Characteristics of study participants
We received a 100% response rate. All 98 participants recruited from four public health facilities gave their responses: Eenhana clinic 28.4% (n = 29), Engela clinic 33.3% (n = 34), Odibo Health Centre 18.6% (n = 19) and Ongha Health Centre 15.7% (n = 16). Rural settings were 95% (n = 93) and urban settings were 5% (n = 5). The demographic was all 98 participants were women. Of the age range, 37% (36) were from 15 to 17 years old and 63% (62) were from 18 to 19 years old. In our sample, 25.5% (n = 25) of the participants had to cover a distance of over 15 km to access the health facility. More than half of the sample 57% (n = 56) attended junior secondary education. Over half of the respondents, 93% (n = 95), were not working.Those who are not working depends heavily on their parents.The majority 96% of the participants were single while one percent was married and widowed respectily and two percent were co-habiting. The demographic data is illustrated in Tables 2 and 3.
Clinical data
The trimester began at first ANC visit
There was no association between distance to the nearest health facility P > 0.210 and the trimester began at first ANC visit. Overall, 27.6% (n = 27) of the sample reported they were in their first (0-3 months) trimester when they started their first ANC, this is in line with WHO recommendations. A majority, 64% (n = 63), reported that they started their ANC in their 2nd trimester (4-6 months). Eight percent (n = 8) reported having started their first ANC while in their 3rd trimester (7-9 months). The clinical data is illustrated in Table 3. We determined correlations between characteristics of participants in the three trimesters, those who started in the 1st, 2nd, and 3rd trimesters (Table 3). The p-value was 0.706, which reflects the significance of a relationship between the three variables.
Status of adolescent girls who received Tetanus toxoid vaccination before pregnancy
More than half, 55% (n = 54), commenced their tetanus toxoid vaccination before pregnancy. Overall, 51% (n = 50) of the sample reported that they did not have their tetanus toxoid vaccination up to date. There was no association between tetanus toxoid vaccination commenced before pregnancy and education P = 0.369.
Status of adolescent girls who received Family planning before pregnancy
More than half of the sample, 90.82% (n = 89), did not use family planning before pregnancy. We determined correlations between the characteristics of participants who used family planning before pregnancy and those who had never used family planning. There was no association between those who used family planning before pregnancy and distance p = 0.072. There was also no association between those who used family planning and age, education, and economic status, p = 0.656, p = 0.644, and p = 0.160, respectively.
Factors influencing the accessing and utilization of MCHI by pregnant adolescent girls, aged 15-19
Type of MCHI received
Overall, 25.5% (n = 25) of the participants reported having received leaflets. Of these, 21.4% (n = 21) reported that the information was easy to understand and helpful. Four percent (n = 4) of those who received leaflets indicated that information was not easy to understand; neither was it helpful, (Table 4). There was no association found between leaflets and information received and is easy to understand and helpful (p = 0.301). In the univariate model, participants who received leaflets had a p = 0.301 when compared to participants who found information easier to understand and helpful.
Overall 22.4% (n = 22) of the sample reported having received brochures. More than 18.4% (n = 18) of the participants who received brochures indicated that information was easy to understand, while 4.1% (n = 4) indicated that it was not easy to understand. Overall, 76.5% (n = 75) of the sample reported not having access to brochures. More than 48% (n = 47) of the sample reported having found the information easy to understand and helpful, 28.6% (n = 28) reported having found information not easy to understand and not helpful. No association was found between brochures and an easier understanding of information (p = 0.673).
Overall 17.3% (n = 17) of the sample reported having received video clips, 14.3% (n = 14) of these samples reported that information was easy to understand and helpful. Three percent (n = 3) of the sample reported having found the information not easy to understand and not helpful. The majority of the samples, 82.7% (n = 81), reported not having accessed video clips. Of these samples, more than 52% (n = 51) reported having found the information easy to understand and helpful, 29.6% (n = 29) reported having found information not easy to understand and helpful. There was no association between video clips and information received and whether it was easy to understand and helpful, p = 0.747.The p-value reflects the significance of a relationship between the two variables.
Overall, 37.8% (n = 37) of the sample reported that they access posters, 27.6% (n = 27) of these samples reported having found the information easy to understand and helpful, 10.2% (n = 10) of these samples reported to have found the information not easy to understand and helpful. The majority of the samples, 62.2% (n = 61), reported not having received posters. More than 38.8% (n = 38) of these reported having found the information easy and helpful to understand, 22.4% (n = 22) indicated that information was not easy to understand. Comparisons were performed to determine the correlation between the sample who received posters and whether the information was easy to understand and helpful in the results. There was no association found between posters and information received and whether it was easy to understand and helpful, p = 0.891. In the univariate model, participants who received posters had a p = 0.891, when compared to participants who found information easier to understand and helpful.
Mode of accessing MCHI
Overall, 85.6% (n = 83) of the sample reported having accessed MCHI through youth clubs, 32% (n = 31) of these reported to have been given MCHI once off. Only 21.6% (n = 21) of these reported that MCHI was given sometimes. No significant difference, p = 0.397.
Overall, 66% (n = 64) of the sample reported having accessed MCHI through peers, 23.7% (n = 23) of these reported having received MCHI once off, while 16.5% (n = 16) indicated that they were given MCHI sometimes. No significant difference, p = 0.259.
A majority of the sample, 72.2% (n = 72), reported having accessed MCHI through health outreach programmes, 25.8% (n = 25) of these reported having received MCHI once off, 17.5% (n = 17) reported having received MCHI sometimes. Only 15.5% (n = 15) reported receiving information always. No significant difference, p = 0.679.
Overall, 58.8% (n = 57) of the sample reported having accessed MCHI through a health facility, 22.7% (n = 22) of these reported to have been given MCHI once off. On average, 15.5% (n = 15) of the sample reported having been given MCHI sometimes. Only 14.4% (n = 14) of the sample reported that MCHI had always been given. Results indicate that there is a significant difference, p = 0.016.
More than two-thirds of the sample, 70.1% (n = 68), reported having accessed MCHI through schools, 27.8% (n = 27) of the sample reported having been given MCHI once off. On average, 21.6% (n = 21) of the sample reported having been given MCHI only sometimes. Results indicate that there is a significant difference, p = 0.019. Figure 4 below illustrates the different modes of distribution available where pregnant adolescent girls receive MCHI. The mode of distribution for MCHI has been illustrated in Figure 3 and Table 3.
Overall, a majority 40% (n = 39) of the sample reported that it is distributed once-off, while less than a quarter of the sample, 23.7% (n = 23), reported that it is distributed sometimes, 19.5% (n = 19) reported that it is distributed always. In the bivariate model, there was no association found between the sample who reported that it is distributed always with those who reported that it is distributed sometimes (P = 0.879).
Distance to the nearest health facilities
The results showed that a majority 34% (n = 33) of the sample had to walk for 6-10 km to access the nearest health facility, a quarter had to cover over 15 km, 25.5% (n = 25), and 15% (n = 15) of the sample had to cover a distance of 11-15 km. A bivariate analysis model was used to conduct the analysis. During the comparison, the distances were merged as follows: 0–<5 km, 5–15 km and above. A comparison was done between samples who traveled a distance of 0-<5 km to those samples who traveled 5–15 km and above. Although found not to be statistically significant, both odds ratios for the participants who traveled 0-<5 km and those participants who traveled 5–15 km indicated more than two-fold for odds ratio [OR= 3.38, 95%CI: 0.05-3.33, P=0.359] and adjusted odds ratio [OR=2.55, 95%CI: 0.24-26.8, P=0.437], respectively. The pregnant adolescent girls who traveled 0-<5 km are 3.38 times more likely to have used family planning before, compared to those who never used family planning. Those who traveled 5–15 km are 2.55 times more likely to use family planning.
Comparisons were made to determine the characteristics of participants who used family planning before pregnancy to participants who had never used family planning before pregnancy to determine the access and use of MCHI, as depicted in Table 5. A multivariate model (binary logistic regression model) was used to determine the comparison, as depicted in Figures 5A and 5B, multivariable model A and multivariable model B. Although found not to be statistically significant, factors such as age and schools had decreased odds ratios of 16% and 17%, [OR=0.84, 95%CI: 0.19 - 62, P = 0.824]; [OR=0.83, 95%CI: 0.19-3.55, P = 0.796] respectively, while social media and health outreach programmes had odds ratios of 64% and 68%, [OR=0.36, 95%CI: 0.04-3.03, P = 0.327] and [OR=0.32, 95%CI: 0.04-2.69, P=0.272] respectively. Furthermore, education, youth-friendly initiatives and community engagement activities were found not to be statistically significant; however, they had odds ratios of one fold each: [OR=1.09, 95%CI: 0.25-4.67, P = 0.865]; [OR=1.11, 95%CI: 1.04-1.19, P = 0.348], and [OR=1.18, 95%CI: 0.29-4.69, P=0.816] respectively. Family members and distance were found to have odds ratios of two-fold and three-fold each: [OR=2.47, 95%CI: 0.29-20.9, P = 0.392]; [OR=3.38, 95%CI: 0.05-3.22, P=0.359]. The distance was not associated with family planning use.
As illustrated in Figure 5B, multivariable model B below, although found not to be statistically significant, factors such as schools, education and community engagement activities had decreased odds ratios of 8% and 10% respectively [OR=0.92, 95%CI: 0.18-4.83, P = 0.925] and [OR=0.90, 95%CI: 0.18-4.56, P = 0.999], while family members had odds ratios of 62% [OR=0.38, 95%CI: 0.33-4.37, P = 0.439]. Social media, health outreach programmes and distance had odds ratios of more than two fold [OR=2.21, 95%CI: 0.23-21.2, P = 0.490], [OR = 2.07, 95%CI: 0.21-20.2, P=0.532] and [OR=2.55, 95%CI: 0.24-26.8, P=0.437] respectively, while age had an odds ratio of one fold [OR=1.18, 95%CI: 0.28-5.03, P = 0.824].
Understanding, implementation, and usefulness of MCHI
Overall, more than a halfof the sample, 66% (n = 65), reported that the information was easy to understand and helpful, while 32.6% (n = 32) reported that the information was not easy to understand, and only one percent (n = 1) did not indicate. Comparisons were made to compare the participants who understand, implement, and find MCHI useful with the participants who did not understand the information. Although found not to be statistically significant, the odds ratio was [OR=0.37, 95% CI: 0.09-1.47, P=0.145] and the adjusted odds ratio was [OR=6.17, 95%CI: 0.49-76.2, P=0.156], respectively.
Frequency of implementation of MCHI by participants
More than half of the sample, 65.3% (n = 64), reported having always implemented what they are told or read, while 35% (n = 34) reported only sometimes putting into practice what they are told or read. Although found not to be statistically significant, the odds ratio was [OR=0.16, 95%CI: 0.04-0.71, P=0.008] and the adjusted odds ratio was [OR=2.77, 95%CI: 0.24–31.9, P = 0.414], respectively.
Satisfaction with MCHI received
Half of the sample, 52% (n = 51), reported being satisfied with the information received, while 47% (n = 46) reported not being satisfied with the information received. Although found not to be statistically significant, the odds ratio was 0.43 [OR=0.43, 95%CI: 0.10-1.82, P=0.238] and the adjusted odds ratio was three-fold [OR=3.03, 95%CI: 0.22-41.64, P = 0.407]. Tables 6 and 7 illustrate the factors that may influence the utilization of MCHI.