Comparative Analysis of Factors Influencing Optimal and Timely Antenatal Care Uptake in Kenya, South Africa, and Nigeria: A Cross-Section Study

Abstract

Background Adequate antenatal care (ANC) visits and early timing are crucial for maternal and foetal health. However, many pregnant women in Kenya, South Africa, and Nigeria delay ANC initiation and fail to meet recommended visit numbers. This study aimed to identify factors associated with timely ANC initiation and achieving optimal number of ANC visits in these countries. Methods A cross-sectional analysis with data from the most recent Demographic Health Survey (DHS) datasets for Kenya (2022), Nigeria (2018) and South Africa (2016) were used. The study included 35,219 women aged 15–49 who had given birth within the previous two years. The women's sociodemographic and maternal health care-seeking characteristics were summarised using descriptive statistics. Multiple logistic regression was used to identify associations between explanatory variables, the timing of the first ANC visit, and the frequency of ANC visits. Results Optimal ANC visits (≥4 visits) were 67.2% in Kenya, South Africa (75.5%), and Nigeria (56.9%). Early timing of first ANC visits (≤3 months) was 30.2% in Kenya, 47.3% in South Africa and 18.3% in Nigeria. Factors associated with adequate ANC visits were maternal age, wealth status, and caesarean section, while parity and household size reduced the odds of optimal ANC visits. Maternal age, caesarean section, wealth status, and others were associated with increased odds of early timing of ANC visits. Parity, male-headed households, employed women and women who had a challenge with treatment costs had reduced the odds of timely ANC uptake. Conclusion More than half of the participants had optimal ANC visits, while less than half initiated ANC early. Tailored interventions addressing specific social, cultural, and economic contexts are crucial to improving early ANC visits and the frequency of ANC visits. Mixed methods research could provide in-depth insights into barriers and facilitators of ANC uptake, informing the design of targeted interventions.