Tafere Tesfahun Zemene, Demissie Kaleb Assegid, Teshale Getachew, Tiruneh Misganaw Guadie, Dellie Endalkachew, Geberu Demiss Mulatu, Hagos Asebe, Worku Nigusu, Jejaw Melak
Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
BMC Pregnancy Childbirth. 2025 Jun 4;25(1):656. doi: 10.1186/s12884-025-07789-5.
Late booking of antenatal care is a major contributing factor to the high rate of maternal deaths. Despite the World Health Organization's recommendation for pregnant women to begin their first antenatal care visit within 12 weeks of gestation, delays in initiating antenatal care are common in sub-Saharan Africa. Therefore, this study intended to examine the prevalence of late antenatal care booking and its predictors in extremely high (over 1,000 maternal deaths per 100,000 live births) and very high (between 500 and 1,000 maternal deaths per 100,000 live births) maternal mortality sub-Saharan African countries.
Our analysis utilized secondary data from the most recent Demographic and Health Surveys conducted between 2014 and 2022. A weighted sample of 74,552 women who had given birth within five years preceding the survey and had antenatal care visits for their last child were included. A multilevel mixed-effect logistic regression model was fitted. Statistical significance was declared at a p-value less than 0.05.
The pooled prevalence of late antenatal care booking in extremely high and very high maternal mortality sub-Saharan African countries was 70.16% (95% CI: 69.83,70.49). Poor wealth quantile (AOR = 1.71, 95%CI: 1.60,1.82), low community media exposure (AOR = 1.70, 95%CI: 1.63,1.78), grand multiparous (AOR = 1.66, 95%CI:1.52,1.81), no media exposure (AOR = 1.59, 95%CI, 1.52,1.67), married (AOR = 1.53, 95%CI: 1.44,1.63), middle wealth quantile (AOR = 1.41, 95%CI: 1.33,1.51), not autonomous of house-hold decision-making (AOR = 1.28, 95%CI: 1.22,1.34), multiparous (AOR = 1.27, 95%CI, 1.18,1.35), secondary education (AOR = 1.24, 95%CI: 1.16,1.34), family size of 5+ (AOR = 1.24, 95%CI:1.15,1.33), rural residence (AOR = 1.22, 95%CI: 1.15,1.30), big problem of distance (AOR = 1.20, 95%CI: 1.14,1.26), Not working (AOR = 1.17, 95%CI: 1.11,1.23), partner's no formal education (AOR = 1.17, 95%CI:1.08,1.27), age 15-24 years (AOR = 1.16, 95%CI:1.07,1.25), female household head (AOR = 0.85, 95%CI: 0.80,0.91) were significant predictors of late antenatal care booking.
This study revealed that on average, seven in ten pregnant women in extremely high and very high maternal mortality sub-Saharan African countries booked antenatal care late. Both individual and community-level factors influenced late antenatal care booking. The study recommends empowering women, improving rural healthcare access, and promoting comprehensive ANC education and community-based interventions to address late ANC booking in extremely high and very high maternal mortality SSA countries.
产前保健预约过晚是孕产妇死亡率居高不下的一个主要促成因素。尽管世界卫生组织建议孕妇在妊娠12周内开始首次产前检查，但在撒哈拉以南非洲，延迟开始产前保健的情况很常见。因此，本研究旨在调查在孕产妇死亡率极高（每10万例活产中有超过1000例孕产妇死亡）和非常高（每10万例活产中有500至1000例孕产妇死亡）的撒哈拉以南非洲国家中，产前保健预约过晚的患病率及其预测因素。
我们的分析利用了2014年至2022年期间进行的最新人口与健康调查的二手数据。纳入了一个加权样本，其中包括74552名在调查前五年内分娩且为其最后一个孩子进行过产前检查的妇女。拟合了一个多层次混合效应逻辑回归模型。当p值小于0.05时，宣布具有统计学显著性。
在孕产妇死亡率极高和非常高的撒哈拉以南非洲国家中，产前保健预约过晚的合并患病率为70.16%（95%置信区间：69.83,70.49）。财富分位数低（优势比=1.71，95%置信区间：1.60,1.82）、社区媒体曝光率低（优势比=1.70，95%置信区间：1.63,1.78）、多产（优势比=1.66，95%置信区间：1.52,1.81）、无媒体曝光（优势比=1.59，95%置信区间：1.52,1.67）、已婚（优势比=1.53，95%置信区间：1.44,1.63）、中等财富分位数（优势比=1.41，95%置信区间：1.33,1.51）、在家庭决策中不自主（优势比=1.28，95%置信区间：1.22,1.34）、经产（优势比=1.27，95%置信区间：1.18,1.35）、接受中等教育（优势比=1.24，95%置信区间：1.16,1.34）、家庭规模为5人及以上（优势比=1.24，95%置信区间：1.15,1.33）、农村居住（优势比=1.22，95%置信区间：1.15,1.30）、距离问题严重（优势比=1.20，95%置信区间：1.14,1.26）、未工作（优势比=1.17，95%置信区间：1.11,1.23）、伴侣未接受正规教育（优势比=1.17，95%置信区间：1.08,1.27）、年龄在15 - 24岁之间（优势比=1.16，95%置信区间：1.07,1.25）、女性户主（优势比=0.85，95%置信区间：0.80,0.91）是产前保健预约过晚的显著预测因素。
本研究表明，平均而言，在孕产妇死亡率极高和非常高的撒哈拉以南非洲国家中，十分之七的孕妇产前保健预约过晚。个人和社区层面的因素都影响了产前保健预约过晚的情况。该研究建议增强妇女权能，改善农村地区的医疗保健服务可及性，并推广全面的产前保健教育和基于社区的干预措施，以解决撒哈拉以南非洲孕产妇死亡率极高和非常高的国家中产前保健预约过晚的问题。
