Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review

Abstract

ObjectivesTo identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.DesignSystematic review.Data sourcesDatabases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.Eligibility criteriaPrimary studies reporting on determinants of ANC utilisation following multivariate analysis, conducted in sub-Saharan Africa and published in English language between 2008 and 2018.Data extraction and synthesisA data extraction form was used to extract the following information: name of first author, year of publication, study location, study design, study subjects, sample size and determinants. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist for reporting a systematic review or meta-analysis protocol was used to guide the screening and eligibility of the studies. The Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was used to assess the quality of the studies while the Andersen framework was used to report findings.Results74 studies that met the inclusion criteria were fully assessed. Most studies identified socioeconomic status, urban residence, older/increasing age, low parity, being educated and having an educated partner, being employed, being married and Christian religion as predictors of ANC attendance and timeliness. Awareness of danger signs, timing and adequate number of antenatal visits, exposure to mass media and good attitude towards ANC utilisation made attendance and initiation of ANC in first trimester more likely. Having an unplanned pregnancy, previous pregnancy complications, poor autonomy, lack of husband’s support, increased distance to health facility, not having health insurance and high cost of services negatively impacted the overall uptake, timing and frequency of antenatal visits.ConclusionA variety of predisposing, enabling and need factors affect ANC utilisation in sub-Saharan Africa. Intersectoral collaboration to promote female education and empowerment, improve geographical access and strengthened implementation of ANC policies with active community participation are recommended.

Monitoring the decomposition of wealth-related inequality in the use of regular antenatal care in Egypt (1995-2014)

“…As modeling is the common approach in assessing the relationship between health variables and their determinants, modeling URAC for the two years of 1995 and 2014 was carried out. The modeling of URAC con rmed the ndings in previous literature on developing countries, and on Egypt [11][12][13][14][15][16][17][18][19][20][21]: both social and health needs were signi cant in determining URAC. On the social side, women's age at birth, their education level, their husbands' education level, the household standard of living/wealth, and the region, were signi cant determinants of URAC.…”

“…Some research efforts have focused on understanding the main determinants of any use or of regular use of antenatal care. As in the literature on determinants of antenatal care use in developing countries [11][12][13][14][15][16], research in Egypt has con rmed the importance of both social and health needs as determinants of antenatal care. On the social side, women's age or age at birth, their education, their husbands' education level, the women's work status, the household standard of living/wealth, and place of residence, assessed in terms of regional level or by rural/urban differentiation, were identi ed as signi cant determinants of antenatal care [17][18][19][20].…”

“…Other research efforts focused on monitoring changes in the use of antenatal care over time [16,19]. Modeling any use of antenatal care separately for the years 2000 and 2014, Zaky and colleagues showed that wealth, higher education attainment of both women and their husbands, and residence in frontier governorates were signi cantly related to the use of any antenatal care in 2000 [19].…”

Factors Associated with Blood Pressure Checkup During Pregnancy Among Women of Reproductive Age in Tanzania; An Analysis of Data from the 2015-16 Tanzania Demographic and Health Survey and Malaria Indicators Survey

“…Furthermore, socioeconomic status of the woman was also a challenge. Several studies showed that good economic status of the woman enables her to complete the required number of BP check-ups [19,22,23]. Moreover, a systematic review study that included 74 studies found out that low parity was associated with adequate ANC service utilization [23].…”

“…Several studies showed that good economic status of the woman enables her to complete the required number of BP check-ups [19,22,23]. Moreover, a systematic review study that included 74 studies found out that low parity was associated with adequate ANC service utilization [23]. Women with high parity tend to under-utilize ANC services, thus missing the opportunity to have their blood pressure adequately checked [24,25].…”