Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis

Abstract

Background: In the context of high maternal morbidity and mortality in Sub-Saharan Africa, less than 80% of pregnant women receive antenatal care services. According to a 2016 national report, only 62% of pregnant women in Ethiopia made at least one antenatal care visit. The aim of this review was to systematically and quantitatively summarize the factors affecting utilization of antenatal care in Ethiopia.

Methods: We searched PubMed, Medline, EMBASE, CINAHL, Google Scholar and Maternity and Infant Care database for studies that had been conducted in Ethiopia between 2002 and 2016. We summarized the studies on the use of antenatal care services quantitatively and qualitatively. A random-effects model was conducted to obtain the pooled estimates.

Results: A total of fifteen observational studies were included in this review. The pooled prevalence of utilization of antenatal care services in Ethiopia was 63.77% (95CI 53.84-75.54). The pooled odds ratio showed that a significant positive association was found between utilization of antenatal care and urban residence (OR = 1.92, 95%CI = 1.35-2.72), women's education (OR = 1.90, 95%CI = 1.52-2.37), husband's education (OR = 1.49, 95%CI = 1.32-1.69) and planned pregnancy (OR = 2.08, 95%CI = 1.45-2.98). Based on narrative synthesis exposure to mass media, family income and accessibility of the service were strongly associated with utilization of antenatal care.

Conclusion: The findings of this review found several modifiable factors such as empowering women through education and increasing their decision-making power, promoting family planning to prevent unplanned pregnancy, increasing awareness of women through mass media and making services more accessible would likely to increase utilization of antenatal care. Further research is needed on accessibility and availability of the service at the individual and community level to assess the predictors of antenatal care service utilization.

Fig 1. Flow chart diagram describing selection of studies included in the systematic review and meta-analysis using PRISMA checklist.

Studies may have been excluded for more than one reason.

Fig 2. Overall pooled estimates of antenatal care service utilization in Ethiopia, 2016.

Fig 3. Forest plot for the association between residence and use of antenatal care service in Ethiopia, 2016.

Notes: In each study, women were assigned to an area of residence (urban/rural). Each adjusted odds ratio is an estimate for a comparison between the women in urban residence and those in rural, with the latter used as the reference category.

Fig 4. Forest plot for the association between educated women and use of antenatal care service in Ethiopia, 2016.

Notes: In each study, women were assigned to educational status (No education/educated). Each adjusted odds ratio is an estimate for a comparison between the women with no education and educated, with the first used as the reference category.

Fig 5. Forest plot of five studies included in a meta-analysis assessing the association between husband or partner education and utilization of antenatal care in Ethiopia, 2016.

Notes: In each study, women were assigned based on husband educational status (No education/educated). Each adjusted odds ratio is an estimate for a comparison between no education and educated, with the first used as the reference category.

Fig 6. Forest plot for the association between age of the women and use of antenatal care service in Ethiopia, 2016.

Notes: In each study, women were assigned to age category (l<20 years />=20 years). Each adjusted odds ratio is an estimate for a comparison between the women with age group <20years and >+20years, with the second used as the reference category.

Fig 7. Forest plot for the association between marital status and use of antenatal care service in Ethiopia, 2016.

Notes: In each study, women were assigned to marital status (Married /Other (Single, divorced, Widowed)). Each adjusted odds ratio is an estimate for a comparison between the women marriage and without marriage, with the second used as the reference category.

Fig 8. Forest plot for the association between parity and use of antenatal care service utilization in Ethiopia, 2016.

Notes: In each study, women were assigned to parity (1-4 />4parity). Each adjusted odds ratio is an estimate for a comparison between the women with parity 1-4 and >4 parity, with the second used as the reference category.

Fig 9. Forest plot for the association between type of pregnancy and use of antenatal care service utilization in Ethiopia, 2016.

Notes: In each study, women were assigned to type of pregnancy (planned versus unplanned). Each adjusted odds ratio is an estimate for a comparison between the women with planned and unplanned pregnancy, with the second used as the reference category.