Fenta Setegn Muche, Fenta Haile Mekonnen, Yilema Seyifemickael Amare, Chen Ding-Geng, Mekonnin Amsalu Worku
Department of Statistics, College of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia.
Trop Med Health. 2024 Oct 15;52(1):70. doi: 10.1186/s41182-024-00631-2.
Sub-Saharan Africa (sSA) continues to rank among the regions in the world with the highest rates of maternal mortality and the lowest rates of utilization of maternal health care. The risk of death for women in sSA is 268 times higher than that of women in high-income nations. Adequate antenatal care (ANC) services utilization is essential to the mother's and the baby's survival and well-being. This study aimed to identify both individual and community-level factors associated with adequate antenatal care services utilization in sSA.
We used data from the most recent Health and Demographic Surveys (DHS), which were carried out between 2012 and 2022 in 33 sSA countries. A total of 240,792 women were included in this study. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with the use of adequate ANC service.
The pooled prevalence of adequate ANC service utilization in sSA was 55.48% (95% CI: 55.28-55.68). The study showed that secondary and above-educated women (AOR = 2.13, 95% CI 2.07-2.19, secondary and above-educated husbands (AOR = 1.55, 95% CI 1.51-1.60), rich women AOR = 1.26, 95% CI 1.24-1.29), women 35-49 years of age (AOR = 1.36, 95% CI 1.32-1.41) and distance to a health facility is not a big problem (AOR = 1.13; 95% CI 1.11-1.16) was significantly and positively correlated with the use of adequate ANC services. However, rural women (AOR = 0.80; 95% CI 0.78-0.82), not having mass media access (AOR = 0.74, 95% CI 0.72-0.75), 5 and above birth order (AOR = 0.73, 95% CI 0.68-0.78) were significantly and negatively correlated with the use of adequate ANC services. Additionally, the random effects model showed that variables at the community and individual levels were responsible for approximately 62.60% of the variation in the use of adequate ANC services.
The sSA countries had a low prevalence of adequate utilization of ANC with a significant variation among countries. Moreover, public health initiatives should focus on rural women, poor women, and uneducated women to enhance maternal health services utilization. Furthermore, policies and programs that address cluster variations in the utilization of adequate ANC services must be developed, and their implementation must be vigorously pursued.
撒哈拉以南非洲（sSA）仍然是世界上孕产妇死亡率最高、孕产妇保健利用率最低的地区之一。sSA地区女性的死亡风险比高收入国家的女性高268倍。充分利用产前保健（ANC）服务对于母亲和婴儿的生存及福祉至关重要。本研究旨在确定与sSA地区充分利用产前保健服务相关的个人和社区层面因素。
我们使用了2012年至2022年期间在33个sSA国家进行的最新健康与人口调查（DHS）数据。本研究共纳入240,792名女性。采用两级混合效应逻辑回归模型来确定与充分利用ANC服务相关的个人和社区层面因素。
sSA地区充分利用ANC服务的合并患病率为55.48%（95%置信区间：55.28 - 55.68）。研究表明，受过中等及以上教育的女性（调整后比值比[AOR]=2.13，95%置信区间2.07 - 2.19）、受过中等及以上教育的丈夫（AOR = 1.55，95%置信区间1.51 - 1.60）、富裕女性（AOR = 1.26，95%置信区间1.24 - 1.29）、35 - 49岁的女性（AOR = 1.36，95%置信区间1.32 - 1.41）以及距离医疗机构不远（AOR = 1.13；95%置信区间1.11 - 1.16）与充分利用ANC服务显著正相关。然而，农村女性（AOR = 0.80；95%置信区间0.78 - 0.82）、无法接触大众媒体（AOR = 0.74，95%置信区间0.72 - 0.75）、生育顺序为5次及以上（AOR = 0.73，95%置信区间0.68 - 0.78）与充分利用ANC服务显著负相关。此外，随机效应模型显示，社区和个人层面的变量约占充分利用ANC服务差异的62.60%。
sSA国家ANC服务的充分利用率较低，且各国之间存在显著差异。此外，公共卫生举措应关注农村女性、贫困女性和未受过教育的女性，以提高孕产妇保健服务的利用率。此外，必须制定应对充分利用ANC服务的群体差异的政策和计划，并大力推动其实施。
