Assessment of effective coverage of antenatal care and factors affecting its outcome in Ethiopia

Abstract

Background: Antenatal care services play a pivotal role in mitigating maternal and new-born morbidity and mortality. In the era of SDG, emphasis has been given to quality. To achieve these health goals, it is no longer sufficient to measure the coverage of service uptake; thus, the quality of care received by people who access services needs to be counted using Effective coverage (EC) as one quality measurements. This study aimed to measure Effective coverage of antenatal care services and factors affecting the outcome in Ethiopia. Methods: This study used secondary datasets from two cross-sectional surveys: the National Health Equity, a household study focused on pregnant women within five years of the survey; and the Service Provision Assessment, a study in facilities offered antenatal care. Data were analyzed using STATA v18. The datasets were merged and linked ecologically at the regional level. Logistic regression analysis was employed to identify determinant factors. Results: The study revealed that 63% of pregnant women had at least one ANC visit while 34% had four or more. Of the total 865 facilities analyzed, 77% were prepared to offer ANC services. The input-adjusted ANC coverage was 48.7%, while the intervention-adjusted coverage was 16.3%, and the Effective coverage of ANC was 12.3%. Pregnant women lacked formal education (AOR = 2.09; 95% CI = 1.66, 2.63), who lived in pastoral regions had AOR: 2.14 (95% CI: 1.50–3.06) and were in the poorest wealth quintile (AOR = 5.56; 95% CI = 4.19, 7.37) were more likely to have low utilization of Effective coverage. Women who reside within 10 km radius to health facility (AOR = 0.33; 95% CI = 0.29, 0.38) and urban residents (AOR = 0.77; 95% CI = 0.64, 0.93) were less likely to have low Effective coverage. Conclusion: Overall, the antenatal care Effective coverage in Ethiopia is low. This could be due to low service contact coverage and high dropout during the antenatal follow-up period. Access to facilities and socio-demographic variables also affect the effectiveness of coverage. To increase the numbers of ANC visits and their completion, providing comprehensive and continuous education to the community are needed and the health system should refocus on improving the quality of ANC services.