Socio-demographic factors associated with early antenatal care visits among pregnant women in Malawi: 2004-2016

• Published in: PloS one 2022-02, Vol.17 (2), p.e0263650-e0263650
• Main Authors: Ng'ambi, Wingston Felix, Collins, Joseph H, Colbourn, Tim, Mangal, Tara, Phillips, Andrew, Kachale, Fannie, Mfutso-Bengo, Joseph, Revill, Paul, Hallett, Timothy B
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biology and Life Sciences; Birth; Bivariate analysis; Demographic variables; Demographics; Demography; Earth Sciences; Economics; Education; Educational Status; Evaluation; Female; Gestational age; Health aspects; Health economics; Health sciences; Health services; Health surveys; Households; Humans; Infectious diseases; Likelihood ratio; Malawi - epidemiology; Maternal & child health; Maternal health services; Maternal mortality; Medical care; Medicine and Health Sciences; Middle Aged; Multivariate analysis; Patient Acceptance of Health Care - statistics & numerical data; People and Places; Polls & surveys; Pregnancy; Pregnant Women; Prenatal care; Prenatal Care - psychology; Prenatal Care - statistics & numerical data; Prenatal Care - trends; Psychological aspects; Quality management; Questionnaires; Regression analysis; Reproductive health; Rural areas; Social Sciences; Sociodemographic Factors; Sociodemographics; Socioeconomic Factors; Socioeconomics; Statistical analysis; Tertiary; Womens health; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0263650

In 2016, the WHO published recommendations increasing the number of recommended antenatal care (ANC) visits per pregnancy from four to eight. Prior to the implementation of this policy, coverage of four ANC visits has been suboptimal in many low-income settings. In this study we explore socio-demographic factors associated with early initiation of first ANC contact and attending at least four ANC visits ("ANC4+") in Malawi using the Malawi Demographic and Health Survey (MDHS) data collected between 2004 and 2016, prior to the implementation of new recommendations. We combined data from the 2004-5, 2010 and 2015-16 MDHS using Stata version 16. Participants included all women surveyed between the ages of 15-49 who had given birth in the five years preceding the survey. We conducted weighted univariate, bivariate and multivariable logistic regression analysis of the effects of each of the predictor variables on the binary endpoint of the woman attending at least four ANC visits and having the first ANC attendance within or before the four months of pregnancy (ANC4+). To determine whether a factor was included in the model, the likelihood ratio test was used with a statistical significance of P< 0.05 as the threshold. We evaluated data collected in surveys in 2004/5, 2010 and 2015/6 from 26386 women who had given birth in the five years before being surveyed. The median gestational age, in months, at the time of presenting for the first ANC visit was 5 (inter quartile range: 4-6). The proportion of women initiating ANC4+ increased from 21.3% in 2004-5 to 38.8% in 2015-16. From multivariate analysis, there was increasing trend in ANC4+ from women aged 20-24 years (adjusted odds ratio (aOR) = 1.27, 95%CI:1.05-1.53, P = 0.01) to women aged 45-49 years (aOR = 1.91, 95%CI:1.18-3.09, P = 0.008) compared to those aged 15-19 years. Women from richest socio-economic position ((aOR = 1.32, 95%CI:1.12-1.58, P