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Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review
Ijeoma Nkem Okedo-Alex1,2, Ifeyinwa Chizoba Akamike3,2, Obumneme Benaiah Ezeanosike4
1African Institute for Health Policy and Health Systems, Ebonyi State University, Abakaliki, Ebonyi, Nigeria ijeomaninadr@gmail.com.
Insights
Socioeconomic status, education, and partner support significantly influence antenatal care (ANC) use in sub-Saharan Africa. Addressing these factors, alongside improving access and health policies, is crucial for enhancing maternal health outcomes.
Area of Science:
- Public Health
- Reproductive Health
- Health Services Research
Background:
- Antenatal care (ANC) utilization in sub-Saharan Africa is influenced by a complex interplay of factors.
- Understanding these determinants is critical for improving maternal and child health outcomes in the region.
Purpose of the Study:
- To systematically review and identify the key determinants of antenatal care utilization in sub-Saharan Africa.
Main Methods:
- A systematic review of primary studies published between 2008 and 2018.
- Studies were identified through extensive database searches (PubMed, OVID, EMBASE, CINAHL, Web of Science).
- Data extraction and quality assessment were performed using standardized tools and frameworks.
Main Results:
- Socioeconomic status, urban residence, education, employment, and marital status were identified as significant positive predictors of ANC attendance.
- Awareness of danger signs, positive attitudes towards ANC, and media exposure facilitated timely and adequate ANC visits.
- Unplanned pregnancy, lack of spousal support, geographical barriers, and high service costs negatively impacted ANC uptake.
Conclusions:
- Predisposing, enabling, and need factors significantly affect ANC utilization in sub-Saharan Africa.
- Recommendations include intersectoral collaboration to promote education, empowerment, improve access, and strengthen ANC policies with community involvement.
Objectives:
To identify the determinants of antenatal care (ANC) utilisation in sub-Saharan Africa.
Design:
Systematic review.
Data Sources:
Databases searched were PubMed, OVID, EMBASE, CINAHL and Web of Science.
Eligibility Criteria:
Primary 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 Synthesis:
A 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.
Results:
74 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.
Conclusion:
A 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.
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