Association of Higher Educational Attainment on Antenatal Care Utilization Among Pregnant Women in East Africa Using Demographic and Health Surveys (DHS) from 2010 to 2018: A Multilevel Analysis

Abstract

The use of antenatal care (ANC) plays a major role in minimizing maternal and child mortality through effective and appropriate screening, preventive, or treatment intervention. Even though almost all pregnancy-related mortalities are largely preventable through adequate use of ANC, sub-Saharan Africa (SSA), particularly East African Countries, continues to share the largest share of global maternal, and newborn mortality. Therefore, this study assesses if educational attainment is associated with optimal ANC utilization in East Africa. Methods: A secondary data analysis was done based on Demographic and Health Surveys (DHS) from 2010 to 2018 in the 11 East African Countries. A total weighted sample of 84,660 women who gave birth in the 5 years preceding each country's DHS survey and had ANC visits were included in this study. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association of educational attainment and ANC utilization. Variables with a p-value <0.05 were declared as significant factors associated with ANC utilization. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). Results: The magnitude of optimal ANC utilization in East African Countries was 56.37% with 95% CI (56.03, 56.69) with the highest optimal ANC utilization in Zimbabwe (80.96%) and the lowest optimal ANC utilization in Rwanda (44.31%). Women who had higher education levels were more likely to have optimal ANC utilization, compared to those with no education (AOR = 2.34; 95 and CI; 2.11-2.59). Women who had media exposure were more likely to have optimal ANC utilization than those who have no media exposure (AOR = 1.07; 95% CI; 1.03, 1.10). Conclusion: Antenatal care utilization was low in East African countries. Educational attainment, maternal age, wealth index, birth order, media exposure, and living countries were factors associated with ANC utilization. Efforts to improve antenatal care and other maternal health service utilization in East Africa must take into account these factors. Specifically, working on the access to mass media by women may also improve antenatal care utilization.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

“…Furthermore, according to the latest Rwanda Demographic and Health Survey (RDHS), less than half of all the women are able to utilise more than four ANC contacts, yet over 94% deliver under the care of a SBA [ 16 ]. This is further supported by a regional paper that shows Rwanda to have the lowest optimal ANC utilization proportion [ 11 ]. In order to ensure successful implementation of the latest WHO ANC guidelines that recommend at least eight contacts for every pregnant woman and progress towards reduction of the MMR to less than 70 per 100,000 live births, there is need to explore the different factors such as quality of ANC that might affect utilisation of ANC [ 4 , 8 , 17 ].…”

“…Tiruye et al showed that attending at least one ANC contact can decrease the risk of neonatal death by 42% [ 10 ]. However, SSA regions such as East Africa continue to share some of the poorest ANC utilization statistics and a significant share of global maternal and newborn mortality [ 10 , 11 ]. This may be related to the quality of ANC care that is provided, which has been criticized in several studies from SSA [ 12 ].…”

“…This may be related to the quality of ANC care that is provided, which has been criticized in several studies from SSA [ 12 ]. Recently published data have documented low ANC utilization in East Africa with overall quality of ANC at 11.6%, utilization of at least 4 contacts at 56.4% and use of skilled ANC providers at 78.7% [ 11 , 13 ]. Countries like Ethiopia have reported the lowest quality of ANC at 5.6% [ 13 ].…”

“…Countries like Ethiopia have reported the lowest quality of ANC at 5.6% [ 13 ]. With the highest proportion of at least four ANC contacts in East Africa observed in Uganda at 61%, this shows the need to prioritize ANC programs in the region to ensure progress in the reduction of maternal and neonatal mortalities [ 11 ].…”

Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation

“…This lack of understanding was suggested to associate with women’s educational level and literacy rate. In fact, it has been shown that the increase in women’s educational level is a major motivator for increasing the likelihood of her ANC attendance [ 16 , 17 ]. This suggests that educated women are more likely to have adequate knowledge of prenatal care services and understand the importance of early booking for ANC as well as attending the recommended eight visits [ 18 ].…”