Factors Affecting Nonadherence to WHO's Recommended Antenatal Care Visits among Women in Pastoral Community, Northeastern Ethiopia: A Community-Based Cross-Sectional Study.

Introduction: More than half of the pregnant women in Ethiopia do not receive the recommended number of antenatal care visits. In the Afar region, where women have limited access to healthcare services due to pastoral livelihood, evidence on noncompliance to the adequate number of antenatal care visits is scarce. Therefore, this study was intended to examine the level of nonadherence to the recommended antenatal care visits and its associated factors in the pastoral community of Northeast Ethiopia.

Methods: A community-based cross-sectional study was conducted from 04 February to 22 March 2020 among randomly selected 703 women who gave birth within 24 months preceding the survey in the Transform HDR districts of the Afar region. Data were collected using a pretested structured interviewer-administered questionnaire. Data were entered into Epi-data version 4.2 and finally exported to Stata version 16 for further analysis. Bivariable and multivariable binary logistic regression analyses were done to identify factors affecting the nonadherence to the recommended antenatal care visits. Odds ratio with the corresponding 95% confidence interval were computed and the statistical significance of the explanatory variables was declared at a p-value <0.05.

Results: Nonadherence to the recommended antenatal care visits was 57.0% (95% CI: 53.3%-60.7%). Attending primary (AOR (95% CI): 0.39 (0.22-0.72)) and secondary education and above (AOR (95% CI): 0.25 (0.08-0.77)), being married at the age of 18 years or older (AOR (95% CI): 0.48 (0.36-0.71)), and attending antenatal care at a health center (AOR (95% CI): 0.46 (0.26-0.81)) were associated decreased odds of nonadherence to the recommend visits. Moreover, a higher likelihood of nonadherence was found among women from households not possessing communication media (AOR (95% CI): 1.85 (1.18-2.88)) and those who initiated antenatal care attendance during the second (AOR (95% CI): 5.23 (3.54-7.72)) and third trimesters (AOR (95% CI): 8.81 (1.88-41.20)).

Conclusions: Nearly six in ten women do not receive the recommended antenatal care visits, consistent with the national prevalence. Women's education, age at marriage, type of health facility, possession of mass media, and timing of antenatal care attendance were associated with nonadherence to the recommended antenatal care visits. Thus, improving women's literacy, dissemination of information regarding antenatal care through mass media, and strengthening interventions targeted to end child marriage are important in scaling up the level of adherence. Moreover, supporting community-based health education through health extension programs is crucial in reaching women with limited access to mass media.