Pattern and determinants of antenatal booking at abakaliki southeast Nigeria.

Dear Editor,

We would like to appreciate the study titled “Pattern and determinants of antenatal booking at Abakaliki Southeast Nigeria” by Onoh et al.[1] and mention that it was informative. While reading the article, we came through certain doubts in the results part of the study.

As per the results, 344 was the total number of respondents in the study; but in Table 1, the total number of respondents for “Religion religion” and “parity” were given as 343 and 402, respectively, which is not as per the total number of respondents. In page no. 171, the 3rd paragraph of the results section mentioned 92.9% were married (13/14), but in Table 1 the percentage mentioned for marital status was 91.9% (316/344).

It is concluded that the socio-demographic factors did not influence the antenatal booking pattern which was analyzed using Chi-square test. This conclusion cannot be drawn with Chi-square test, as in most of the cells the expected value was less than 5.

According to Table 2, the analysis for “events of previous pregnancy and its influences on the booking pattern” was done for 233 respondents. But “chronic illness diagnosed in previous pregnancy” included 344 respondents in total. It is not clear whether this part is done for all the respondents or only to those participants with an event of previous pregnancy. It is also given that the influence of counseling in previous pregnancy on the booking pattern had a P -value of –0.601. This may be wrong as the probability value lies between 0 and 1.

In page no. 172, the 6th paragraph briefing about the complications such as preterm delivery, difficult labor, cesarean section, fetal deaths, and miscarriage in the previous pregnancies (1/2, 2/5, 6/21, 2/8, and 1/12) did not have impact on the booking pattern (P -value 0.587); this conclusion cannot be derived using Chi-square test, without having sufficient cell value.

The study concluded by stating that misconception and financial constraints were the significant promoters of late antenatal booking. First of all, the study has not defined the term “misconception.” Secondly, in the text or in the table, the data regarding misconception are not shown. Regarding financial constraint, the authors cannot conclude this as a significant promoter for two reasons: one reason is that one of the cell values is zero (early booking = 0 and late booking = 19) and the other is that among the total participants, only 5.5% have financial constraints, which cannot be considered as one of the important factors.

Though the study has successfully met one of the objectives, i.e. identifying booking patterns, the second objective of finding determinants could not be achieved since the statistical tool (Chi-square) used was inappropriate. Chi-square used in Table 1, Table 2 and Table 4 misleads the study conclusion and other future research. We would like to point out that this kind of incorrect use of statistical methods leads to fallacious conclusion than providing benefits.