Factors influencing the uptake of antenatal care in Uganda: a mixed methods systematic review

Abstract

Background: In 2016, the World Health Organization (WHO) recommended increasing antenatal care (ANC) visits from four to eight to reduce maternal morbidity and mortality. However, many low-middle income countries (LMICs), including Uganda, struggle to achieve even the basic four ANC visits. To further improve ANC attendance, understanding the perceptions and beliefs of end users is crucial. This systematic review explores the perceptions, experiences, and behavior of pregnant or previously pregnant women, their families and healthcare workers on ANC attendance in Uganda.

Methods: The review includes qualitative and quantitative studies published from January 2012 to September 2022. Outcomes include early initiation of ANC visits and any attendance or utilization of routine ANC services. The Critical Appraisal Skills Programme (CASP) checklist was used to assess the quality of included studies.

Results: We searched 7 databases, identified 725 references and assessed 107 in full text for eligibility based on selected inclusion criteria. Forty-seven studies were eligible and are included in this review. Quantitative findings highlight socioeconomic factors like occupation, wealth index, and marital status as key determinants of ANC uptake and timely uptake of care, favoring higher wealth, younger age, marriage, and media access. Qualitative evidence reveals challenges to ANC attendance including financial constraints, cultural beliefs, gendered decision-making, and geographical distance from healthcare facilities. Potential solutions involve financially empowering women, providing reliable ANC equipment and medication, and community engagement and education.

Conclusions: This review offers valuable insights for policymakers and healthcare providers seeking to tailor interventions that address the unique needs and challenges faced by pregnant women, their families, and healthcare workers in Uganda. By doing so, it may enhance ANC accessibility and quality, ultimately aligning with the WHO's recommendation of eight ANC contacts (ANC8) and contributing to reducing maternal morbidity and mortality rates.

Keywords: ANC guidelines; Antenatal care; Barriers; Delivery of health care; Health workers; Healthcare utilization; Implementation; Maternity care; Respectful care; Uganda.

Fig. 1

PRISMA diagram illustrating the search result process

Fig. 2

Maternal education and ANC uptake Forest plot showing adjusted Odds Ratio (AOR - squares) and 95% Confidence Intervals (lines) for the associations between maternal educational level and ANC uptake in the included studies

Fig. 3

Maternal education and early ANC initiation Forest plot showing adjusted Odds Ratio (AOR - squares) and 95%Confidence Intervals (lines) for the associations between maternal educational level and early ANC initiation in the included studies

Fig. 4

Pathways between barriers and enablers to ANC accessibility and impact on ANC attendance

Fig. 5

Summary of findings - barriers to attending ANC from women, HCWs, and family members perspective