Determinants of complete antenatal care in Sub-Saharan Africa: a multilevel analysis of Demographic and Health Surveys from 28 countries
Abstract
Background Antenatal care (ANC) quality is assessed by the number of recommended ANC services a woman receives during pregnancy, including blood pressure checks, urine and blood sampling, and administration of iron supplements. The World Health Organization recommends that, to make ANC services an effective preventive measure, the content and quality of care should be routinely monitored. Methods A total of 394,067 women who gave birth 5 years before the survey were included. We used Stata version 17 for data management and analysis. A multilevel logistic regression model was fitted. Finally, the adjusted odds ratios (aOR) with 95% confidence intervals (CIs) are reported. Statistical significance was defined as P-value < 0.05. Results Complete ANC was significantly higher among women with primary (aOR 1.63, 95% CI 1.59–1.66), secondary (aOR 2.31, 95% CI 2.26–2.37), or higher education (aOR 2.99, 95% CI 2.84–3.15); among those living in poorer (aOR 1.05, 95% CI 1.03–1.08), richer (aOR 1.04, 95% CI 1.01–1.07), or the richest households (aOR 1.14, 95% CI 1.10–1.18), and among women who wanted later pregnancies (aOR 1.25, 95% CI 1.23–1.28). It was lower among women with unwanted pregnancies (aOR 0.54, 95% CI 0.53–0.56), those who were working (aOR 0.90, 95% CI 0.89–0.92), those exposed to media (aOR 0.97, 95% CI 0.95–0.99), those living in female-headed households (aOR 0.96, 95% CI 0.94–0.98), and among all ever-married women (married aOR 0.67, 95% CI 0.63–0.71; cohabiting aOR 0.68, 95% CI 0.64–0.72; widowed aOR 0.38, 95% CI 0.33–0.43; divorced aOR 0.66, 95% CI 0.60–0.74; separated aOR 0.63, 95% CI 0.57–0.68). Conclusion This study demonstrates that fewer than 2 in 10 women in Sub-Saharan Africa receive all recommended antenatal care services, indicating low coverage. The key determinants of complete antenatal care were identified, including household wealth, maternal education, pregnancy intention, marital status, media exposure, sex of the household head, and maternal employment status.