Tamir Tadesse Tarik, Gebrehana Deresse Abebe, Zegeye Alebachew Ferede, Terefe Bewuketu, Tekeba Berhan
Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
PLoS One. 2025 Aug 18;20(8):e0330596. doi: 10.1371/journal.pone.0330596. eCollection 2025.
Pregnancy is a pivotal stage that fosters health and prepares women and their families for the transition to parenthood. Antenatal care (ANC) encompasses the services provided by skilled healthcare professionals to pregnant women and adolescent girls, ensuring optimal health outcomes for both mother and child throughout pregnancy. The majority of maternal and child deaths occur in low- and middle-income countries (LMICs), where access to essential healthcare services, including ANC, remains a significant challenge. This study was aimed to assess the magnitude, spatial distribution, and determinants of non-utilization of ANC services in LMICs.
This study analyzed data from the most recent Demographic and Health Surveys conducted between 2015 and 2024, encompassing a total of 47 LMICs. The analysis included a weighted sample of 480,068 women. We employed spatial analysis to illustrate the geographic distribution of non-utilization of antenatal care and hierarchical analysis to identify contributing factors. ArcGIS 10.8 and Stata 17 were utilized for spatial and hierarchical analysis, respectively. Adjusted odds ratios with 95% confidence intervals (CIs) were calculated, and factors were considered statistically significant at a p-value of less than 0.05.
Pooled magnitude of non-utilization of ANC among women in LMICs was at 10.59%, ranging from 40.05% in Afghanistan to 0.76% in Burundi, with many regions in several countries identified as hotspots for ANC non-utilization. Factors significantly associated with higher odds of non-utilization included having no (AOR = 3.28; 95% CI: 3.02-3.55) or low (primary schooling: AOR = 1.81; 95% CI: 1.67-1.96, and secondary schooling: AOR = 1.28; 95% CI: 1.18-1.38) education, being unmarried (AOR = 1.35; 95% CI: 1.29-1.41), lower wealth index (poorest: AOR = 1.87; 95% CI: 1.77-1.98), poorer: AOR = 1.45; 95% CI: 1.38-1.54, middle: AOR = 1.17; 95% CI: 1.11-1.24, and richer: AOR = 1.09; 95% CI: 1.04-1.15), having no media exposure (AOR = 1.68; 95% CI: 1.64-1.73), residing in rural areas (AOR = 1.05; 95% CI: 1.02-1.09), facing distance issues to health facilities (AOR = 1.31; 95% CI: 1.28-1.34), and the low-income level of the countries (AOR = 2.27; 95% CI: 1.23-6.74).
A significant proportion of women in LMICs have not utilized antenatal care services. Factors at the individual, community, and country levels contribute to this non-utilization. Policymakers should focus on addressing these barriers to achieve the WHO recommendation of eight or more ANC contacts in LMICs.
怀孕是一个关键阶段，它促进健康，并使妇女及其家庭为过渡到为人父母做好准备。产前保健（ANC）涵盖了熟练的医疗保健专业人员为孕妇和少女提供的服务，以确保母婴在整个孕期都能获得最佳健康结果。大多数孕产妇和儿童死亡发生在低收入和中等收入国家（LMICs），在这些国家，获得包括产前保健在内的基本医疗服务仍然是一项重大挑战。本研究旨在评估低收入和中等收入国家产前保健服务未使用的程度、空间分布及其决定因素。
本研究分析了2015年至2024年期间进行的最新人口与健康调查数据，涵盖了总共47个低收入和中等收入国家。分析包括480,068名妇女的加权样本。我们采用空间分析来说明产前保健未使用情况的地理分布，并采用分层分析来确定影响因素。分别使用ArcGIS 10.8和Stata 17进行空间和分层分析。计算了调整后的比值比及其95%置信区间（CIs），当p值小于0.05时，认为因素具有统计学意义。
低收入和中等收入国家妇女产前保健未使用的合并比例为10.59%，从阿富汗的40.05%到布隆迪的0.76%不等，几个国家的许多地区被确定为产前保健未使用的热点地区。与未使用几率较高显著相关的因素包括未接受教育（调整后的比值比[AOR]=3.28；95%置信区间：3.02 - 3.55）或低教育水平（小学教育：AOR = 1.81；95%置信区间：1.67 - 1.96，中学教育：AOR = 1.28；95%置信区间：1.18 - 1.38）、未婚（AOR = 1.35；95%置信区间：1.29 - 1.41）、财富指数较低（最贫困：AOR = 1.87；95%置信区间：1.77 - 1.98）、较贫困：AOR = 1.45；95%置信区间：1.38 - 1.54，中等：AOR = 1.17；95%置信区间：1.11 - 1.24，较富裕：AOR = 1.09；95%置信区间：1.
