Factors associated with antenatal care utilization among women of reproductive age in Sub- Saharan Africa: a systematic review and meta-analysis report from 2016-2023

Abstract

Background: Despite the recommendations by the World Health Organization (WHO), antenatal care utilization among women in sub-Saharan Africa remains sub-optimal. Antenatal care (ANC) is the routine care provided to women with a confirmed pregnancy status by a skilled healthcare provider. Maternal and Neonatal deaths are public health concerns that antenatal care utilization (ANC) seeks to address. The United Nations’ SDG global target 3.1. and 3.8. aims to reduce the Maternal Mortality Ratio to less than 70 per 100 000 viable births by 2030. Antenatal Care aims to optimize health outcomes by reducing undesirable maternal and neonatal health outcomes. This study aims to characterize (determine and describe) factors associated with antenatal care utilization among women of reproductive age in sub- Saharan Africa from 2016-2023 through literature synthesis and meta-analysis. Methods: A data search from PubMed, Google Scholar, EBSCO-Host (Global health), ProQuest (Public health), SABINET African Journals and Scopus databases using keywords was conducted. Critical appraisal and data extraction was conducted by two reviewers (M.M and M.M) working independently of each other in Joanna Briggs Institute System for the Unified Management, Assessment, and Review Information (JBI SUMARI). For meta-analysis, a random effects model was used for pooled prevalence proportions of antenatal care utilization based on attendance, optimal timing and optimal number of visits. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I2 statistics. To assess for publication bias, funnel plot and Egger’s test were conducted at 95% CI and p-value=0.05 significance level. Results: A total of 15 observational cross-sectional studies were included in this study from 14 countries in SSA. The pooled prevalence estimates of antenatal care attendance were 59.1% (95% CI: 39.0%, 79.3%), optimal timing 36.8% (95% CI: 29.0%, 44.6%) and optimal number of visits were 20.3 (95% CI: 14.4%, 26.2%). Factors that were found to influence antenatal care utilization as identified by the number of studies included for analysis were: maternal age 100%, maternal education 93.3%, partner’s education 40%, household size 26.7%, household headship 20%, birth order 40%, ethnicity 20%, religion 46.7%, employment status 53.3%, wealth index 73.3%, marital status 80%, residence 100%, distance from the healthcare facility 46.7%, media exposure 46.7%, parity 60%, and health insurance 46.7%. Conclusion: The synthesized studies elucidated the pooled prevalence estimates and factors associated with ANC utilization, providing a comprehensive understanding of the socio- demographic, economic, and healthcare-related determinants shaping maternal health- seeking behaviors. The findings call for policymakers, healthcare practitioners, and researchers alike, to advocate for multifaceted interventions aimed at addressing structural, socioeconomic, and healthcare-related barriers to enhance ANC access, thereby fostering equitable and inclusive maternal healthcare provision.