Maternal, New-born, and Child Health (MNCH) indicator improvement is one of the Sustainable Development Goals (SDGs) agenda, where the main aim is to reduce the global burden of maternal, new-born, and child mortality (Knbs, 2023; World Health Organization, 2018). Despite international efforts and progress, maternal deaths are still high, of which almost 800 pregnant women die annually from pregnancy-related complications worldwide, and over 90% of those deaths are experienced in Asia and Sub-Saharan African regions (Khalil et al., 2023). Maternal mortality rates in Kenya have decreased from 362/100,000 live births in 2014 to 355/100,00 live births in 2022, which is still high compared to global incidence rates (Knbs, 2023). In most developing countries the direct causes of maternal mortality include; postpartum hemorrhage, hypertensive disorders, infections, obstructed labour, unsafe abortion, and ruptured uterus (Bhandari and Dangal, 2014), which contribute to almost 78% of all deaths while remaining are caused by indirect causes like anaemia, diabetes, malaria, tuberculosis and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) (Girum and Wasie, 2017). Most causes of these deaths are conditions that can be prevented if proper screening is given during antenatal and postnatal care (Say et al., 2014).

The 2016 WHO Antenatal Care model aims to provide at least eight ANC contacts to all pregnant women. The primary contact occurs in the first trimester, the second and third contacts in the second trimester, and the remaining five contacts in the third trimester (World Health Organization, 2016). The first-trimester contact is very important for assessing the women’s health by identifying risk factors and establishing a baseline for subsequent care (Tunçalp et al., 2017). Some of the antenatal profiles that should be done during the first trimester as indicated in the Mother and Child Health booklet by the Ministry of Health (MOH)-Kenya (Mudany et al., 2015) include; hemoglobin level, blood grouping, and rhesus factors, urinalysis, random blood sugar (RBS), syphilis, hepatitis B, HIV counselling and testing, and Mycobacteria Tuberculosis (TBC) screening.

Despite efforts made by the Kenyan government to enhance MNCH in North Eastern counties, Marsabit County still has low MNCH indicators (Keats et al., 2017). The county has four major sub-counties namely: North Horr, Moyale, Saku, and Laisamis, The proportion of pastoralists within the county is 81%, with the majority residing in Moyale Sub-County. It is the largest, most arid area, with the majority of the population being pastoralists, and the least developed county in Kenya. According to the 2022 Kenya Demographic Health Survey (KDHIS 2022), Marsabit County had 67% ANC coverage, 59.3% health facility deliveries, 41% postpartum check-ups, and 62% of women aged 15–49 have no formal education (Knbs, 2023). At the county level, most of the health facilities that provide ANC services concentrate in the county and sub-county hospitals, of which only a few provide ANC services. Dispensaries and clinics have no laboratories but provide ANC consultation (Muga et al., 2005). WHO recommended that all pregnant women should be referred to a laboratory for the complete set of ANC screening tests during the first ANC visit (Abalos et al., 2016). During pregnancy, a woman’s body undergoes significant changes and monitoring is very important for early intervention (Azab et al., 2020). Marsabit County, being one of the vast counties in Kenya, has very few medical laboratories for testing, and also almost 80% of the residents are pastoralists; therefore, few pregnant women have access to healthcare facilities for testing.

Clinical examination and laboratory screening during antenatal visits are considered timely to prevent, identify, and correct the abnormalities that might affect the mother and foetus. The findings guide the clinicians in treating existing diseases or others that may occur during pregnancy leading to early intervention and treatment (Anversa et al., 2012; Habte et al., 2024). Inadequate care during pregnancy breaks a critical link in the continuum of care and affects both women and the foetus (Ahmed and Mohamed, 2018). Some of the risk factors like anaemia, high blood pressure, diabetes, undiagnosed infections, and other pre-existing health conditions frequently complicate pregnancy (Gupton et al., 2001). No research has been done in Marsabit County to understand pastoralist pregnant women’s clinical examination and laboratory antenatal screening. Therefore, this cross-sectional study aims to describe the clinical and laboratory presentation of pastoralist pregnant women during the first antenatal visit, which includes the prevalence of hypertension, urinary tract infection, anaemia, syphilis, intestinal parasite infection, hepatitis infections, and any demographic-associated factors.

The study population was pastoralist pregnant women attending the Integrated Maternal Mobile Health (IMMH) outreach clinic in Moyale Sub-County, Marsabit County, Kenya. The IMMH project provides health services to pregnant pastoralist women through a health outreach program. The study was done in ten mobile/pastoralist communities, which include, Chirach, El-raya, Er-wede, Funandimo, Laqi, Mansile Water Point, Qalaliwe, Qilta, Tesso, and Yaballo Godha.

Clinical examination and laboratory screening are critical when it comes to the management of pregnant women during pregnancy, the findings will guide the clinician to identify any pregnancy-related complications and to put prevention measurements in advance (Bohn and Adeli, 2022). Some of the laboratory screenings that are recommended to be done for all pregnant women are, malaria test, Human Immunodeficiency Virus (HIV), hepatitis virus, syphilis, diabetes, and haemoglobin level (Mudany et al., 2015), but all these depend on the region where women are coming from (World Health Organization, 2018). This study explores the clinical examination and the laboratory antenatal screening outcome of pastoralist pregnant women who attended the IMMH outreach clinic for antenatal care from 10 selected pastoralist communities. The main findings of this research showed that the majority of the participants walk long distances to health facilities, are illiterate, have low attendance of antenatal care and a higher percentage are anaemic. The analysis revealed that illiteracy significantly increases the risk of anaemia during pregnancy. In addition, laboratory outcomes showed some conditions like hyperglycemia, UTI, and intestinal infestation among pregnant women. Overall, these findings illustrated that literacy, antenatal care attendance, marital status, and access to healthcare facilities intertwine to affect maternal health outcomes. This can be addressed through targeted intervention which can significantly improve pregnancy outcomes and reduce complications associated with anaemia, hyperglycaemia, UTIs, and intestinal parasites.

According to the WHO, each pregnant woman must receive at least eight ANC visits, however, only a few pregnant women have at least visited their first antenatal clinic during pregnancy (Habte et al., 2024). According to our findings, only 27 (11.4%) of women were able to attend to antenatal clinic, this finding is consistent with District Health Information Software 2 (DHIS2, 2017) and Marsabit County reproductive maternal new-born child, and adolescent health scorecard of 2017, which showed that almost 3,206 (80%) of these mothers did not achieve the WHO recommendation and antenatal care coverage is 43% against National coverage of 58% (David, 2022). This study is also consistent with a cross-sectional study conducted in Ethiopia among pastoralist communities which shows that only 156 (20%) of women received the recommended standard ANC (Biza and Mohammed, 2016). The majority, 139 (58.6%) of the women were in the age group of 20–29 years, this finding was similar to the study led by Abok (Abok, 2012) in Turkana County on the determining factors for the utilization of ANC among pastoralist women, of which most of the women were aged between 21 and 29 years, and also other study done in Marsabit county which shows the same result (Galgalo et al., 2024). The finding also was consistent with the mean reproductive age of women in Kenya which is 20–24 years as per (DHIS 2020).

Anaemia is a condition that occurs when there are not enough red blood cells to carry sufficient oxygen throughout the body and, it’s a common condition among pregnant women (Gupta, 2020). Anaemia in expectant women has an adverse pregnancy outcome and it’s a serious public health problem (Ogunbode and Ogunbode, 2021). Some of the adverse pregnancy outcome i.e., miscarriage and preterm birth is associated with anaemia (Shen et al., 2015). Our findings show that almost 57% of pregnant women are anaemic, this study differs from the study done in Kenya led by Seteti, (Siteti et al., 2014), which shows that the prevalence of anemia among pregnant women was 40%, This study was consistent with studies done by Acheampong K. and Pobee RA who find that the prevalence of anemia in pregnancy to be more than 50% and 63% respectively. (Acheampong et al., 2018; Pobee et al., 2021). Detection of anemia can help identify important maternal risk factors, and in this study, there was a significant association between illiteracy level and anemia, with women without any form of education being more likely to be anaemic.

Women who didn’t attend the antenatal clinic for the duration of their pregnancy were significantly associated with anemia compared to women who attended. Due to higher illiteracy levels within the pastoralist community women lack knowledge about proper iron-rich foods which may lead to anemia (Hussein, 2016). Iron and nutritional supplements in an integrated program can be used for the prevention and management of pregnancy-related anemia (Siteti et al., 2014). Different countries have shown different ways to treat anaemia in pregnancy like the use of oral iron, intravenous iron, and direct blood transfusion (Al et al., 2005; Burwick and Govindappagari, 2019; Omotayo et al., 2018), Lack of antenatal care among pastoralist communities may be attributed to higher illiteracy level, which is often correlated with limited access to health information and resources. Illiterate women may not understand the importance of iron-rich diets or the risks of anemia during pregnancy (Rai, 2018).

Parasitic infestation was noted among pregnant mothers in this study, this is the most important determinant of anemia and low hemoglobin level. The educational level of women significantly impacts their likelihood of having intestinal worms, as lower education correlates with higher prevalence rates. Studies indicate that women with no formal education are at greater risk for intestinal parasitic infections, including helminths, due to a lack of awareness about hygiene practices and health information necessary for prevention (Feleke and Jember, 2018; Mutalazimah and Mustikaningrum, 2020; Yesuf et al., 2019). Maternal education has been shown to influence not only the health of children but also the prevalence of conditions like anaemia and intestinal infections (Balaji et al., 2022; Quihui et al., 2006; Al-Hindi et al., 2019).

Screening for hepatitis virus is critical during pregnancy, hepatitis virus is a life-threatening liver disease, caused by hepatitis B and C viruses, and it’s a major public health problem, the common mode of transmission is through perinatal vertical transmission or during early childhood (Biondi et al., 2020). A positive mother has up to 90% likelihood of Mother-To-Child Transmission (MTCT) if no prophylaxis is given (Navabakhsh et al., 2011). According to our study, approximately 8 (3.4%) of pregnant women tested positive for hepatitis B virus this is low compared to another study done in Kenya with pooled hepatitis B virus prevalence estimation of 7.8%. (Makokha et al., 2023). But this is consistent with the studies done in Ethiopia and Tanzania, which showed a prevalence rate of 3% (Tegegne et al., 2014), (Metaferia et al., 2016) (Geffert et al., 2020). Some of the arid counties in Kenya, like Marsabit, West Pokot, and Baringo have witnessed an outbreak of Malaria (Owino, 2018). In Kenya malaria remains a major public health problem with over 70% of the population being at risk of the infection (Kenya, 2016), our study finds a prevalence of 2.5% of malaria among pregnant women. Malaria parasite is among the most common and easily preventable causes of poor birth outcomes in the world, and pregnant women are three times more likely to be affected by severe malaria (Kovacs et al., 2015).

According to this study, women in monogamist marriages were significantly more likely to be anaemic, with high blood pressure, and UTI compared to women in polygamous marriages, Women in monogamous families may face challenges related to nutrition and also have limited access to diverse diets or lack awareness about iron-rich foods, and poor dietary choices can lead to anaemia, on the other hand, high blood pressure (hypertension) could be associated with stress and lifestyle factors, women in monogamous marriage may experience stress related to family responsibilities, financial pressures, or social expectations. This chronic stress can contribute to high blood pressure. On the other hand, women in polygamous marriages shared a proximity within the same household, this shared living space could increase the likelihood of exposure to similar environmental conditions. All the above factors are in line with the lower socioeconomic status of monogamous families (Du and Mace, 2019; Coast, 2006; Needham et al., 2021). The study findings indicated that pregnant women who are multigravida are significantly associated with urinary tract infections compared to primigravida. This suggests that the risk of UTIs during pregnancy may be higher for women who have had multiple pregnancies. This finding suggests that the risk of developing UTIs increases with the number of previous pregnancies (MacLean, 2001). This can also be attributed to the anatomical and physiological changes that occur with each pregnancy, these changes can lead to urinary stasis and increased susceptibility to infections. Due to physiological changes, hormonal fluctuations cause ureteral dilation and can compress the bladder, increasing the likelihood of urinary retention and infection. Present in women who had multiple pregnancies, as their bodies may be more affected by these changes (Graseck et al., 2023; Johnson et al., 2021; Delzell and Lefevre, 2000).

Clinical examination and laboratory screening are important in the management of pregnant women during pregnancy. This study provides an important finding that requires an implementation within the pastoralist communities to improve the health outcomes of pregnant women. ANC attendance within this population is very low despite recommendations passed by WHO, this shows that pastoralist women miss all opportunities for early screening and intervention of any pregnancy-complicated conditions. Anaemia, hepatitis B, syphilis, malaria parasites, intestinal parasites, and urinary tract infections were observed among the study participants. Higher illiteracy levels and not attending antenatal clinics during pregnancy were also associated with Aneamia. Therefore, fully integrated outreach programs with clinical examination, laboratory screening, and health education to empower pastoralist pregnant women should be enhanced within this community. The findings of this research can be adapted and implemented in frontier counties in Kenya and other countries occupied by pastoralists to enhance maternal healthcare and improve the outcome.