Conference Abstract | Volume 9 (ConfPro7): Abstract 094 | Published: 06 Oct 2026
Muniru Awini1,2,&, George Akowuah2, Magdalene Odikro2, Gideon Kye-Doudu2,3, Zakaria Adam1,2, Samuel Sackey2
1Ghana Health Service, Pusiga District Health Directorate, Upper East Region, 2Ghana Field Epidemiology and Laboratory Training Programme, School of Public Health, Legon, Accra, 3Fred Newton Binka School of Public Health, University of Health and Allied Sciences, Ho, Volta Region
&Corresponding author: Muniru Awini, Ghana Health Service, Pusiga District Health Directorate, Upper East Region, Email: munirua965@gmail.com
Received: 29 Aug 2025, Accepted: 28 Oct 2025, Published: 06 Oct 2026
Domain: Maternal and Child Health
This is part of the Proceedings of the 8th Ghana FELTP Scientific Conference and FELTP Competency Graduation, Accra, Ghana, 10 – 11 December, 2025
Keywords: antenatal, root causes, critical cause, problem analysis, fishbone, Pusiga
©Muniru Awini et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Muniru Awini et al. Low initiation of antenatal care attendance: A problem analysis in Pusiga District, 2025. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfPro7):094. https://doi.org/10.37432/JIEPH-CONFPRO7-0094
Despite the benefits of early antenatal (ANC) attendance, many low- and middle-income countries continue to experience challenges in achieving the WHO target of at least 55% of women initiating ANC before 12 weeks of gestation. In Pusiga District, early ANC remains below target, ranging from 33.8% to 45.9% between 2020 and 2024. To address this issue, a problem analysis was conducted to identify the underlying factors and critical cause of low ANC attendance in the Pusiga District.
A problem analysis in the Pusiga district involving a team of Nurses, Physician Assistants, Community Health Officers, Midwives and Disease Control Officers was conducted. The team brainstormed to identify contributory factors to the problem. The factors (root causes) were grouped into categories. Each root cause was labelled as T (totally), P (partially) and N (Not) to indicate the level of control over them. The cause with the highest influence among those either totally or partially under control was identified as the critical cause. We presented results using a fishbone diagram.
A total of 19 factors were identified under four categories; knowledge and awareness level of the pregnant women, health system factors, socioeconomic factors and sociocultural factors. About 21.1% (4/19) were totally under staff control; 57.8% (11/19) were partially under staff control and 21.1% (4/19) was beyond staff control. The critical cause was limited awareness among pregnant women and their families regarding the benefits of early ANC initiation.
Root causes identified included knowledge and awareness level of the pregnant women, health system, socioeconomic and sociocultural factors. The critical cause of delayed initiation of ANC is limited awareness among pregnant women and their families. Strengthening community outreach and intensifying ANC counselling and education will help improve awareness level and promote early ANC attendance.
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