………………………….…..…..7

CHAPTER THREE

objective of thestudy…………………………………………………………………………………………………..……………………….8
3.1.General Objective……………………………………………………………………………….…………………………………….……8
3.2 . Spesfic Objectives…………………………………………………………………………………………….……….……….….….8
CHAPTER FOUR

iv
METHODS, MATERIALS AND PROCEDURE………………………………………………………………………………………………9
4.1.Study area .........................................................................................................................................9
4.2.Study period ………………………………………..…………………………………………………………………………………….…9
4..3. Study Design,………………………………………………………….……………………………………………………………….………9
4.4. Population………………………………………………………………………………………………………………………………………..9
4.4.1 Source population………………………………………………………………………………………………….………………………9

4.4.2 Study population………………………………………………………………………………………………………..…………….……9

4.5.Inclusion criteria………………………………………………………………………………………………………………………….….10

4.6.Exclusion criteria………………………………………………………………………………………………………………………….…10

4.7. sample size…………………………………………………………………………………………………….…………..…….…….…….10

4.8. Sampling technique……………………………………………………………………………………………………………………..…11

4.9.Study Variables ………………………………………………………………………………………..…………………………………….11

4.10.Data collection instrument……………………………………………………………………………………………………………12
4.11.Data collection method…………………………………………………………………………………………………………………12

4.12.Data analysis…………………………………………………………………………………………………………………………………12
4.13.Data quality control………………………………………………………………………………………………………………………12

4.14.Ethical consideration……………………………………………………………………………………………………………….......12
4, 15.Dissimination of result…………………………………………………………………………………………………………………13

4.16.Oprational definition…………………………………………………………………………………………………………………….13

CHAPTER FIVE

Work plan………………………………………………………………………………………………………………………………….…………14
CHAPTER SIX

Budget……………………………………………………………………………………………………………………………………….…………15
References……………………………………………………………………………………………………………………………………………16
ANNEX

Annex 1

List of dummy tables………………………………………………………………………….………………………………….19

v
Annex 2

English version questioner…………………………………………………………………………………………………………………22

Annex 3

Amharic version questioner………………………………………………………………………………………………………………30

vi
LIST OF TABLES

1. Table 1: budget……………………………………………………………………………………………………………………………….15

vii
LIST OF FIGURES

Fig: 1: Work plan………………………………………………………………………………………………………………………………….14

viii
SUMMARY

Introduction

Worldwide, about half a million women die every year in connection with pregnancy and
childbirth, 99% of which occurs in low and middle income countries. Antenatal care provides an
opportunity to deliver different services which are important in improving maternal survival.
However, the utilization of this service is very low even for women who have access to the
service in Ethiopia in general and in Amhara region in particular. Although socioeconomic and
some obstetric factors have been stated by few studies in other areas.ANC utilization inTach
akesta kebele is not assessed before. Therefore, study in assess the status of antenatal care
service utilization and associated factors among women in this kebele have a big value.

Objective
To assess the knowledge, attitude and practice towards antenatal care utilization among pregnant
mothers who are found in Tach akesta kebele,Wollo, Ethiopia.

Methods
Community based descriptive, cross sectional method of simple random sampling technique will
be undertaken to get a total of 179 study units of pregnant women and structured interview
administered questionnaire will be used to generate quantitative data. The descriptive statistics
will be used to describe as frequency distribution and percentage in tables and figures.
Work plan and budget:
The whole study will be conducted from February 1 to February 25,2016 G.C. And total budget
of 2857.5 Ethiopia birr is required to complete the study.

ix
 CHAPTER ONE

Introduction

1.1. Back ground information

Antenatal Care (ANC) means “care before birth”, and includes education, counseling, screening

and treatment to monitor and to promote the well-being of the mother and fetus. ANC is the care

that a woman receives during pregnancy, helps to ensure healthy outcomes for women and

newborn. It includes care during pregnancy, should begin from the early stages of pregnancy.

Women can get ANC services either by visiting a health centre where such services are available

or from health workers during their domiciliary visits (1).

One of the most important components of ANC is to offer information and advice to women

about pregnancy-related complications and possible curative measures for the early detection and

management of complications to Women of reproductive age as those who are aged 15-49 years

old (2).According to the WHO recommendation, every pregnant woman should receive at least

four ANC visits during pregnancy. The use of maternal healthcare services is important for the

early detection of mothers who are at a high risk of morbidity and mortality during pregnancy

(3).The use of ANC in developing countries is low compared to developed countries (97%)

(3).In developing countries, these problems are even more prevalent due to the current

socioeconomic conditions and inaccessibility to health facilities (4).ANC has long been

recognized as an important intervention step in preventing maternal morbidity and mortality

during pregnancy and in the post-partum period.

1
It is assumed by many maternal and child health care services providers that ANC improves the

general health condition of both mother and child during pregnancy, delivery and the puerperium

(5).

1.2. Statement of the problem

An estimated of 515,000 women die of pregnancy related causes, rate of over 1,400 maternal

deaths each year. The overwhelming majority of these deaths and complication occur in

developing countries. Effective ante natal care, appropriate emergency treatment of complication

and competent referral level encompass the most effective answers to reduction of maternal

death. The maternal mortality was estimated to be 673 deaths per 100,000 live births and infant

mortality rate was 77 per 1,000 live births, which is among the highest in the world (6).

Every minute, at least one woman dies from complications related to pregnancy or child birth

that means 529,000 women day per a year. In addition to every woman who die in child birth,

around 20 more suffer injury, infection or disease approximately 10 million women die each

year. Studies reveals that the causes of maternal mortality in developing countries is mostly

due to poor accessibility to maternal health’s services poor referral to appropriate ante natal and

delivery care unit, and in adequacies of available care. As result, each year a number of women

die due to absence of ANC support (7).Therefore, the aim of this study will be conducted to

assess the knowledge, attitude .and practice of pregnant mothers towards ANC utilization in

Tach akesta, Wollo, North part of Ethiopia.

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 1.3. JUSTIFICATION AND SIGNIFICANCE OF THE STUDY

ANC service utilization is very essential for improvement of maternal and child health, the use

of the service is still very limited in Amhara region, Akesta,Wollo Ethiopia .In Ethiopia many

mothers were not aware of the relevance of ANC due to a number of factors such as lack of

knowledge and influence of cultures and religion; hence many women and their babies were

exposed to a vast number of diseases. Therefore knowing about prevalence of women who has

good knowledge positive attitude, practice and identifying the reasons in a given society has

important contribution in addressing maternal health need of the women and child. It is hoped

that this research finding will give an insight to the necessity of ANC among pregnant women to

protect their right and prevent themselves from diseases that appears during pregnancy as well as

complication that occur after delivery in Tach akesta ANC- followers in particular and in the

country in general. It may be used as a source for other researchers.

CHAPTER TWO
3
 LITRATURE REVIEW

Maternal health comprises the health of women during pregnancy, childbirth, and the postpartum
period. Health problems during pregnancy may have serious consequences, not only for the
woman but also for her child, her family, and her community. Although motherhood is often a
positive and fulfilling experience, for too many women birth is associated with suffering, ill-
health, and even death (9).

Maternal health and health care are important determinants of neonatal survival and child health
outcomes. Therefore, improvements of maternal and child health are important global public
health goals. In the Millennium Development Goals (MDGs) formulated in 2000, members of
the United Nations are committed to reduce the under five mortality rate (U5MR) by two thirds
and the maternal mortality ratio (MMR) by three fourths during the period 1990–2015(10).

ANC is an important determinant of maternal mortality rate and one of the basic components of
maternal care, on which the lives of mothers and babies depend. WHO defines antenatal care as a
dichotomous variable with a pregnant woman having one or more visit to a trained person during
the pregnancy. Health knowledge is considered to be one of the key factors that enable women to
be aware of their right and health status in other to seek appropriate health services (11).

A study that was conducted in Tunisia to investigate mothers’ knowledge about preventive care
indicated that 95% of women knew the importance of antenatal examination, but this study did
not report the extent of availability and utilization of antenatal services .In Sub-Saharan Africa,
72% of pregnant women received antenatal care visit one or more times and 68% in South East
Asia. Less than one third of pregnant women received antenatal care in Pakistan. Only 64% of
pregnant women in Nigeria received antenatal care from a qualified health care provider while
37% of the deliveries take place in health institutions and 57% of deliveries take place at home.
A regional disparity also exist as 28% of women in the Northwest zone and 54% in the Northeast
zone of Nigeria received antenatal care from trained health professionals (12).

The proportion of births that occur at home remains high in Ethiopia, and skilled health
professionals attend very few births. The proportion of births attended by a skilled health
professional and delivered in a health facility has remained around 6 percent over the past five
years (13).

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2.1. Knowledge

Understanding of ANC is vital to the health of pregnant women. Most people do not have
awareness about ANC follow-up which is prominent to keep a pregnant woman full informed on
the progress of her pregnancy and to provide her with information and support to make informed
decision. Historically relatively few women had been involved in recognition of the importance
of ANC care. The U.S national institute of health (NIH) has out lined the recognition of women
about ANC. Medical disorders during pregnancy such as HTN, renal disease, cardiac disease;
DM, hematologic and infectious disease etc are not effectively recognized by every individual.
Knowledge of ANC is still low in the world with only 20% of the population knowing where to
source (14).

There was a low utilization of ANC service and lack of appropriate knowledge about the benefits
of ANC service. Place of residence, educational status, possessing radio, income and knowledge
of ANC were identified as factors associated with ANC service utilization. Place of residence
was found to affect ANC service use where being from urban setting increased ANC use by
about 1.5 times. Subjects‟ education and husband’s education of secondary school and above
increased ANC use by more than 6 and 1.5 times, respectively .which was similar with the other
study done in southern Ethiopia (15).In study done in metekel zone, Northwest Ethiopia
among the socio-demographic factors being in urban residence, possessing radio, and
educational status of secondary school and above were more than four time two times and
three times likely knowledgeable about ANC (16).

2.2. Attitude

Attitude is state of readiness or tendency to respond in certain manner when

confronted with certain stimuli, is mostly dormant and is expressed in speech or
behavior only when the object or situation is encountered. It is a person’s affective
feeling of like and dislikes antenatal care service (17).

A number of studies have been carried out in different parts of the world with different cultures
and religious groups to assess the utilization of ANC follow-up. In1997 review of studies on 40

5
different countries conducted by WHO found that 80 to 96% of ANC followers rated the
importance of ANC. This study observed that there are both negative and positive thoughts that
exist among the communities towards ANC support follow-up. Most of the negative thoughts are
as the result of myths and misconception they have hard. This was true of rural dwellers (18).

According to bthe study conducted in Nigeria attitude of pregnant womens to wards antenatal
care services was positive. It reveals attitude of pregnant women with secondary schhol and
teritiary education was positive while pregnant women with no formal education and primery
educations were negative respectively(3).

2.3. Practice

The life time risk for sub-Saharan Africa from pregnancy related causes is about 1 in 16 which is
more than 500 times higher than for northern Europe (19).

Evidences showed that in developed countries most pregnant women (73%) attend their first
ANC visit earlier. However nine of ten (91%) pregnant women do not come early for ANC visit
in Africa (20).

Similarly in Ethiopia many study indicated that most pregnant women who attend ANC come
too late for their first ANC visit ranges from 40 to 60 %(21).

The level of usage of ANC follow-up in the communities is represented by respondents. This
depends on whether people in the communities practice ANC and if they do not, what could be
the possible reasons. There were varying responses to questions with some agreeing that people
in their area use ANC while others indicating that ANC are not conducted in their areas.
However respondents said that people in their areas utilize ANC, they further explained that very
few women in the area follow ANC on the basis that they are not readily available, myths and
misconception, lack of awareness and orientation on the use of ANC (18).

Based on EDHS 2011 report, in Ethiopia the maternal mortality rates have been estimated to be
676 per 100000 live births. Because based on this data the ante natal care coverage of Ethiopia
was 43%.Regular ante natal visit can provide some benefits for the women such as care

6
provider that can result in reducing complication during pregnancy the absence of this activity
affects million of mothers in rural as well as urban areas.

2.4. Conceptual frame work

Based on the literature review done in Ethiopia and other part of the world knowledge, attitude
and practice of women towards antenatal care use can be affected by socio-demographic
characteristics, socio-economic information, media exposure, educational status and others.
Therefore we develop and modify our questioner based on the literature review of different study
conducted in different part of the world and Ethiopia.

CHAPTER THREE

7
 OBJECTIVE OF THE STUDY
3.1. General objective
A study to assess the knowledge, attitude and practice towards Antenatal Care utilization among
pregnant women’s in Tach akesta Keble, south Wollo Ethiopia

3.2 .Specific Objective

 To determine the knowledge about ANC care follow-up among pregnant mothers at Tach
akesta kebele.
 To describe their attitudes towards ANC follow-up
 To determine the level of practice among these individuals

CHAPTER FOUR

METHODS, MATERIALS AND PROCEDURE

8
 4.1. Study area
Tach akesta kebele which Is found in leg ambo woreda, in south Wollo, 580
km far from Bihar dare the capital city of Amhara region and 100km far from
Dessie capital city of south wollo zone. Which is located with elevation of
2000m above sea level? It is surrounded by Temu from north, Tikise from
south, Dechaye and akesta town from east and Gole from west. The total
population lives in Legambo woreda are 165026 among this 83268 are women
and 81268 are men (the data obtained from centeral stastical agencies of 1999
E.C census). From the data obtained from the above source legambo woreda
has 35 Keble of this Tach akesta is one and represent by 029 kebele.4566 of
total population lives in Tach akesta among these 2301 male and 2261 are
females, but in this year the total number of pregnant women found within the
kebele are 209 (the data obtained from health extension workers found in the
kebele).Generally in akesta 86.3 % Muslim, 13.4 orthodox and 0.3% others
lived in the kebele.

4.2. Study period

This study will be conducted from February 1 up to February 15, 2008

E, C.

4.3 .Study Design

Community based Descriptive cross sectional study will be applied for this
study.

4.4. Population
4.4.1. Source population
The population source is Tach akesta kebele and all pregnant mothers found in
the area.
4.4.2. Study population.
The study population will include all sampled pregnant women who are found
in the area during the study period.

9
4.5. Inclusion criteria
Pregnant women these found in the study area

4.6. Exclusion criteria

 Women’s these are not pregnancy,

 Pregnant women’s these are with mental disable critical patient and these not found
in the area during study period.

4.7. Sample size

Sample size calculation:-

The sample size is determined by single proportion formula

N= =(1.96)2*0.5(1-0.5)/(0.05)2=384.16

Where:

n = No of sample that will be included

132Z = Standard normal distribution

α/2 = level of significance

P= population proportion

d= maximum acceptable difference

n= 384.16

Therefore in the area our study population is pregnant women

these are 279 pregnant mothers in Tach akesta kebele. The

10
 population is less than 10,000 so we make population
correction:-

nf=n1/1+n1/
N=384.16/1+384.16/279=384.16/2.38=161.34=162

nf=total sample after population correction

n1=no of samples obtained from population proportion

N=target population that the sample drawn so these are pregnant

women in Tach akesta Keble equal to 279

Adding with non respondent rate (10%) =17 is we will have a

sample size of Adding with non respondent rate (10%) is we will
have a sample size of =179.

4.8. sampling technique

Simple random sampling method will be used to select study unit (pregnant
woman).the sampling frame is the list of all pregnant women’s found in the
Keble. This will be obtained from Keble health extensions workers. And the
sample is selected randomly from the list of sampling units by lottery method
to interview 179 pregnant women and collect the relevant information.

4.9. Study Variables

 Knowledge
 Attitude
 Practice
 Age
 Sex Marital status

11
  Religion
 Educational level
 Income
 profession
 Access
 Availability

4.10. Data collection instrument

The data will be collected by interview administered structured questioner after

the sample is already selected. The questioner developed and modified based
on the conceptual frameworks of other study conducted through the world and
Ethiopia that is obtained from literature review. And the questioner is prepared
originally in English version and translated to Amharic version also it contains
4 components knowledge, attitude, practice and reasons of poor practicing.

4.11. Data collection method

All five members will be involved in data collection. And data collectors will be
oriented about how to collect both qualitative and quantitative data. The data
will be collected by face to face interview. Generally to collect the relevant data
about knowledge, attitude and practice towards ANC utilization among
pregnant mothers structured interview administered questioner will be used.

4.12. Data analysis

The findings of this study will be analyses and presented using percentages
and appropriate tables and figures.

4.13. Data quality control

Questionnaire is prepared in English version and translated to Amharic version
and it will be assessed before data collection for its accuracy and completeness.
If there will be a problem in the questioner additional correction will be done.
And the data will be checked every day for completeness and accuracy before
data processing.

12
4.14. Ethical consideration
Ethical clearance will be obtained from the department of Midwifery College of
medicine and health science in Wollo University of ethical review committee.
Permission will be obtained from Tach akesta Keble administrator. And informed consent
will be obtained from the individual respondent those are included in the study. This permission
and consent may be arranged by organizing meeting in addition to ethical consideration will be
approved by the department of midwifery in Wollo university.

4.15. Dissemination of the result of study

After the study will be completed the result of the study will be submitted to
department of midwifery in Wollo University College of medicine and health
science, school of nursing and midwifery. The result of the study also will be
given to administrator of Tach akesta Keble.

4.16. Operational definitions

Cross-sectional study: The studies design that information about the status of
an individual with respect to and the presence or absence of exposure is
assessed at a point in time. It is also mean that the study of the prevalence of
chronic or acute conditions in health

Level of knowledge: the measure of the women’s knowledge on what, when,

why and how to follow ANC.

Attitude about ANC: person’s feelings toward ANC.

Practice of ANC follow-up: is the person’s level of utilization of ANC.

Antenatal: This relates to the medical care given to pregnant women before
child birth.

Attitude: The opinion, thinking or feeling of pregnant women and the way they
behave towards the antenatal care.

13
Pregnancy: The state of carrying an unborn offspring in the uterus.

14
 CHAPTER FIVE

Work plan

No Activity Responsible Month

person

Nov Dec Jan Feb Mar Apr May

1 Topic PI+Advi
preparation
and selection
2 Proposal PI+Advi
preparation
3 Submission of PI
proposal to
department
and advisor

4 Data PI
collection

5 Data PI
checking and
coding

6 Data PI+Advi
analysis ,
writing and
interpretation
7 Result PI
presentation,
submission
and
dissemination

Fig 1 category of works and responsible person in specific period of time

PI……………………principal investigator Advi…………………advisor

15
 CHAPTER SIX

Budget

No Budget category Unit cost Multiplying Total

factor cost(birr)

Personnel Daily cost per Number of

individual× staff days(no.
working day of staff×
no. of total
cost per
individual
1 Principal investigator(4) 50×5=250 4×250=1000 1000
2 Super visor(1) 100×1=100 2×100=200 200
Subtotal Total 1200
personnel
Supplies Cost per item Number of Total cost
item/pages
1 Duplication of questioner 2 birr/peg 425 peg 850 birr
2 Pens 4 birr/pen 5 20 birr
3 Pencils 1 birr/pencil 5 5 birr
4 Eraser 1birr/eraser 6 6 birr
5 Sharper 1 5 5 birr
birr/sharper
6 Photo copy 50 cent/peg 1543 peg 771.5 birr
Total 1657.5 birr
Grand total 2857.5 birr
Table 1 budget of the study

By adding contingency budget that is 10% of grand total therefore the total
budget will be used to the study is equal to 3143.25 birr.

16
References

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Missed
Opportunities- An analysis of trend, Levels and Diffrentials, 1990-
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WHO: Geneva. 2003.
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17
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health
survey.2010.availableat.https://www.globalhealthaction.net/index.php/
gha/article/view/28082.
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hbreif-FANC.perf.accessed.4-4-2014.
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17. Isaac B, Charles M, Alice H.Factors Associated with late Ante natal care
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18. Phoxa C,Okumura J,Nakamura Y,Wakayi S.influence of womens

knewledge on maternal health utilization in southern laos .Asia pac
Journal public health 2001.13:13-19.

19. Carl A, Tessa W, Blank A,Van P.etal.ANC in developing

countries :promises,achivements and miss opportunities.An analysis of
trends,levels and differentials.1990-2001.WHO Geneva;2003.

20. Phoya A, Kang oma S.Factors influencing womens choice of place of

delivery in rular malawi-An explorative study:African journal of
reproductive health.2006;10(3).

21. Tariku A, Melkamu Y,Kebede Z.Previous utilization of service does not

improve timely booking in ante natal care :cross sectional study on timing
of ante natal care booking at public health fascilities in Addis
Ababa:Ethiop j.Health dev.2010;24(3);226-233.

22. Orc M,etal;Ethiopia demographic and heaith survey Addis ababa ,Ethiopia
and USA:CSA,2011:

19
Annex I:
Dummy tables of demographic data, knowledge, attitude and practice

Table: 1 socio demographic characteristic of pregnant women respondents in

South Wollo zone, Tach akesta Keble from February 1 to February15, 2016G.C.

N Variables Frequencies(no) %
o
1 Age
15-19
20-24
25-29
30-34
35-39
40-44
45-49
Total
2 Ethnicity
Oromo
Amhara
Tigre
Kefa
Others
Total
3 Religion
Muslim
Orthodox
Protestant
Others
Total
4 Occupation
Households
Government employees
Merchants
Students
Farmers
Others(unemployed)
Total
5 Educational status
Primary(1-8)
Secondary(9-12)
Diplomas’
University

20
 Total
6 Marital status
Married
Single
Divorced
Widowed
Total

Table-2 Knowledge of respondent pregnant mothers towards ANC utilization in

South Wollo Zone, Tach akesta Keble, from February 1 to February15, 2016
G.C.

No Variables Frequencies(no) %
1 Good knowledge
2 Poor knowledge
Total
Table-3 Attitude of respondents towards ANC in South Wollo Zone, Tach akesta
kebele from February 1 to February 15, 2016 G.C.

No Variables Frequencies(no) %
1 Favorable
2 Unfavorable
3 Neutral
4 Total

Table-4 Practice of ANC among respondent pregnant women in South Wollo

zone, Tach akesta Keble from January 25 to February15, 2016 G.C.

No Variables Frequencies(no) %
1 Yes
2 No
Total

21
Table – 5 Reason of poor ANC practice among respondent pregnant women of
South Wollo Zone, Tach akesta Kebele from January 25 to February 15, 2016
G.C.

No Variables Frequencies(no) %
1 Influence of community
2 Influence of religion
3 Influence of families and friends
4 Lack of awareness
5 Inaccessibility of health center
near your locality
6 Shortage of money
7 Others
Total

Annex II
22
English version of the questionnaire

WOLLOUNIVERSITY
COLLEGE OF MEDICINE AND HEALTH SCIENCEs
SCHOOL OF NURSING AND MIDWIFERY

DEPARTMENT OF MIDWIFERY

Questionnaires on assessment of knowledge, attitude and practice of pregnant

women towards antenatal care in Tach akesta Kebele, Leg ambo, Wollo
Ethiopia.

Instruction

Dear data collector, the respondent name will not be written on this form and
no individual response will be reported to anybody. Hence, their answers are
completely confidential; they can refuse all or some question to answer. If they
are cooperative to responding to the question it means they have their own
contribution to the success of this answer. You are kindly requested to fill the
questionnaires individuality and confidentiality without any modification of
behavior your name is not regarded. If there is any problem in the
understanding of the question any mother can ask data collectors to clarify for
them. Write the correct answer of respondents by mark “ X” inside the box
found in front of the alternative of the question. And write the respondents
answer in the given space after the respondents willing to answer by consent
form.

CONSENT FORM

This respondent consent form is uses to assess knowledge, attitude and

practice of pregnant women’s towards ante natal care utilization.

23
Introduction, My name is.....................................................I come from Wollo
university 4th year midwifery students of this research team member. We want
to do our graduation research about knowledge, attitudes and practices of
pregnant women towards ANC utilization. The purpose of this study is to
assess the level of knowledge, attitude and practice of pregnant mothers
towards the utilization of ANC in this Keble. I, am going to ask you some
questions that are not difficult to answer. I assure you your response is kept
confidentially. You are not required to write your name. You are kindly
requested to respond the questions; therefore your honest answers are
important to this study and used for future planning and health service. The
study team members will appreciate your help in responding to this survey
questions. The interview will may take about 20 minutes,

Are you willing to respond to the questions below? Yes____________

No_______________

I Socio-demographic characteristics

1. Age (years)

2. Monthly income ___________(birr)

3. Marital status:

24
A. Married  C. Widow 

D. Divorced
B. Single

4. If you are married what is the

educational status of your
husband?

A. Illiterate  C. Secondary (9-12) 

B. Elementary(1- D. College diploma 
8)
E. University and above 

5. Your educational status:

A. Illiterate  C. Secondary (9-12) 

B. Elementary(1-8) D. College diploma 
E. University and above

6. Do you watches TV?

A. Yes  B. No 
7. If yes for how many time you watching TV?:
A. Once per week  C. At least once a

B. Less than once a week

week D. Daily 
8. .Which program you watched?
A. Related with health  B. Drama only C. sport D. Other
programsE .all 
9. Occupation:

B. Farmer 
A. Merchant 
25
 C. Government D. Self employed
E. Other(specify)_______
employed

10. Religion:
A. Orthodox B. Muslim 
A. Protestant  C. Other (Specify)

11. Ethnicity:

A. Amhara  E. Kefa  F.

B. Tigre  Others(specify) --------

C. Oromo 
D. Gurage 

12. Residence: A. Urban  B. Rural 

II.Knowledge of ANC
1. Have you ever heard about ANC?
A. Yes  B. No 
2. If your response for (1) is “yes” where did you get the information?

A. friends  D.Media
B. health center  E. other (specify)
C. health extension __________
workers

3. Do you think ANC is important?

A. Yes B. No 
4. For (4), if your answer is “yes”, what are the benefits you get? (you can
choose more than once)
A. prevent disease transmission to the fetus 

26
 B. protect the mother from Medical disorders 
C. reduce the cost of medication 
D. any other (specify)_______________________
5. Do you have knowledge about ANC

A. Yes B. No

6. Did you know the dangers signs during pregnancy?

A. Yes  B. No

7. If your answer for question is yes what are they?

A. Headache  B. Vision problem  C. Fever D. convulsion E.

anemia F. abdominal discomfort G.  .All

8. Did you plan where you will deliver?

A. Yes  B. No 

9. If yes where you deliver?

A. In health institutions B .In home C. Others specify……………..

10. Did you know the times at least the pregnant mother visits the clinic?

A. Yes  B. No

11. If yes for how many times?

A. Two times  B. Three times  C. .Four times D. .Five times

12. Are you prepared yours self for delivery?

A. Yes  B. No

27
13. If yes what you fulfill

A. Delivery place  B.phone no of health profession  C.for different

expenditures’ money  D. family who support during delivery E.

Different material for baby  F. All

III Attitude towards ANC

1.ANC services should be available everywhere is good for pregnant women

A. Strongly disagree 

. Disagree  C. Neutral D. Agree  E. Strongly agree

2. Antenatal care is supportive care for pregnant women’s and fetuses

A. Strongly disagree  B. Disagree

C. Neutral D. Agree E. strongly

agree

3. Utilization of ANC services is appropriate and fairly distributed in this area

used as to follow ANC easily .
A. Strongly disagree  B. Disagree  C. Neutral

D. Agree E. Strongly agree 

4. Pregnant women have a strong belief towards ANC?
A. Strongly disagree  B. Disagree C. Neutral  D. Agree  E.

strongly agree

5. Early ANC checking is important during pregnancy.

28
 A. strongly disagree  B.Disagree C.Neutral

D. Agree  E. strongly agree 

6. Preparation for deliver during ANC follow up is important for all pregnant
women.

A. Strongly disagree B. Disagree  C. Neutral 

D. Agree  E.Strongly agree 

7. Checking blood pressure during ANC follow up for every pregnant women is
important.

A. Strongly disagree  B. Disagree  C. Neutral 

D. Agree  E. Strongly disagree 

8. At least four ANC follow up is good to monitor mothers and fetuses health
condition during pregnancy.

A. Strongly disagree  B. Disagree  C. Neutral 

D. Agree E. strongly agree 

9. Ante natal care during late pregnancy is very necessary.

A. Strongly disagree  B. Disagree C. Neutral 

D. Agree  E.Strongly agree 

10. Early checking of fetal wellbeing by ultrasound during pregnancy is

necessary.

A. Strongly disagree  B. Disagree  C. Neutral 

D. Agree  E. Strongly disagree 

29
Practice of ANC
1. Have you ever followed ANC?
A. Yes  B. No
2. If your response for (1) is “yes”, do you get any benefit from it?
A. Yes  B. No
3. If your answer is for (2) is “yes”, what do you think the benefits are?
A. better mother health  B. better child health 
C. other (specify)
4. What do you think the drawbacks of utilization of ANC are?

A. Infection  B. discomfort C. Depression

D. Other (specify)

5. Do you know other people these are a model in practice of ANC?

A. Yes B. No

V. Reasons affecting the utilization of ANC

1. Did you follow ANC? A. Yes  B. No

2. If your response for (1) is “No”, what is your possible reason? (You can
choose more than once)
A. Inaccessibility of health centers near your locality

B. lack of awareness

C. Shortage of money 
D. Influence of religion

E. Personal discomfort
F. Influence of husband and other family members
Other

Thank you for your contribution

30
Name of collector……………………………Date………………signature……………

ANNEX III

ወሎ ዩኒቨርስቲ የህክምናና ጤናሳይንስ ፋካልቲ

የሚድዋይፈሪ ትምህርት ክፍል

የአማረኛ ጥያቄዎች ዝርዝር

የሚስጥር አጠባበቅ ስምምነት

መግቢያ

ስሜ-------------------------እባላለሁⵆየመጠሁት ከወሎ ዩኒቨርስቲ አራተኛ አመት የሚድዋይፈሪ

ትምህርት ክፍል የዚህ ጥናት ቡድን አባል ስሆን እናቶች በቅድመ ወሊድ ክትትል ያላቸውን
ግንዛቤ፣አመለካከት እና ትግበራ ዙሪያ የመመረቂያ ጽሁፋችን ለመስራት ሲሆን የዚህ ጥናት ዋና አላማም
እናቶች የቅድመ ወሊድ ክትትል ባለማድረግ በነሱ እና በልጆቻቸዉ የሚገጥማቸዉን የጤና ችግር ለማወቅ
እና ለመከላክል ታስቦ የሚሰራ ሲሆን በጥናቱ የእርስዎ ተሳትፎ ትልቁን ድርሻ ይይዛልⵆስለዚህ ጥናቱን
መሰረት በማድረግ ጥያቄዎችን ልንጥይቀዎት ሲሆን ፍቃደኛነተዎትን ለማዎቅ ነውⵆመልስ በሚሰጡ ስአት
ስመዎን መናገር አያስፈልግም፣ለሚሰጡት መልስ ሚስጥረዎ የተጠበቀ ሲሆን ጥያቄዎቹም ቢበዛ 20 ደቊቃ
ይወስዳሉⵆመልስ ለመስጠት ፍቃደኛ ከሆኑ ወደ ጥያቄየ በቀጥታ እገባለውⵆ

መልስ ለመስጠት ፍቃደኛ ነዎት? ሀ. አዎ ለ. አይደለዉም

ክፍል 1 ፡ከማህበራዊ ሁኔታዋች ጋር የተያያዙ ጥያቄዋች

1.ዕድሜ /በአመት: -----------------------------

31
2 . የጋብቻ ሁኔታ : ሀ ） ያላገባች  ለ . ያገባች  ሐ . የተፋታች  መ . የትዳረ
አጋ ሯ የሞተባት 

3. የርሰዎ የትምህርት ደረጃ : ሀ . ያልተማረች  ለ . 1-8 ኛ  ሐ .9-12 ኛ 

መ . ዲፕሎማ  ሠ . ዲግሪ እና ከዚያ በላይ 

4. ያገቡ ክሆነ የባለቤትዎ የትምህርት ደረጃ : ሀ . ያልተማረ  ለ . 1-8 ኛ 

ሐ .9-12  መ . ዲፕሎማ  ሠ . ዲግሪ እና ከዚያ በላይ 

5. ሀይማኖት : ሀ . ኦርቶዶክስ  ለ . ሙስሊም  ሐ . ፕሮቴስታንት 

ሠ . ሌላ ካለ ይግለፅ ----------------

6. ብሄር ሀ . አማረ  ለ . ኦሮሞ  ሐ . ትግራይ  መ . ጉራጌ

 ሠ . ከፋ  ረ ሌላ -------

7. ነዋሪነት : ሀ . ከተማ  ለ . ገጠር 

8. ስራ : ሀ . ተማሪ  ለ . ነጋዴ  ሐ . የቤትእመቤት 

መ . ሌላ --------

10. ቴሌቪዝንተከታትለውያውቃሉ

ሀ . አዎ  ለ . አላውቅም 

11. መል ሱ አዎ ከሆነ ለስንት ጊዜ ሀ . በየቀኑ  ለ . በሳምንት አንድ ጊዜ  ሐ . በወር

አንድ ጊዜ

12. መል ሱ እከታተላለው ከሆነ የትኛውን ፕሮገራም ሀ . ጤና ነክ ፕሮግራም  ለ . ድራማ

 ሐ . ስፖርት  መ . ሌሎች ልዩልዩ ፕሮግራሞች  ሠ . ሁሉም 

ክፍል 2 ፡ስለአገልገሉቱ ያላቸው ዕውቀት

1. ስለቅድመ ወሊድና እረግዝና ክትትል አገልገሎት ሰምተው ያውቃሉ ?

ሀ . አዎ  ለ . አላውቅም 

2. ለ 1 ኛ ጥያቄ መልሰ ዎ አ ዎ ከሆነ የሰሙት ;?

ሀ . ከጉደኛ  ለ . ከጤና ተቀም 

32
 ሐ . ከሚዲያ  መ . ከሌላ ----------------

3. የእርግዝና ክትትል መች ጀመሩ ? ሀ . በሶስተኛ ወሬ 

ለ . በአራተኛ ወሬ  ሐ . በአምስተኛ ወሬ 
4. በእረግዝና ጊዜ ሊከሰቱ የሚችሉ አደገኛ ምልክቶችን ያውቃሉ ?

ሀ . አዎ  ለ . አላውቅም 

5. አራተኛዉ ጥያቄ መልስዎ አዎ ከሆነ ምንምን ናቸው ?

ሀ . ከፍተኛ ራስ ምታት  ለ . ትኩሳትና የአይን ብዝታ 

ሐ . በማህጸን ደምመፍሰስ  መ . የፅንሱ እንቅስቃሴ መቀነስ 
ሠ . ምጥ ከጊዜው ቀድሞ መምጣት  ረ . ከፍትኛየሆድህመም፣ራስንመሳት፤መጨነቅ 
ሰ . ሁሉም 

6. የት መውልድ እንዳለበውት ያውቃሉ ? ሀ . አዎ  ለ . አላውቅም 

7. ለ 6 ኛዉ ጥያቄ መልሰዎ አዎ ከሆነ የት ? ሀ . ጤና ተቋም  ለ . ከቤቴ 

ሐ . ሌላ --------

8. አንድ እናት በእርግዝና ወቅት ቢያንስ ስንት ጊዜ ወደ ጤና ጣቢያ መሄድ እነዳለባት

ያውቃሉ ? ሀ . አዎ  ለ . አላውቅም 

9. አዎ ከሆነ ስንት ጊዜ ሀ . አንድ ጊዜ  ለ . ሁለት ጊዜ 

ሐ . ሶስት ጊዜ  መ . አራት ጊዜ 

10. ለመውለድ በቂ ዝግጅት አድርገውአል ? ሀ . አዎ  ለ . የለም አላድርኩም 

11. ተራ ቁጥር 10 አዎ ከሆነ ምን ? ሀ . የወሊድ ቦታ  ለ . የሰለጠነ ባለሙያ
ስልክ  ሐ . ለትራንስፖረት ምቹ ቦታ  መ . ለልዩ ልዩ ወጭወች ገንዘብ

ሠ . ደጋፊ ቤተሰብ  ረ . ለህፃኑ የሚያስፈልጉ ነገሮች  ሰ . ሁሉም 

12. የእርግዝና ክትትል አገልግሎት ይጠቅመኛል ብለውያምናሉ ?

ሀ . አዎ  ለ . አላምንም 
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13. ለአስራ ሁለተኛው ጥያቄ መልሰወ አዎ ከሆነ ጥቅሞቹ ምንድን ናቸው ?

ሀ . የፅንሱን ጤንነት በመጠበቅ  ለ . የህክምና ወጭን ለመቀነስ 

ሐ . ራሴን ከበሽታ ለመከላከል  መ . ሁሉም  ረ . ሌላ ––––––––

ክፍል 3. ስለ አገልግሎቱ ያላቸው አመለካከት

1. የዕረግዠና ክትትል መስጫ ጣቢያዋች በየቦታው ቢገኙ ጥሩ ነውⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . አልስማማም  ሠ . በጣም እስማማለዉ

2,ቅድመ ወሊድ ክትትል ማድረግ ለእናትም ሆነ ለህፃኑ ጥቅም አለዉ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 
3. የቅድመ ክትትል ተቋም በቅርብ መኖር ለክትትል ያመቻልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 
4. ቅድመ ወሊድ ክትትል በሚሰጠዉ ጥቅም ጠንካራ እምነት አለኝⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 
5. እርግዝና እንደተክሰተ ወዲያሁኑ ክትትል ማድረግ ያስፈልጋልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 
6.በቅድመ ወሊድ እርግዝና ክትትል ለመዉለድ መዘጋጀት ለእናትም ሆነ ለህጻኑ አስፈላጊ ነዉⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 

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7.ነፍሰ ጡር እናቶች በእርግዝና ስአት የደም ግፊታቸዉን መለካት ይኖርባቸዋልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 
8. ነፍሰ ጡር እናት ቢያንስ አራት ጊዜ ከትትል ማድረግ ይኖርባቸዋልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 

9. ነፍሰ ጡር እናቶች የመዉለጃ ስአታቸዉ ሲደርስ ወደ ቅድመ ወሊድ ቦታ ለክትትል መሄድ

ይኖርባቸዋልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 

10.በቅድመ ወሊድ ክትትል ስአት ነፍሰ ጡር እናት ቢያንስ አንድ ጊዜ አልትራሳወንድ ማድረግ ይኖርባታልⵆ

ሀ . በጣም አልስማማም  ለ . አልስማማም 

ሐ . ከሁሉም አይደለዉም  መ . እስማማለዉ  ሠ . በጣም እስማማለዉ 

ክፍል 4 . አ ገልግሎቱን ተግባራዊ ስለማድረግ

1. ከዚህ በፊት የእርግዝና ክትትል አድርገዉ ያዉቃሉ ?

ሀ . አዎ  ለ . የለም 

2. ለ 1 ኛው ጥያቄ መልስዎ አዎ ከሆነ ተጠቃሚ ሁነዎል ?

ሀ . አዎ  ለ . የለም 

3. ለ 2 ኛው ጥያቄ መልስዎ አዎ ከሆነ ያገኙት ጥቅም ምንድን ነው ?

ሀ . የእርስዎ ጤና  ለ . የልጅዎ ጤና 

ሐ . ሌላ ካለ ይቀጥሉ --------------

4. የቅድመ ወሊድ ክትትል ተጠቃሚ በመሆነዎ የደረሰበዋት ችግር አለ ?

ሀ . በበሽታ መበከል  ለ . ምቶት ማጣት  ሐ . ሌላ ካለ ይጠቀስ --------

35
ክፍል 5. የአገልግሎት ተጠቃሚ እንዳይሆኑ የማያደርጉ ምክንያ ቶ 1

1. ከዚህ በፊት አገልግሎት ተጠቃሚ ሁነው ያውቃሉ ?

ሀ . አዎ  ለ . የለም 
2. ለተራ ቁጥር አንድ መልስዎ የለም ከሆነ ምክንያተዎ ምንድን ነው ?

ሀ . በአካባቢው የጤና ጠቋም አለመኖር  ለ . የእውቀት ወይም የግንዛቤ ማነስ 

ሐ . የዕምነት ተፅኖ  መ . የቤተሰብና የአካባቢ ተፅኖ 

ሠ . የገንዘብ ተፅኖ  ረ . ሌላካለ ይጠቀስ ---------------

ለአደረጉልኝ ቀና ትብብር አናመሰግናለን

ዳታውን የሰበሰበው ስም ------------------------- ቀን -------------

ፊርማ -------------------

እናመሰግናለን

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