Determinants of antenatal care dropout among pregnant women in Africa: a systematic review and meta-analysis.

Abstract

Background: Antenatal care (ANC) is a comprehensive healthcare service designed to support pregnant women through education, monitoring, and interventions to promote a healthy pregnancy and ensure a positive childbirth. Regular ANC visits play a crucial role in preventing complications, managing existing health conditions, and promoting the overall well-being of both the mother and the unborn child. Dropout from ANC visits results in potential complications during pregnancy, and these complications can involve the mother's health, the fetus's health, or both. Common complications of pregnancy include high blood pressure, gestational diabetes, anemia, preeclampsia, preterm labor, stillbirth, and miscarriage. The objective of this study is to estimate the prevalence of dropout from antenatal care and determinant factors among pregnant women in Africa.

Methods: This systematic review and meta-analysis included with open or free access to full text all full, English-language original research articles, and doctoral dissertations on observational studies (cross-sectional, case control, or cohort) conducted worldwide between 2000 and December 15, 2023, which were published in peer-reviewed journals that report dropout rates from prenatal care and its determinants. We follow PRISMA checklist. Using keywords, papers were retrieved from the electronic databases PubMed, Cochrane Library, Google Scholar, and gray literature. Stata 17 was used to conduct the meta-analysis. The Egger's regression, Begg's test, and funnel plot were employed to investigate publication bias. To ascertain the level of heterogeneity, the I² statistics were employed.

Results: The overall magnitude of antenatal care dropout among pregnant women, as pooled from the 16 studies, was found to be 29.44%, with a 95% confidence interval (CI) ranging from 19.16% to 39.72%. The pooled odds ratio showed that rural pregnant women (AOR = 3.55, 95 CI (1.17-5.92). women who had no formal education (AOR = 3.88, 95 CI (- 0.24-8.00), inaccessible PHC facilities (AOR = 5.90, 95 CI (0.54-11.26), lack of support from family or husband (AOR = 4.91 CI (- 1.31-11.19), and women with poor economic status (AOR = 2.50, 95 CI (1.19-3.81) were determinant factors for maternal dropout from antenatal care service.

Conclusions: This systematic review and meta-analysis revealed that the prevalence of antenatal care dropout was high based on the included 16 articles. According to the review, pregnant women's antenatal care dropout was significantly correlated with living in a rural area, being unable to access a primary health facility, lacking formal education, not having support from her husband or family, and having low socioeconomic status. These findings suggest that various socio-economic and geographical factors play a significant role in determining whether pregnant women continue with antenatal care services. Addressing these determinants, such as improving access to healthcare facilities, providing educational support, and enhancing economic conditions, may contribute to reducing the dropout rates and improving overall maternal healthcare outcomes. Additionally, understanding these factors is essential for tailoring interventions to specific populations and regions to ensure effective ANC retention.