Abstract
BackgroundThe spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya.MethodsData from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities.ResultsThe coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries.ConclusionSuboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.
Highlights
The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths
Until 2016, the World Health Organization (WHO) recommended at least four ANC visits later revised to eight visits in line with new evidence supporting improved safety during pregnancy through increased frequency of maternal and fetal assessment shown to be associated with a reduced likelihood of perinatal deaths [5, 6]
Participants characteristics A total of 14,858 women aged between 15 and 49 years had at least one pregnancy each in the five years preceding the KDHS 2014 survey and in theory expected to attend the recommended number of ANC visits during the pregnancy period
Summary
The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. We aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. Between 30 to 50% of maternal mortality is due to inadequate care during pregnancy, while two-thirds of stillbirths are antepartum caused by maternal infections and pregnancy complications [3]. These deaths are preventable through services offered during antenatal care (ANC) [3, 4]. The timing (initiation of first ANC visit) is monitored and plays a crucial role in determining the completion of the recommended visits
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
