Quality of antenatal care and associated factors among pregnant women in East Africa using Demographic and Health Surveys: A multilevel analysis

Abstract

Introduction: Antenatal care offers a forum for critical healthcare functions, including health education, screening, and disease prevention. Several pocket studies carried out in specific localities of East African countries were investigated. However, these were neither representative of the country nor specific to the recommended minimum of four antenatal care visits. Therefore, this study aimed to identify factors associated with quality of antenatal care among pregnant women in East Africa. Methods: A secondary data analysis was done using Demographic and Health Survey data of six East African Countries from 2008 to 2018. A total of 46,656 women who gave birth in the 5 years preceding the survey were included in this study. A multilevel mixed-effect logistic regression model was fitted. Variables with a p-value < 0.05 were declared as significant factors associated with the quality of antenatal care. Results: The magnitude of quality of antenatal care in East Africa was 11.16% (95% confidence interval: 10.87–11.45). Women of age 35–49 (adjusted odds ratio = 1.51; 95% confidence interval: 1.25–1.80), primary education (adjusted odds ratio = 1.35; 95% confidence interval: 1.18–1.55), richest wealth index (adjusted odds ratio = 2.35; 95% confidence interval: 2.02–2.74), and rural resident (adjusted odds ratio = 0.62; 95% confidence interval: 0.55–0.69) were among factors significantly associated with quality of antenatal care. Conclusion: The magnitude of antenatal care quality was low in East Africa. Age, level of education, wealth index, birth order, husband/partners’ level of education, residence, and living countries were among the factors associated with the quality of antenatal care. It would be useful to increase financial support strategies that enable mothers from poor households to use health services and enhance women’s understanding of the significance of antenatal care utilization through health education targeting both women and partners with no education is very crucial.

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

“…The odds of receiving all ANC components were six times higher among women who had at least one child, and reduced by half to three times higher among those with two to four children, compared to those with five or more children. This finding is not surprising because it has been reported consistently by studies in Ethiopia [ 45 , 49 ], Haiti [ 50 ], Nigeria [ 51 ], and in an analysis of combined DHS data of six East African countries [ 13 ]. This could be due to the fact that women with multiple parities have a lower desire to continue attending all the recommended ANC visits.…”

“…Although still very low, at 13.1%, this proportion of women who utilized all ANC components in Rwanda represents a significant increase from the 1.9% of the 2015 RDHS [ 12 ]. It is slightly higher than the East African region prevalence of 11% [ 13 ]. In 2019, Benova et al, analyzed DHS data from 10 LMICs’s, which showed that Rwanda’s current proportion of women receiving all ANC components is higher than Nigeria’s (6.7%), close to that of Democratic Republic of Congo (12.6%) and lower than that of Zambia (21.8%) [ 12 ].…”

“…Largely because of the erroneous belief that they might no longer be in need of those services as they already have experience with pregnancy and childbirth [ 45 , 49 ]. Therefore, they are less anxious and perceive their risk to be very low [ 13 ]. It could also possibly be because high parity pregnancies are more likely to be unintended, which has been linked to the later timing and lower amount of antenatal visits and hence reduced likelihood of receiving complete ANC components [ 52 ].…”

“…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 ].…”

“…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 ]. 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 ].…”