BackgroundAn effective continuum of maternal care ensures that mothers receive essential health packages from pre-pregnancy to delivery, and postnatally, reducing the risk of maternal death. However, across Africa, coverage of skilled birth attendance is lower than coverage for antenatal care, indicating mothers are not retained in the continuum between antenatal care and delivery. This paper explores predictors of retention of antenatal care clients in skilled birth attendance across Africa, including sociodemographic factors and quality of antenatal care received.MethodsWe pooled nationally representative data from Demographic and Health Surveys conducted in 28 African countries between 2006 and 2015. For the 115,374 births in our sample, we estimated logistic multilevel models of retention in skilled birth attendance (SBA) among clients that received skilled antenatal care (ANC).ResultsAmong ANC clients in the study sample, 66% received SBA. Adjusting for all demographic covariates and country indicators, the odds of retention in SBA were higher among ANC clients that had their blood pressure checked, received information about pregnancy complications, had blood tests conducted, received at least one tetanus injection, and had urine tests conducted.ConclusionsHigher quality of ANC predicts retention in SBA in Africa. Improving quality of skilled care received prenatally may increase client retention during delivery, reducing maternal mortality.

Objective: We investigated the spatiotemporal trends in the burden of maternal, adolescent and child anaemia in sub-Saharan Africa, and evaluated some individual and household predictors of anaemia. Design: Average haemoglobin concentrations and anaemia prevalence were estimated, plotted over time, and mapped by country and sub-region. Multilevel linear regression models were used to evaluate individual and household predictors of haemoglobin concentration. Participants: Data from Demographic and Health Surveys (DHS) spanning 2000 – 2018 were merged into datasets for 37,623 pregnant women, 89,815 older adolescent girls, and 401,438 preschool children. Setting: The merged DHS represent nationally representative samples from 33 countries. Results: Prevalence of anaemia remains high in sub-Saharan Africa, affecting 60%, 36% and 44% of children, adolescents and pregnant women respectively. Anaemia prevalence among children did not materially improve from 2000 to 2018. Anaemia prevalence among older adolescent girls and pregnant women did not also improve, but this masks a period of improvement followed by depreciation in population anaemia status. Pregnant adolescents had 12.5g/L (95% CI: 11.3 – 13.6) lower haemoglobin concentration compared to non-pregnant adolescents, and 1.7g/L (95% CI: 0.7 – 2.6) lower haemoglobin concentration compared to pregnant women >40yrs respectively. Stunting and wasting were associated with 1.3 to 3.3g/L lower haemoglobin concentration among children. Other significant predictors of haemoglobin concentration were educational attainment, wealth quintiles, source of drinking water, number of children < 5 years in the household, and possession of bed-nets. Conclusion: Anaemia in sub-Saharan Africa has not improved remarkably since year 2000 and remains excessive among children.

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