Quality of Antenatal Care and Associated Factors Among Pregnant Women in East Africa: Evidence from Demographic and Health Surveys (2008 to 2018)

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Abstract Introduction: Antenatal care (ANC) offers a forum for critical healthcare functions, including health education, screening and diagnosis, and disease prevention. According to WHO, "Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with evidence-based professional knowledge. Several pocket studies carried out in specific localities of East African countries were investigated factors influencing the ANC utilization. However, these factors were neither representative of the country nor specific to the recommended minimum of four ANC visits. Therefore, this study aimed to estimate the overall magnitude and factors associated with ANC quality among pregnant women in the six East African Countries from 2008 to 2018 data of Demographic and Health Surveys (DHS).Methods: A secondary data analysis was done using DHS data of six East African Countries from 2008 to 2018. A total weighted sample of 46,656 women who gave birth in the five years preceding the survey was included in this study. A multilevel mixed effect logistic regression model was fitted. Variables with a p-value<0.05 were declared significant factors associated with the quality of ANC.Results: The overall magnitude of quality of ANC in the six East African Countries was 11.16% (95% CI: 10.87-11.45). An average age of the women was 28.95. Women of age 20-34 (AOR= 1.29; 95% CI; 1.11-1.50), 35-49 (AOR = 1.51; 95% CI; 1.25-1.80), primary education (AOR = 1.35; 95% CI; 1.18-1.55), richest wealth index (AOR = 2.35; 95% CI; 2.02-2.74), being in rural resident (AOR = 0.62; 95% CI; 0.55,0.69), and living in Rwanda (AOR = 3.03; 95% CI; 2.52-3.66) were factors significantly associated with quality of ANC.Conclusion and Recommendations: The magnitude of ANC quality was low in the East African countries. Age, level of education, wealth index, birth order, husband/partners' level of education, residence, and living countries were factors associated with ANC quality. It would be helpful to increase financial support strategies that enable mothers from poor households to use health services and enhance women's understanding of the significance of ANC utilization through health education; targeting both women and partners with no education is crucial.

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