A multilevel analysis of receipt of adequate antenatal care and its determinants among pregnant women in 11 sub-Saharan African countries: insights from recent demographic and health surveys

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-09-13 DOI:10.1016/j.cegh.2025.102185

Abdu Hailu Shibeshi , Getnet Mamo Habtie , Gezachew Gebeyehu Arega , Nuru Mohammed Hussen , Kedir Endris Hamed , Seid Ali Tareke

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引用次数: 0

Abstract

Background

Adequate antenatal care (ANC) is critical for improving maternal and neonatal health, yet its utilization remains insufficient in many sub-Saharan African (SSA) countries. Understanding the factors influencing ANC uptake is essential for informed policy and health system interventions.

Objective

This study examined the prevalence and determinants of receiving adequate ANC among pregnant women across eleven sub-Saharan African countries using recent DHS data.

Participants and Setting

and Setting: The analysis included 43,323 women aged 15–49 years with recent live births from nationally representative surveys conducted between 2019 and 2024 in 11 SSA countries.

Methods

Adequate ANC was defined according to WHO guidelines as eight or more visits with complete service components. We employed three-level mixed-effects logistic regression to examine individual, household, and community-level predictors while accounting for the hierarchical data structure. Model performance was assessed using standard fit statistics including AIC/BIC and ROC-AUC (0.949).

Results

The prevalence of adequate ANC was only 3 % (95 % CI: 2.84–3.17 %), ranging from 18.4 % in Ghana to less than 1 % in Burkina Faso and Kenya. Significant predictors included secondary or higher education for both women (AOR = 1.12, 95 % CI:1.01–1.38) and their partners (AOR = 1.41, 1.15–1.73), media exposure (AOR = 1.28, 1.15–1.74), health insurance coverage (AOR = 1.22, 1.02–1.63), family size (AOR = 0.86, 0.69–0.96), urban residence (AOR = 1.24, 1.02–1.52), and recent survey year (2023/24: AOR = 2.59, 1.36–4.89).

Conclusion

The findings reveal alarmingly low ANC adequacy in SSA with marked cross-country disparities. Targeted interventions should prioritize women's education, health insurance expansion, and community-based programs in rural areas, while leveraging media for health promotion to address existing inequities in ANC utilization.

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11个撒哈拉以南非洲国家孕妇获得适当产前护理及其决定因素的多层次分析：来自最近人口和健康调查的见解

充分的产前保健（ANC）对于改善孕产妇和新生儿健康至关重要，但在许多撒哈拉以南非洲国家（SSA），其利用率仍然不足。了解影响ANC使用的因素对于制定知情政策和卫生系统干预措施至关重要。目的：本研究利用最近的DHS数据，调查了撒哈拉以南非洲11个国家孕妇接受充足ANC的流行情况和决定因素。参与者和环境：该分析包括11个SSA国家2019年至2024年间进行的具有全国代表性的调查中最近活产的43,323名15-49岁的妇女。方法根据世卫组织指南，充分的ANC定义为8次或更多的就诊，并提供完整的服务内容。在考虑分层数据结构的同时，我们采用三水平混合效应逻辑回归来检查个人、家庭和社区水平的预测因子。采用AIC/BIC和ROC-AUC（0.949）等标准拟合统计量评价模型性能。结果充足ANC的患病率仅为3% (95% CI: 2.84 - 3.17%)，从加纳的18.4%到布基纳法索和肯尼亚的不足1%不等。有意义的预测因子包括女性的中等或高等教育程度（AOR = 1.12, 95% CI: 1.01-1.38）及其伴侣（AOR = 1.41, 1.15-1.73）、媒体接触（AOR = 1.28, 1.15-1.74）、医疗保险覆盖率（AOR = 1.22, 1.02-1.63）、家庭规模（AOR = 0.86, 0.69-0.96）、城市居住情况（AOR = 1.24, 1.02-1.52）和最近调查年份（2023/24:AOR = 2.59, 1.36-4.89）。结论：研究结果显示，SSA的ANC充分性低得惊人，且存在明显的跨国差异。有针对性的干预措施应优先考虑妇女教育、扩大医疗保险和农村地区的社区项目，同时利用媒体进行健康宣传，以解决目前在非农业药物利用方面存在的不公平现象。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.