Use of eight or more antenatal care contacts and determinants among healthcare providers in Ethiopia: systematic review and meta-analysis

BACKGROUND

Eight or more antenatal care contact sessions are recommended as part of antenatal care to prevent pregnancy-related complications. However, studies across Ethiopia have shown discrepancies and inconsistent results.

OBJECTIVE

The goal of this study was to determine the pooled compliance to ≥8 antenatal care contact sessions and associated factors among Ethiopian healthcare providers.

STUDY DESIGN

Studies were systematically searched from March 1, 2024, to April 2, 2024, using Embase, Web of Science, PubMed/MEDLINE, Science Direct, African Journal Online, and the Wiley Online Library. The data were subsequently transferred to Stata software, version 11, for further data analysis. Pooled effect sizes were calculated based on the prevalence of ≥8 antenatal care contact sessions, and the odds ratios and 95% confidence intervals to indicate statistical significance were determined for the associated factors. To evaluate statistical heterogeneity, the Cochrane Q test and I² statistic were used.

RESULTS

In this systematic review and meta-analysis, a total of 492,000 articles were retrieved from various databases and registers. Finally, 16 studies with 7781 participants were included. The overall compliance to the guidelines that recommend ≥8 antenatal care contact sessions was 18.35% (95% confidence interval, 10.98–25.73). Healthcare providers who worked at hospital health facilities (adjusted odds ratio, 5.09; 95% confidence interval, 2.26–11.47) had knowledge of the importance of ≥8 antenatal care contact sessions for pregnant women (adjusted odds ratio 2.04; 95% confidence interval, 1.10–3.78). Those who were able to clearly differentiate between the guidelines recommending 8 antenatal care contact sessions and those recommending 4 antenatal care visits (adjusted odds ratio, 3.95; 95% confidence interval, 2.10–7.33) were more likely to record ≥8 antenatal care contact sessions, which was significantly associated with the outcome variable.

CONCLUSION

In this study, more than 80% of antenatal care healthcare providers did not comply with the modern and World Health Organization–recommended antenatal care contact guidelines for a variety of reasons. It is very important to address factors that prevent healthcare providers from complying with the recommended ≥8 antenatal care contact sessions. To improve compliance to the World Health Organization guidelines of ≥8 antenatal care contact sessions, training on these guidelines is recommended.