Identifying spatial variation, individual and community-level determinants affecting quality of antenatal care among women in sub-Saharan Africa: evidence from nationally representative cross-sectional surveys

Abstract

Objectives: Using nationally representative data, this study aimed to examine spatial variation, and individual and community-level determinants influencing the quality of antenatal care (ANC) services among women in sub-Saharan Africa (SSA).

Design: A community-based cross-sectional study was conducted using the data from a recent Demographic and Health Surveys (DHS) of 31 sub-Saharan African countries. A total weighted sample of 204 776 women aged 15-49 years who had ANC visits for their last child was included in this study. The quality of ANC was assessed using six essential components: blood pressure measurement, blood sample test, urine sample test, tetanus toxoid vaccination, iron supplementation and administration of antiparasitic medications. Finally, we employed multilevel analysis to detect the association between determinant variables and the quality of ANC services.

Setting: This study was conducted over 31 sub-Saharan African countries with recent DHS.

Outcome variable: Received good quality of ANC services (yes/ no).

Results: Only 15.0% (95% CI: 12.0% to 18.0%) of the women in SSA received good-quality ANC services, which varied from 1% (95% CI: 0.0 to 1.0) in Zimbabwe to 41.0% (95% CI: 40.0 to 43.0) in Zambia. Blood pressure measurement is the most offered component (88.1%), and the least offered component of ANC was the provision of tetanus vaccination (44.8%). Factors associated with higher odds of the quality of ANC included age 24-35 years and ≥35 years, attending secondary education, having mass media exposure, those in the richer wealth quintile, having four or more ANC contacts, timely ANC initiation, residing in urban areas, women from a community with high education and women from a community with high media exposure.

Conclusion and recommendation: This study showed a low proportion of women who received quality ANC in SSA. Both individual and community-level factors play a crucial role in determining the quality of ANC. Therefore, we recommended to upgrade the quality of ANC in SSA by improving women's education, increasing access to mass media exposure, enhancing timely initiation of ANC and increasing the frequency of ANC contacts, which are vital.

Keywords: Antenatal; Factor Analysis, Statistical; Health Services Accessibility; Mortality; Pregnant Women; Public health.

Figure 1. Flow chart for country selection and data extraction.

Figure 2. Proportion of quality of antenatal care services in 31 sub-Saharan African countries. MDG, Millennium Development Goal; SDG, Sustainable Development Goal.

Figure 3. Spatial distribution of poor quality of antenatal care among pregnant women in sub-Saharan Africa, 2023. Source: United Nations Geoscheme for Africa, 2013.