Document
Metadata
Category
Medical and Health Sciences
Authors
Hamse Adam Abdi, Abdulkadir Mohamed Nuh, Hamse Arab, Abdisalam Hassan Muse & Osman Mohmed Osman
Title
Determinants of Complete Quality Antenatal Care in Sub-Saharan Africa: A Multilevel Analysis of Demographic and Health Surveys from 28 Countries
Journal
Frontiers in Global Women's Health
Year of Publication
2026
DOI
DOI: 10.3389/fgwh.2026.1845317
Abstract
Abstract Background: Quality in ANC is assessed by the number of recommended ANC services a woman receives during pregnancy, including blood pressure checks, taking the woman’s urine and blood samples as well as the receipt of iron supplement. The World Health Organization (WHO) recommends that to make ANC services an effective preventive measure, the content and quality of care should be routinely monitored. Methods: A total of 394,067 of women who gave birth five years before the survey were included. We used STATA version 17 for data management and analysis. A multilevel logistic regression model was fitted. Finally, the Adjusted Odds Ratio with its 95% CI confidence interval was reported. Statistical significance was declared at P-value < 0.05. Results: Complete quality of ANC was significantly higher among women with primary (aOR 1.63, 95% CI 1.59–1.66), secondary (2.31, 2.26–2.37), or higher education (2.99, 2.84–3.15), and those in poorer (1.05, 1.03–1.08), richer (1.04, 1.01–1.07), or richest households (1.14, 1.10–1.18), and among women with pregnancies wanted later (1.25, 1.23–1.28); it was lower among women with unwanted pregnancies (0.54, 0.53–0.56), those working (0.90, 0.89–0.92), exposed to media (0.97, 0.95–0.99), living in female-headed households (0.96, 0.94–0.98), and all non–never-married women (married 0.67, 0.63–0.71; cohabiting 0.68, 0.64–0.72; widowed 0.38, 0.33–0.43; divorced 0.66, 0.60–0.74; separated 0.63, 0.57–0.68). Conclusion: The study demonstrates that fewer than two out of ten women in Sub-Saharan Africa receive all recommended antenatal care components, indicating low coverage. Key determinants of complete antenatal care were identified, including household wealth, maternal education, pregnancy intention, marital status, media exposure, sex of the household head, and maternal employment status