Noncompliance with the WHO's Recommended Eight Antenatal Care Visits among Pregnant Women in Sub-Saharan Africa: A Multilevel Analysis.

Emmanuel Kolawole Odusina,Edward Kwabena Ameyaw,Bright Opoku Ahinkorah,Sanni Yaya,Betregiorgis Zegeye,Abdul-Aziz Seidu,Eugene Budu

doi:10.1155/2021/6696829

Abstract

Background In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA). Methods We used data from the Demographic and Health Surveys of eight countries in SSA. A pooled sample of 63,266 pregnant women aged 15-49 years who had given birth to children within 5 years prior to the surveys was included in this study. To examine the factors associated with noncompliance with ANC 8+ visits, multilevel binary logistic regression analysis was conducted, and the results were reported using odds radios at 95% confidence interval (CI). Results The pooled prevalence of noncompliance with ANC 8+ visits was 92.3% (95% CI: 91.1%-93.3%) with the highest and lowest prevalence in Zambia (98.7%, 95% CI: 98.3%-99.1%) and Libya (73.4%, 95% CI: 70.4%-76.2%), respectively. With the individual level factors, women's age (44-49 years-aOR = 0.33, 9% CI: 0.14-0.78), health insurance registration, (yes-aOR = 0.53, 95% CI: 0.29-0.98), and economic status (richest-aOR = 0.16, 95% CI: 0.05-0.49) were negatively associated with noncompliance with 8+ ANC visits, while parity (five or more children-aOR = 1.68, 95% CI: 1.12-2.52) was positively associated with noncompliance with 8+ ANC visit. With the community level factors, community level literacy was negatively associated with noncompliance with 8+ ANC visit (high-aOR = 0.56, 95% CI: 0.32-0.99). Conclusion About eight out of ten pregnant women did not comply with the WHO's recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Empowering the economic status of women , enhancing health insurance and education coverage, and giving more attention to young pregnant women and those with more children are crucial for improving the coverage of ANC 8+ visits in the region.

Highlights

In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes
More than half of the participants were living in rural areas (52.7%), were currently working (69.4%), and did not report distance to health facility as a big problem (57.5%) and exposed to media
We found that the likelihood of noncompliance of ANC 8+ visits among richest/rich pregnant women was lower compared to that among those pregnant women who were from poorest households

Summary

Introduction

In 2016, the World Health Organization (WHO) introduced a minimum of eight antenatal care (ANC) visits for positive pregnancy outcomes. This study examined the prevalence of noncompliance with 8+ ANCvisits and its associated factors in sub-Saharan Africa (SSA). About eight out of ten pregnant women did not comply with the WHO’s recommended minimum of eight ANC visits for positive pregnancy outcomes in SSA. Efforts toward achieving significant reduction in maternal and child morbidity and mortality have not achieved desired outcome, especially in low- and middleincome countries (LMICs) [1,2,3]. The use of ANC services is a key component [1, 4, 7] This is associated with the rate of maternal morbidity and mortality [1, 4]. To achieve the global Sustainable Development Goals (SDG) especially the third goal of achieving a reduction in maternal mortalities to less than 70 per 100,000 live births by 2030, evidence-based interventions and policies are required [4, 7, 9]

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Results

Discussion

Conclusion