Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys

Abstract

Objective: To explore the factors associated with antenatal care (ANC) visits.

Design: A secondary data analysis from cross-sectional studies was conducted.

Setting: Sub-Saharan Africa.

Participants: 56 002 women aged 15-49 years in Ghana (3224), Kenya (10 981), Malawi (9541), Namibia (2286), Rwanda (4416), Senegal (6552), Tanzania (5536), Uganda (7979) and Zambia (5487) were analysed.

Outcomes: 4⁺ANC visits.

Results: Overall, 55.52% (95% CI: 55.11% to 55.93%) of women made 4⁺ANC visits. The highest 4⁺ANC visits were in Ghana (85.6%) and Namibia (78.9%), and the lowest were in Senegal (45.3%) and Rwanda (44.5%). Young women 15-19 years had the lowest uptake of 4⁺ANC visits. Multivariable analysis indicated that the odds of 4⁺ANC visits were 14% lower among women from rural areas compared with those living in towns (adjusted OR (AOR) 0.86; 95% CI: 0.81 to 0.91). This difference was significant in Kenya, Malawi, Senegal and Zambia. However, in Zambia, the odds of 4⁺ANC visits were 48% higher (AOR 1.48; 95% CI: 1.2 to 1.82) among women from rural compared with urban areas. Women with higher educational level had more than twofold higher odds of 4⁺ANC visits in seven of the nine countries, and was significant in Kenya, Malawi, Rwanda and Zambia. Compared with the poorest household wealth category, odds of 4⁺ANC visits increased by 12%, 18%, 32% and 41% for every 20% variation on the wealth quantile. Women in their first-time pregnancy had higher odds of 4⁺ANC visits compared with others across all countries, and women who had access to media at least once a week had a 22% higher probability of 4⁺ANC visits than women who had no access to media (AOR 1.22, 95% CI: 1.15 to 1.29).

Conclusion: The number of ANC visits was considered to be inadequate with substantial variation among the studied countries. Comprehensive interventions on scaling uptake of ANC are needed among the low-performing countries. Particular attention should be given to women of low economic status and from rural areas.

Keywords: community child health; epidemiology; health policy; prenatal diagnosis.

Figure 1

Flow chart of the process of selection of women for analysis of 4⁺ANC visits. 4⁺ANC, four or more antenatal care; DHS, Demographic and Health Survey.

Figure 2

Proportion of 4⁺ANC visits of women in nine sub-Saharan African countries, 3 years preceding the DHS of each country. 4⁺ANC, four or more antenatal care; DHS, Demographic and Health Survey.

Figure 3

Proportion of 4⁺ANC visits of women in nine sub-Saharan African countries and their sociodemographic factors, with 95% CI. 4⁺ANC, four or more antenatal care.