Determinants of adequate antenatal care among immediate postpartum mothers in Eastern Uganda: a multicenter cross-sectional study

Abstract

Background:

Antenatal care is essential for reducing maternal and neonatal mortality, particularly in low-income regions. However, the adequacy of the care provided is crucial for achieving maternal health goals. Maternal mortality rates in Uganda are still among the highest globally. Thus, evaluating the adequacy of antenatal care (ANC) services, especially in high-risk regions is imperative.

Objective:

To determine the prevalence of adequate ANC and associated factors in Eastern Uganda.

Design:

A multicenter quantitative cross-sectional study was conducted at four healthcare facilities in Eastern Uganda from July to August 2022.

Methods:

We included immediate postpartum mothers who had given birth within 48 h with a record of their ANC information on a card or book. Adequate ANC was measured by a composite index of 10 core components per WHO guidelines on ANC for a positive pregnancy experience. Data were collected using a structured questionnaire designed with Kobo Toolbox and analyzed using Stata 15.0. Bivariable and multivariable logistic regression analyses assessed factors associated with receiving adequate ANC. Statistical significance was determined by a p value <0.05.

Results:

We recruited 1104 postnatal mothers, most aged 20–34 years (n = 805, 72.9%). Only 5.9% received adequate ANC, with most mothers receiving an average of 6.9 (±2.0) of the 10 assessed ANC components. Receiving adequate ANC was associated with urban residency (AOR: 2.3; 95% CI: 1.16–4.38, p = 0.017), age between 20 and 34 years (AOR: 3.5; 95% CI: 1.07–11.30, p = 0.038), current or previous complications (AOR: 1.8; 95% CI: 1.02–3.29, p = 0.043), and delivery at a general hospital (AOR: 4.8; 95% CI: 2.60–8.83, p < 0.001).

Conclusion:

There is a critical gap in providing adequate ANC in Eastern Uganda, especially for rural and younger mothers. Policy efforts should focus on expanding access, enhancing maternal education, and strengthening healthcare infrastructure to meet the recommended ANC standards.

Plain language summary

Understanding what determines the quality of prenatal care for new mothers in Eastern Uganda: a detailed examination

This research was conducted to understand the quality of antenatal care (ANC) that pregnant mothers receive in Eastern Uganda and to identify factors influencing whether they get comprehensive care. Antenatal care is the support and medical care given to pregnant women to ensure their and their babies’ health during pregnancy. The study interviewed 1,104 mothers who had just given birth in four major healthcare facilities in Eastern Uganda. Researchers checked if these mothers received all the services the World Health Organization recommended during their pregnancy. These services include regular health check-ups, education on pregnancy health, and essential vaccinations and tests. Unfortunately, the findings showed that only 6 out of 100 mothers received all the recommended antenatal services. Those who lived in cities between the ages of 20 and 34 or had a history of pregnancy complications were more likely to receive better care. Mothers who delivered at general hospitals also had higher chances of receiving comprehensive care than those at referral hospitals. The study reveals the urgent need for improvement in prenatal care services, especially for younger and rural-dwelling mothers. By ensuring that every mother receives the support she needs for a healthy pregnancy, we can significantly reduce the risks during pregnancy and childbirth. This improvement will not only benefit mothers but also their children, fostering a healthier future for the region.

Keywords

adequate antenatal care antenatal care components antenatal care contacts maternal health services

Background

Maternal and child health outcomes are a significant global issue. Preventable causes related to pregnancy and childbirth lead to about 830 maternal deaths per day worldwide.¹ Almost 99% of these deaths occur in low-income countries, and sub-Saharan Africa (SSA) has the highest maternal and under-5 mortality rates.² Although Uganda’s maternal mortality ratio (MMR) has substantially reduced from 336 per 100,000 live births in 2016 to 189 per 100,000 live births in 2022, it still has one of the highest MMRs globally.³ Widespread access to quality antenatal care (ANC) can prevent most maternal deaths. A recent systematic review showed that ANC reduced the risk of maternal and neonatal mortality by 39% in SSA countries.⁴

Over the last two decades, there has been an increase in the use of ANC services.⁵ However, only the initiation of ANC and the number of visits are insufficient for countries to achieve their maternal health goals. Women must receive adequate ANC with the recommended components.^6,7 Adequate ANC and timing of initial ANC visit are essential for positive pregnancy outcomes.^8,9 The timing, frequency, and components of care provided at each visit determine adequate ANC.¹⁰ WHO recommends eight ANC contacts, with the initial contact in the first trimester of pregnancy, two more in the second trimester (at 20 and 26 weeks), and five in the third trimester (at 30, 34, 36, 38, and 40 weeks).⁸ Although the components of ANC may vary between countries, WHO recommends a set of core services, including history taking and physical examination, health promotion, including offering nutrition advice, planning for birth, and counseling on danger signs of pregnancy, measuring blood pressure, administering tetanus toxoid vaccination, testing urine and blood, providing iron tablet supplementation, and measuring body weight.¹¹

There is a significant shortage of adequate ANC provision in SSA. While at least one ANC appointment is available in 71% of cases, many women do not receive the full range of recommended components during ANC visits.¹² A systematic review of 36 African countries found that ANC utilization was lowest in the Eastern region.¹² In Rwanda, only 27.6% of women received adequate ANC.¹⁰ In Ethiopia, many mothers attended insufficient visits, starting late in pregnancy.¹³ Kawungezi et al.¹⁴ revealed poor ANC usage and quality in rural areas of Uganda, with many women turning to traditional birth attendants for care. Several studies have associated receipt of adequate ANC components with maternal age, marital status, multiparity, type of facility where ANC was conducted, cadre of ANC provider, number of ANC visits attended, maternal education, access to media, previous history of pregnancy complications, household socioeconomic status, and utilization of family planning.^15–17

Uganda’s maternal and newborn clinical care guidelines have incorporated the World Health Organization’s eight ANC contact schedules to improve the pregnancy experience and reduce maternal mortality.¹⁸ Previous studies in Uganda have mainly evaluated aspects of ANC services based on the 4-schedule visit without thoroughly assessing a variety of components as currently included in the new guidelines. According to the latest ANC contact schedule guidelines, adequate ANC services should include completing all eight ANC contacts throughout the pregnancy, having the first visit within 12 weeks of gestation, being conducted by a skilled health worker providing health education, performing ultrasound, measuring blood pressure, conducting blood tests and urinalysis, administering tetanus vaccination, and providing recommended drugs.⁸ This study assessed the receipt of adequate ANC and its associated factors among immediate postpartum mothers across multiple high-volume ANC health facilities in Eastern Uganda, based on the latest eight ANC contact schedule guidelines.

Methods

Study design

This multicenter cross-sectional study, which employed quantitative techniques using a structured questionnaire, was conducted from July to August 2022. This study was conducted in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.¹⁹ The relevant checklist was followed to ensure comprehensive reporting.

Study setting

The study was conducted in four healthcare facilities in Eastern Uganda. Uganda has a hierarchical public health system consisting of five tiers. At the top are national and regional referral hospitals offering specialized services. Below them are district-level general hospitals, followed by sub-district health center IVs. These sub-district facilities serve as referral centers for health center IIIs, IIs, and Village Health Teams or community health workers operating within communities. ANC is generally provided at health center IIIs and higher levels.

The healthcare facilities included in this study were Jinja Regional Referral Hospital (JRRH), Iganga General Hospital (IGH), Mbale Regional Referral Hospital (MRRH), and Kamuli General Hospital (KGH). JRRH, located in Jinja District, has a capacity of 600 beds and performs approximately 500 deliveries per month. IGH, situated in Iganga District, has a capacity of 100 beds and conducts around 550 deliveries per month. MRRH, located in Mbale District, is a referral hospital for 13 districts, with a capacity of 500 beds and approximately 800 monthly deliveries. KGH, situated in Kamuli District, has a capacity of 100 beds and performs about 200 deliveries per month.

Study population

We included postnatal mothers in the above-selected healthcare facilities who had given birth within 48 h, gave informed written consent, and for whom we obtained assent. During the interview, we excluded mothers who could not communicate and those without a record of their ANC information, evidenced by an ANC card or book.

Sample size estimation and sampling procedure

This study analyses data in a broad study assessing compliance with the WHO’s recommended eight or more ANC contacts. The sample size was determined by assuming a 1.9% prevalence of eight or more ANC contacts, obtained from further analysis of the Uganda Demographic Health Survey 2016.¹⁰ We considered a precision of 5% and 95% confidence interval, a non-response rate of 10%, and a design effect of 2. This gave a total sample size of 64 participants. We further calculated the sample size to estimate the factors associated with attending 8+ ANC contacts. Maternal age was used to assess the sample size for factors, using findings from the Uganda Demographic Health Survey 2016, where 61.5% of mothers aged 20–30 years received four or more ANC contacts, while 52.6% of mothers aged 35–49 received four or more ANC contacts. This gave us a maximum sample size of 1104 mothers. Considering the average number of deliveries at each selected hospital, we calculated the sample size per hospital. We recruited 287 from JRRH, 319 from IGH, 337 from MRRH, and 161 from KGH. Consecutive sampling was used to recruit the eligible mothers until the required sample size was attained at each hospital.

Study variables

Dependent variable

The primary outcome of interest was the receipt of adequate ANC, which was constructed by creating a composite index based on 10 core components recommended by the WHO on ANC for a positive pregnancy experience⁸ and adapted by the Uganda Ministry of Health’s Essential Maternal and Newborn Clinical Care Guidelines, as shown in Table 1.¹⁸ All these were coded as “Yes” or “No.” A dichotomous variable was created to indicate receipt of adequate ANC. It was coded 1 for “Yes” if all 10 components were received and 0 for “No” if not.

Table 1.

Components used to assess adequate ANC.

No.	ANC component	Measurement criteria
1	Compliance with eight or more ANC contacts	Receiving the recommended ANC contacts per the gestational age at delivery following current WHO eight ANC contact guidelines, not just the total number of contacts. For example, a mother who delivered at 36 weeks with at least six ANC contacts was compliant
2	First ANC within 12 weeks of gestation	Mother’s first ANC visit occurred within 12 weeks of pregnancy
3	ANC done by a skilled health worker	ANC conducted by a doctor, nurse, or midwife
4	Health education provided	Education on nutrition, immunization, and danger signs provided during ANC contacts
5	Ultrasound scan performed	An ultrasound scan was performed during ANC contacts
6	Blood pressure measured	Blood pressure was measured during ANC contacts
7	Blood tests done	Blood tests for HIV, syphilis, and hepatitis B were conducted
8	Urinalysis done	Urinalysis was performed during ANC contacts
9	Vaccination against tetanus	Vaccination against tetanus was administered
10	Recommended drugs provided	Drugs such as folic acid, iron, and fansidar were given

ANC, antenatal care.

Independent variables

Based on existing literature the following predictor variables were included: age, maternal and paternal education level, marital status, maternal and paternal occupation, religion, residence, health facility of delivery, facility where ANC was done, distance to health facility, insurance coverage, parity, HIV status, and previous/current pregnancy complications.

Data collection and procedure

Data were collected by eight trained research assistants, two at each of the four selected health facilities, using a data entry questionnaire designed through Kobo Toolbox (Cambridge, MA, USA). Kobo Toolbox is an open-source software developed by the Harvard Humanitarian Initiative with support from United Nations Agencies, CISCO, and partners to support data management by researchers and humanitarian organizations (https://www.kobotoolbox.org/).

Research assistants identified eligible mothers in the postnatal ward daily throughout the data collection phase and thoroughly explained the purpose of the study before obtaining participation consent. Interested, eligible participants gave written consent and participated voluntarily. All completed questionnaires were uploaded onto Kobo Toolbox servers.

Statistical analysis

Data were extracted into an Excel sheet, cleaned, coded, and imported to Stata 15.0 (StataCorp LLC, College Station, TX, USA) for analysis. We summarized numerical data as means and standard deviations and categorical data as frequencies and proportions. We conducted multivariable logistic regression to assess factors associated with receipt of adequate ANC care. Factors with a p value less than 0.2 at bivariable analysis, those with biological plausibility, and those known to affect adequate ANC from the literature were added to the multivariable logistic regression model. Statistical significance was set at p value <0.05.

Results

Participant characteristics

Overall, 1104 postnatal mothers participated in the study with a mean age of 26.0 (SD: 6.4) years; most were within the age group of 20–34 years (n = 805, 72.9%). The majority had delivered from a referral hospital (n = 624 56.5%), were married (n = 993, 89.9%), and from an urban setting (n = 574, 52.0%). Most mothers had attained a tertiary education level (n = 502, 45.5%) and had no insurance cover (n = 1043, 94.5%; Table 2).

Table 2.

Socio-demographic characteristics of the participants.

Variable	Total, n (%)	Adequate antenatal care		p Value
Variable	Total, n (%)	No, n (%)	Yes, n (%)	p Value
Overall	1104 (100)	1039 (94.1)	65 (5.9)
Age mean ± SD years	26 ± 6.4
15–19	166 (15.0)	162 (15.5)	4 (6.1)	0.037
20–34	805 (72.9)	749 (72.1)	56 (86.2)
⩾35	133 (12.1)	128 (12.3)	5 (7.7)
Study center
Referral hospital	624 (56.5)	606 (58.3)	18 (27.7)	<0.001
General hospital	480 (43.5)	433 (41.7)	47 (72.3)
Marital status
Single	111 (10.1)	109 (10.5)	2 (3.1)	0.055
Married	993 (89.9)	930 (89.5)	63 (96.9)
Religion
Christian	759 (68.7)	718 (69.1)	41 (63.1)	0.309
Muslim	345 (31.3)	321 (30.9)	24 (36.9)
Mother’s education level
None	32 (2.9)	30 (2.9)	2 (3.1)	0.167
Primary	403 (36.5)	387 (37.2)	16 (24.6)
Secondary	502 (45.5)	468 (45.1)	34 (52.3)
Tertiary	167 (15.1)	154 (14.8)	13 (20.0)
Partner’s education level
None	46 (4.2)	42 (4.0)	4 (6.2)	0.010
Primary	274 (24.8)	268 (25.8)	6 (9.2)
Secondary	496 (44.9)	460 (44.3)	36 (55.4)
Tertiary	288 (26.1)	269 (25.9)	19 (29.2)
Mother’s occupation
Employed	674 (61.1)	635 (61.1)	39 (60.0)	0.858
Unemployed	430 (38.9)	404 (38.9)	26 (40.0)
Partner’s occupation
Employed	937 (84.9)	879 (84.6)	58 (89.2)	0.312
Unemployed	167 (15.1)	160 (15.4)	7 (10.8)
Residence
Rural	530 (48.0)	510 (49.1)	20 (30.8)	0.004
Urban	574 (52.0)	529 (50.9)	45 (69.2)
Distance to a health facility
<1 km	318 (28.8)	298 (28.7)	20 (30.8)	0.775
1–5 km	437 (39.6)	414 (39.8)	23 (35.4)
>5 km	349 (31.6)	327 (31.5)	22 (33.8)
Insurance coverage
Yes	61 (5.5)	54 (5.2)	7 (10.8)	0.056
No	1043 (94.5)	985 (94.8)	58 (89.2)
Parity
Primiparous	399 (36.1)	374 (36.0)	25 (38.5)	0.279
Multiparous	525 (47.5)	491 (47.3)	34 (52.3)
Grand multiparous	180 (16.3)	174 (6.7)	6 (9.2)
Planned pregnancy
Yes	795 (72.0)	749 (72.1)	46 (70.8)	0.818
No	309 (28.0)	290 (27.9)	19 (29.2)
HIV status
Positive	79 (7.2)	78 (7.5)	1 (1.5)	0.110
Negative	1005 (91.0)	941 (90.6)	64 (98.5)
Unknown	20 (1.8)	20 (1.9)	0 (0)
Antenatal care facility type
Public hospital	1021 (92.5)	965 (92.9)	56 (86.2)	0.046
Private hospital	83 (7.5)	74 (7.1)	9 (13.8)
Current or previous obstetric complications
Yes	266 (24.09)	243 (23.39)	23 (35.38)	0.028
No	838 (75.91)	796 (76.61)	42 (64.62)

Adequate ANC among immediate postpartum mothers in Eastern Uganda

Out of 1104 participants, only 65 (5.9%) received all the 10 assessed ANC components, thus deemed adequate ANC. On average, the participants received 6.9 ± 2.0 components. About 85% received at least half of the 10 components (Figure 1).

Figure 1.

Percentage of mothers receiving specific numbers of ANC components. “Receiving X components” (dotted line) refers to the percentage of mothers who received exactly that number of ANC components, while “Receiving at least X components” (dashed line) represents the cumulative percentage of mothers who received X or more ANC components. The mean number of ANC components received was 6.9 (±2.0).

Almost all participants (n = 1103, 99.9%) were attended to by a skilled healthcare worker, 32.4% (358) had the first ANC contact within the first 12 weeks of gestation, 23.4% (258) were a complaint to the WHO-recommended 8+ ANC contacts schedule, 79.9% (882) were health educated about the nutrition and immunization and danger signs of pregnancy, 90.7% (1001) had their blood pressure measured during ANC visits, 62.2% (687) did an ultrasound scan during ANC, 81.5% (900) received the tetanus toxoid vaccine, and 81.8% (903) were given required medications including folic acid, fansidar (sulfadoxine/pyrimethamine), and iron (Figure 2).

Figure 2.

Percentage of participants per component received during their ANC visits.

Factors associated with receiving adequate ANC among immediate postpartum mothers in Eastern Uganda

Mothers between the ages of 20 and 34 had 3.5 times (AOR: 3.5; 95% CI: 1.07–11.30, p = 0.038), and those from urban areas had 2.3 times the odds of receiving adequate ANC care (Adjusted Odds Ratio (AOR): 2.3; 95% CI: 1.16–4.38, p = 0.017). Mothers with current or previous complications had 80% more odds of receiving adequate ANC care (AOR: 1.8; 95% CI: 1.02–3.29, p = 0.043). Mothers who delivered from a general hospital had 4.8 times the odds of receiving adequate ANC care (AOR: 4.8; 95% CI: 2.60–8.83, p < 0.001; Table 3).

Table 3.

Multivariable logistic regression analysis showing factors associated with receiving adequate ANC.

Variable	AOR	95% CI	p Value
Age (years)
15–19	Ref
20–34	3.5	1.07–11.30	0.038
⩾35	3.7	0.73–19.12	0.114
Marital status
Single	Ref
Married	2.0	0.43–9.08	0.376
Religion
Christian	Ref
Muslim	1.2	0.67–2.015	0.589
Study center
Referral hospital	Ref
General hospital	4.8	2.60–8.83	<0.001
Maternal education
None/primary	Ref
Secondary/tertiary	1.2	0.60–2.36	0.621
Paternal education
None/primary	Ref
Secondary/tertiary	1.8	0.82–3.91	0.147
Maternal occupation
Employed	Ref
Unemployed	1.3	0.69–2.26	0.445
Paternal occupation
Employed	Ref
Unemployed	1.9	0.77–4.80	0.162
Residence
Rural	Ref
Urban	2.3	1.16–4.38	0.017
Distance to health facility (km)
<1	Ref
1–5	1.4	0.70–2.72	0.351
>5	1.9	0.89–4.00	0.095
Insurance coverage
Yes	Ref
No	0.6	0.21–1.51	0.256
Parity
1	Ref
2–4	0.7	0.39–1.33	0.300
⩾5	0.4	0.13–1.34	0.142
HIV status
Positive	Ref
Negative	3.6	0.48–27.10	0.215
ANC facility type
Public hospital	Ref
Private hospital	1.7	0.71–3.87	0.248
Planned pregnancy
Yes	Ref
No	1.8	0.956–3.23	0.070
Current or previous complications
No	Ref
Yes	1.8	1.02–3.29	0.043

ANC, antenatal care; AOR, Adjusted Odds Ratio. Bolded values represent statistically significant variables at p<0.05.

Discussion

This study analyzed the provision of adequate ANC based on new guidelines of goal-oriented ANC, which recommend a minimum of eight antenatal contacts during pregnancy. Only 5.9% of the participants had received adequate ANC. Despite being low, this was better than that reported in Western Uganda, where no mother received adequate ANC.²⁰ This study was conducted at only district-level public hospitals, while ours included district and regional referral levels. The difference in ANC adequacy may reflect varying service quality and unique socio-cultural factors affecting ANC use across regions that warrant deeper investigations. A comparatively higher rate of adequate ANC (36%) was reported among adolescent mothers in rural Eastern Uganda.²¹ However, this study did not include the timing of ANC and compliance with either four or eight ANC visits in their assessment. Higher percentages were reported from Rwanda’s Demographic Health Survey analysis for 2022 (27.62%)¹⁰ and Bangladesh for 2014 (22%).¹¹ These studies were based on their assessment of the previous four ANC visit recommendations and assessed fewer components of those recommended for ANC—3 and 6 components, respectively—compared to the 10 we assessed. The variability in variables used to assess ANC’s quality and/or adequacy in different studies makes an objective comparison difficult.

In this study, although few mothers received all 10 ANC components, on average, they received 6.9 components, and at least 85% received half. This highlights that while the number of women receiving comprehensive ANC is low, there is potential for improvement with further efforts. Notably, patients were less likely to comply with the eight ANC contacts (23.4%) and initiate ANC within 12 weeks of gestation (32.4%) compared to components such as measuring blood pressure (90.7%), conducting blood tests (81.9%), and providing necessary medications (81.8%). This reveals that health workers and the system are trying to perform their roles. In accordance, an analysis of the 2016 Demographic Health Survey of Uganda showed that the majority of high-parity women (73%)²² and adolescent mothers in rural Uganda alike (53%)²¹ seek ANC late and are likely to miss out on critical interventions. Although healthcare providers may schedule antenatal visits for mothers, the timing and number of visits are determined by individual factors.²⁰ Health workers play a crucial role in providing ANC information and sensitization to the community¹⁴; therefore, they should be encouraged and empowered to carry out this task.

We found that mothers between the ages of 20 and 34 years were almost four times more likely to obtain adequate ANC than adolescents (15–19 years). Similarly, a study from Ethiopia reported that mothers above 20 years were more likely to start on time and utilize adequate ANC.²³ Several other studies from Uganda,²¹ Ethiopia,²⁴ and Nigeria²⁵ have revealed a similar negative association between younger ages with compliance to ANC schedules and receipt of adequate ANC care. This highlights the need for targeted interventions and reinforced efforts aimed at this group. It is possible that the low levels of knowledge of ANC among young mothers could be a contributing factor. However, conducting in-depth qualitative studies to fully understand the underlying factors mediating poor ANC utilization among younger mothers is crucial.

Furthermore, mothers from urban areas were twice as likely to receive adequate ANC care than their rural counterparts. Several other previous studies have reported similar findings.^26–30 Factors typical to rural areas, such as financial constraints that hinder their transportation to the facilities and longer distances to facilities among others, could be contributing factors.²⁶ A multicenter study focused on rural areas in Uganda revealed misconceptions and poor ANC utilization practices that need to be addressed through increased awareness and education. It further highlighted the importance of husbands’ support in utilizing ANC.¹⁴

Mothers with current or previous complications had 80% more chances of receiving adequate ANC care. This is in agreement with another study conducted in India.³¹ Studies suggest that women who have experienced miscarriages tend to exhibit better health-seeking behaviors and are more punctual when it comes to accessing ANC services.^32–34 This is particularly important, as early initiation of ANC allows for timely monitoring of the fetus and provides necessary support to women with poor obstetric history and complications.

Mothers who delivered at a general hospital were 4.8 times more likely to have received adequate ANC compared to those who delivered at a referral hospital. Like many other low-income countries, in Uganda, many mothers who give birth at referral hospitals are referred from lower centers due to complicated labor. This is not surprising that they could have not received adequate ANC considering that poor utilization of ANC has been linked to unfavorable perinatal outcomes.³⁵

Strengths and limitations

This study was conducted at four healthcare facilities with a large sample size, which enhances our findings’ precision and increases the study population’s diversity and the ability to generalize the findings. The study focused on immediate postpartum mothers and ensured the availability of their ANC card records. This controlled recall bias provides concrete and context-specific insight into ANC. In addition, the study used a composite index based on 10 core components, as recommended by the World Health Organization and adapted by the Uganda Ministry of Health. This comprehensive assessment of adequate ANC is grounded in recognized international and local guidelines, making the study more relevant to policy and practice. However, the study is not without limitations. The study focused on high-volume ANC health facilities, which may not represent those in remote or lower-volume areas, potentially leading to overestimating ANC adequacy. In addition, the short data collection period could introduce temporal biases, limiting the ability to capture seasonal variations in service utilization. Furthermore, the lack of standardization in variables used to assess ANC adequacy across studies complicates comparisons between contexts and settings.

Conclusion

The study reveals inadequate ANC among immediate postpartum mothers in Eastern Uganda. This low ANC adequacy mainly arises from non-adherence to the eight-visit schedule and not initiating ANC within the first 12 weeks of pregnancy, critical components that support the provision of adequate ANC. Addressing barriers that prevent timely and consistent access to ANC is necessary. Interventions should focus on educating expectant mothers about the importance of early and regular ANC visits through community-based campaigns and making these services more accessible through mobile health initiatives, especially to younger and rural-dwelling mothers less likely to receive adequate care. The findings also reveal an active healthcare-seeking behavior among mothers with previous complications. Healthcare practitioners should focus on personalized patient education and follow-up for high-risk and young mothers. We advocate for a dual approach to enhancing ANC services at health facilities and empowering mothers to engage more proactively in utilizing the services.

Supplemental Material

sj-docx-1-reh-10.1177_26334941241305074 – Supplemental material for Determinants of adequate antenatal care among immediate postpartum mothers in Eastern Uganda: a multicenter cross-sectional study

Supplemental material, sj-docx-1-reh-10.1177_26334941241305074 for Determinants of adequate antenatal care among immediate postpartum mothers in Eastern Uganda: a multicenter cross-sectional study by Seungwon Lee, Ritah Nantale, Solomon Wani, Samuel Kasibante and Andrew Marvin Kanyike in Therapeutic Advances in Reproductive Health

Footnotes

Acknowledgements

We would like to thank the research assistants and village health team members who participated in this research study. We also extend gratitude to the Communities for Childbirth International administrator Musana Sophie who coordinated the data collection activities.

Declarations

ORCID iDs

Ritah Nantale

Samuel Kasibante

Andrew Marvin Kanyike

Supplemental material

The STROBE checklist for this study is provided as supplemental material available online.

References

Andegiorgish

Elhoumed

, et al. Determinants of antenatal care use in nine sub-Saharan African countries: a statistical analysis of cross-sectional data from Demographic and Health Surveys. BMJ Open 2022; 12(2): e051675.

World Health Organization. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division, https://www.who.int/publications/i/item/9789240068759 (2023, accessed 1 April 2024).

Ministry of Health. National Annual Maternal and Perinatal Death Surveillance and Response (MPDSR) Report FY 2022/2023, www.health.go.ug (2023, accessed 15 November 2024).

Tekelab

Chojenta

Smith

, et al. The impact of antenatal care on neonatal mortality in sub-Saharan Africa: a systematic review and meta-analysis. PLoS One 2019; 14(9): e0222566.

Victora

Requejo

Barros

AJD

, et al. Countdown to 2015: a decade of tracking progress for maternal, newborn, and child survival. Lancet 2016; 387(10032): 2049–2059.

Kanyangarara

Munos

Walker

Quality of antenatal care service provision in health facilities across sub-Saharan Africa: evidence from nationally representative health facility assessments. J Glob Health 2017; 7(2): 021101.

Ssetaala

Nabawanuka

Matovu

, et al. Components of antenatal care received by women in fishing communities on Lake Victoria, Uganda: a cross sectional survey. BMC Health Serv Res 2020; 20(1): 901.

World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: summary, https://apps.who.int/iris/bitstream/handle/10665/259947/WHO-RHR-18.02-eng.pdf (2018, accessed 10 February 2023).

Kisuule

Kaye

Najjuka

, et al. Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda. BMC Pregnancy Childbirth 2013; 13(1): 121.

10.

Tengera

Nyirazinyoye

Meharry

, et al. Factors associated with receipt of adequate antenatal care among women in Rwanda: a secondary analysis of the 2019–20 Rwanda Demographic and Health Survey. PLoS One 2023; 18: e0284718.

11.

Islam

Masud

MS.

Determinants of frequency and contents of antenatal care visits in Bangladesh: assessing the extent of compliance with the WHO recommendations. PLoS One 2018; 13(9): e0204752.

12.

Tessema

Teshale

Tesema

, et al. Determinants of completing recommended antenatal care utilization in sub-Saharan from 2006 to 2018: evidence from 36 countries using Demographic and Health Surveys. BMC Pregnancy Childbirth 2021; 21(1): 192.

13.

Abosse

Woldie

Ololo

Factors influencing antenatal care service utilization in hadiya zone. Ethiop J Health Sci 2011; 20(2): 75–82.

14.

Kawungezi

AkiiBua

Aleni

, et al. Attendance and utilization of antenatal care (ANC) services: multi-center study in upcountry areas of uganda. Open J Prev Med 2015; 5(3): 132–142.

15.

Bbaale

Factors influencing childhood immunization in Uganda. J Heal Popul Nutr 2013; 31(1): 118–127.

16.

Okedo-Alex

Akamike

Ezeanosike

, et al. Determinants of antenatal care utilisation in sub-Saharan Africa: a systematic review. BMJ Open 2019; 9(10): e031890.

17.

Woldegiorgis

Hiller

Mekonnen

, et al. Determinants of antenatal care and skilled birth attendance in sub-Saharan Africa: a multilevel analysis. Health Serv Res 2019; 54(5): 1110–1118.

18.

Ministry of Health. Essential maternal and newborn clinical care guidelines for Uganda, http://154.72.196.19/sexual-and-reproductive-health/maternal-health/essential-maternal-and-newborn-clinical-care (2022, accessed 15 November 2024).

19.

von Elm

Altman

Egger

, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Prev Med (Baltim) 2007; 45(4): 247–251.

20.

Muwema

Kaye

Edwards

, et al. Perinatal care in Western Uganda: prevalence and factors associated with appropriate care among women attending three district hospitals. PLoS One 2022; 17(5): e0267015.

21.

Kayemba

Kabagenyi

Ndugga

, et al. Timing and quality of antenatal care among adolescent mothers in a rural community, Uganda. Adolesc Health Med Ther 2023; 14: 45–61.

22.

Tumwizere

Mbonye

Ndugga

Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey. BMC Pregnancy Childbirth 2024; 24(1): 32.

23.

Gudayu

Woldeyohannes

Abdo

AA.

Timing and factors associated with first antenatal care booking among pregnant mothers in Gondar Town; North West Ethiopia. BMC Pregnancy Childbirth 2014; 14(1): 287.

24.

Tariku

Melkamu

Kebede

Previous utilization of service does not improve timely booking in antenatal care: cross sectional study on timing of antenatal care booking at public health facilities in Addis Ababa. Ethiop J Heal Dev 2011; 24(3): 226–232.

25.

Ebeigbe

Igberase

GO.

Reasons given by pregnant women for late initiation of antenatal care in the niger delta, Nigeria. Ghana Med J 2010; 44(2): 47–51.

26.

Yaya

Bishwajit

Ekholuenetale

, et al. Timing and adequate attendance of antenatal care visits among women in Ethiopia. PLoS One 2017; 12(9): e0184934.

27.

Gebremeskel

Dibaba

Admassu

Timing of first antenatal care attendance and associated factors among pregnant women in Arba Minch Town and Arba Minch District, Gamo Gofa Zone, South Ethiopia. J Environ Public Health 2015; 2015: 971506.

28.

Gupta

Yamada

Mpembeni

, et al. Factors associated with four or more antenatal care visits and its decline among pregnant women in Tanzania between 1999 and 2010. PLoS One 2014; 9(7): e101893.

29.

Joshi

Torvaldsen

Hodgson

, et al. Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data. BMC Pregnancy Childbirth 2014; 14: 94.

30.

Fagbamigbe

Idemudia

ES.

Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey. Reprod Health 2015; 12: 88.

31.

Chandra Sekhar

. Profile of antenatal care among pregnant women attending outpatient clinics in a rural based medical college. Int J Sci Res 2023; 12: 8–10.

32.

Bicking Kinsey

Baptiste-Roberts

Zhu

, et al. Effect of multiple previous miscarriages on health behaviors and health care utilization during subsequent pregnancy. Womens Health Issues 2015; 25(2): 155–161.

33.

Brezina

Kutteh

WH.

Recurrent early pregnancy loss. In: Falcone

Hurd

(eds). Clinical reproductive medicine and surgery. Cham: Springer International Publishing; 2017, pp. 269–288.

34.

Hutti

Armstrong

Myers

Healthcare utilization in the pregnancy following a perinatal loss. MCN Am J Matern Nurs 2011; 36(2): 104–111.

35.

Awoleke

Olofinbiyi

BA.

Poor prenatal service utilization and pregnancy outcome in a tertiary health facility in Southwest Nigeria. Pan Afr Med J 2020; 35: 28.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.03 MB