Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 May 9:12:20503121241248275.
doi: 10.1177/20503121241248275. eCollection 2024.

Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis

Dereje Bayissa Demissie  1   2 , Gebeyaw Molla  1 , Firew Tiruneh Tiyare  3 , Abebe Sorsa Badacho  1 , Ashenif Tadele  1
Affiliations
Review

Magnitude, disparity, and predictors of poor-quality antenatal care service: A systematic review and meta-analysis

Dereje Bayissa Demissie et al. SAGE Open Med. .

Abstract

Background: Antenatal care is directed toward ensuring healthy pregnancy outcomes. Quality antenatal care increases the likelihood of receiving an effective intervention to maintain maternal, fetal, and neonatal well-being, while poor quality is linked to poor pregnancy outcomes. However, owing to the complex nature of quality, researchers have followed several approaches to systematically measure it. The evidence from these variable approaches appears inconsistence and poses challenges to programmers and policymakers. Hence, it is imperative to obtain a pooled estimate of the quality of antenatal care. Therefore, considering the scarcity of evidence on the quality of antenatal care, this study aimed to review, synthesize, and bring pooled estimates of accessible evidence.

Objective: This study aimed to estimate the pooled magnitude and predictors of quality of antenatal care services and compare regional disparity.

Method: We conducted a comprehensive systematic three-step approach search of published and unpublished sources from 2002 to 2022. The methodological quality of eligible studies was checked using Joanna Briggs Institute critical appraisal tool for cross-sectional studies. Meta-analysis was carried out using STATA version 16. Statistical heterogeneity was assessed using Cochran's Q test. In the presence of moderate heterogeneity (I2 more than 50%), sensitivity and subgroup analyses were conducted and presented in a forest plot. Effect size was reported using standardized mean difference and its 95% confidence interval. Funnel plots and Egger's regression test were used to measure publication bias at the 5% significance level. A trim-and-fill analysis was conducted to adjust for publication bias. Pooled estimates were computed using random-effects models and weighted using the inverse variance method in the presence of high heterogeneity among studies. A 95% CI and 5% significance level were considered to declare significance variables.

Results: The global pooled poor-quality antenatal care was 64.28% (95% CI: 59.58%-68.98%) (I2 = 99.97%, p = 0.001). The identified pooled predictors of good-quality antenatal care service were: number of antenatal care visits (fourth and above antenatal care visit) (Adjusted odds ratio (AOR) = 2.6, 95% CI: 1.37-3.84), family wealth index (AOR = 2.72, 95% CI: 1.89-3.55), maternal education attainment (AOR = 3.03, 95% CI: 2.24-3.82), residence (urban dwellers) (AOR = 4.06, 95% CI: 0.95-7.17), and confidentiality antenatal care (AOR = 2.23, 95% CI: -0.36 to -4.82).

Conclusions: The study found regional and country-level disparities in the quality of antenatal care services for pregnant women, where poor-quality antenatal care services were provided for more than two-thirds to three-fourths of antenatal care attendants. Therefore, policymakers and health planners should put a great deal of emphasis on addressing the quality of antenatal care services.

Keywords: Antenatal care; pooled prevalence; poor quality; pregnant women.

Plain language summary

This study aimed to estimate the magnitude, disparity, and predictors of the quality of antenatal care services. A comprehensive literature search was conducted from August 24/2022 to September 08/2022 found that a total of 76 studies with a sample size of 940,164 were included in the final analysis. The global pooled poor quality of antenatal care service utilization was 64.28%. The study found that nearly two-thirds of pregnant women worldwide received poor-quality antenatal care services, and nearly 3/4th of pregnant women in Ethiopia received poor-quality ANC. This study discovered continental, regional, and country-level disparities in the quality of antenatal care services, with pregnant women in the Asian, African, and South American continents using low-quality antenatal care services compared to those in North America and Europe. The authors strongly recommend providing high-quality antenatal care based on WHO recommendations globally for pregnant women in need of quality services at all levels to provide quality healthcare to the target population.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow chart showing the study selection process.
Figure 2.
Figure 2.
Trend of poor-quality ANC services utilization globally from 2008 to 2022.
Figure 3.
Figure 3.
Forest plot showing the global pooled prevalence of poor-quality ANC services per 100 among pregnant women 2022.
Figure 4.
Figure 4.
Funnel plot showing the distribution of included studies global pooled prevalence of poor-quality ANC services per 100 pregnant women 2022.
Figure 5.
Figure 5.
Sensitivity analysis to identify the possible source of heterogeneity 2022.
Figure 6.
Figure 6.
Funnel plot showing the distribution of included studies of the global pooled prevalence of poor-quality ANC services per 100 pregnant women in 2022.
Figure 7.
Figure 7.
Subgroup analysis to estimate the pooled prevalence of poor ANC services based on continent pooled prevalence of poor-quality ANC services per 100 pregnant women 2022.
Figure 8.
Figure 8.
Forest plot showing the developed country (North America and Europe) pooled prevalence of poor-quality ANC services per 100 pregnant women in 2022.
Figure 9.
Figure 9.
Funnel plot showing the distribution of included studies of the global pooled prevalence of poor-quality ANC services per 100 pregnant women in 2022.
Figure 10.
Figure 10.
Forest plot showing LMICs pooled prevalence of poor-quality ANC services per 100 pregnant women 2022.
Figure 11.
Figure 11.
Funnel plot showing the distribution of included studies LMICs pooled prevalence of poor-quality ANC services per 100 pregnant women 2022.
Figure 12.
Figure 12.
Funnel plot after trim-and-fill analysis of linear estimator in LMICs pooled prevalence of poor-quality ANC services per 100 pregnant women 2022.
Figure 13.
Figure 13.
Forest plot showing Africa continent pooled prevalence of poor-quality ANC services per 100 among pregnant women 2022.
Figure 14.
Figure 14.
Forest plot showing the pooled prevalence of poor-quality ANC per 100 among pregnant women in Africa.
Figure 15.
Figure 15.
The pooled proportion of poor-quality ANC services in Ethiopia 2022.
Figure 16.
Figure 16.
Forest plot showing Ethiopia pooled prevalence of poor-quality ANC services per 100 among pregnant women 2022.
Figure 17.
Figure 17.
Forest plot showing the pooled prevalence of poor-quality ANC per 100 among pregnant women in Africa 2022.
Figure 18.
Figure 18.
The pooled odds ratio of forth and above ANC visit with good-quality ANC services in Ethiopia 2022.
Figure 19.
Figure 19.
The pooled odds ratio of maternal education with good-quality ANC services in Ethiopia 2022.
Figure 20.
Figure 20.
The pooled odds ratio of family wealth indexes with good-quality ANC services in Ethiopia 2022.
Figure 21.
Figure 21.
The pooled odds ratio of residences with good-quality ANC services in Ethiopia 2022.
Figure 22.
Figure 22.
The pooled odds ratio of maintained confidentiality with good-quality ANC services in Ethiopia 2022.
See this image and copyright information in PMC

References

    1. Carlsen L, Bruggemann R. The 17 United Nations’ sustainable development goals: a status by 2020. Int J Sustain Develop World Ecol 2022; 29(3): 219–229.
    1. Sachs J, Kroll C, Lafortune G, et al.. Sustainable development report 2022. Oxford: Cambridge University Press, 2022.
    1. Sharma B, Raina A, Kumar V, et al.. Counting stillbirth in a community-to understand the burden. Clin Epidemiol Global Health 2022; 14: 100977.
    1. Mergl R, Quaatz SM, Edeler L-M, et al.. Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies. Eur J Psychotraumatol 2022; 13(2): 2108578. - PMC - PubMed
    1. Asim M, Karim S, Khwaja H, et al.. The unspoken grief of multiple stillbirths in rural Pakistan: an interpretative phenomenological study. BMC Women’s Health 2022; 22(1): 1–11. - PMC - PubMed

LinkOut - more resources