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. 2025 Apr 14;25(1):441.
doi: 10.1186/s12884-025-07568-2.

Determinants of attendance in antenatal care clinics in rural settings in Mali and Burkina Faso: a cross-sectional study

Joel D Bognini  1 , Kadiatou Koita  2   3 , Jean-Baptiste N'takpe  4 , Biébo Bihoun  5 , Mahamadou Dembélé  2 , Oumou Coulibaly  2 , Toussaint Rouamba  5 , Efundem Agboraw  6 , Sirima Traoré  2 , Dario Scaramuzzi  7 , Eve Worrall  3 , Jenny Hill  3 , Kassoum Kayentao  2 , Halidou Tinto #  5 , Valérie Briand #  8   9
Affiliations

Determinants of attendance in antenatal care clinics in rural settings in Mali and Burkina Faso: a cross-sectional study

Joel D Bognini et al. BMC Pregnancy Childbirth. .

Abstract

Background: Since 2016, the World Health Organization (WHO) has recommended a minimum of eight antenatal care (ANC) contacts during pregnancy, replacing the previous recommendation of four focused ANC visits. In Mali and Burkina Faso, the four ANC visits are still recommended and their coverage remains low or insufficient. To anticipate possible obstacles to the implementation of the new recommendations, this study aimed to identify the individual determinants of ANC attendance in two study districts, with a representative sample of women recruited from the community.

Methods: Data were collected in June 2022 through a three-stage household survey with a representative sample of women who delivered in the previous 12 months in the health districts of Kangaba (Mali) and Boussé (Burkina Faso). Country-specific analyses were performed using self-reported data. Women's sociodemographic and clinical characteristics, as well as attitudes towards ANC attendance, were described to account for clustering. Multivariable logistic regression models using generalized estimating equations were used to identify the determinants of four or more ANC uptakes. A p-value < 0.05 was considered statistically significant in the adjusted model.

Results: Overall, 1590 women participated (780 in Mali; 810 in Burkina Faso) in the study. Women in Burkina Faso were older and less educated than women in Mali. The proportions of women with at least four ANC visits were 80% and 54%, and that of ANC in the first trimester was 38.7% and 43.8% in Burkina Faso and Mali respectively. Factors significantly associated with a greater probability of women attending ANC4 + visits were found only in Mali: a history of stillbirth and time spent at ANC. Factors reducing the use of ANC4 + were the lack of transportation/distance in Burkina Faso, travel time of less than 1 h to reach the maternity clinic, women's nonrecognition of the importance of ANC visits, and the perceived high cost of the ANC visit in both countries.

Conclusion: ANC was lower in Mali than in Burkina Faso. Health policies aimed at achieving the WHO recommendation of 8 ANC contacts should prioritize health information and sensitization of pregnant women to improve their knowledge of the importance of attending ANC several times.

Trial registration: Retrospectively registered on August 11th, 2022 registration # PACTR202208844472053. Protocol v4.0 dated September 04, 2023.

Keywords: Antenatal care; Epidemiology; Maternal and childbirth; Pregnant women; West Africa.

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Conflict of interest statement

Declarations. Ethical approval and consent to participate in the survey: The study protocol was approved by the Institutional Review Boards/Ethics Committees and local health authorities in both countries (No 2022/83/CE/USTTB for Mali, No 2022-03-051/MSHP/MESRI/CERS for Burkina Faso) and of the Liverpool School of Tropical Medicine (22 - 006). Informed consent was obtained from the participants, their parents and their legally authorized representatives in this study. Only the participants’ anonymous study ID was captured in the database. Consent of publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study profile
Fig. 2
Fig. 2
Distribution of the number of ANC visits during the previous pregnancy, by country
Fig. 3
Fig. 3
Distribution of the gestational age at the first ANC visit among women, by country
See this image and copyright information in PMC

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