Determinants of attendance in antenatal care clinics in rural settings in Mali and Burkina Faso: a cross-sectional study

Bognini, Joel D., Koita, Kadiatou, N’takpe, Jean-Baptiste, Bihoun, Biébo, Dembélé, Mahamadou, Coulibaly, Oumou, Rouamba, Toussaint, Agboraw, Efundem, Traoré, Sirima, Scaramuzzi, Dario, Worrall, Eve ORCID: https://orcid.org/0000-0001-9147-3388, Hill, Jenny ORCID: https://orcid.org/0000-0003-1588-485X, Kayentao, Kassoum, Tinto, Halidou and Briand, Valérie (2025) 'Determinants of attendance in antenatal care clinics in rural settings in Mali and Burkina Faso: a cross-sectional study'. BMC Pregnancy and Childbirth, Vol 25, Issue 1, p. 441.

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Abstract

Background
Since 2016, the World Health Organization (WHO) has recommended a minimum of eight antenatal care (ANC) contacts during pregnancy, replacing the previous recommendation of four focused ANC visits. In Mali and Burkina Faso, the four ANC visits are still recommended and their coverage remains low or insufficient. To anticipate possible obstacles to the implementation of the new recommendations, this study aimed to identify the individual determinants of ANC attendance in two study districts, with a representative sample of women recruited from the community.

Methods
Data were collected in June 2022 through a three-stage household survey with a representative sample of women who delivered in the previous 12 months in the health districts of Kangaba (Mali) and Boussé (Burkina Faso). Country-specific analyses were performed using self-reported data. Women’s sociodemographic and clinical characteristics, as well as attitudes towards ANC attendance, were described to account for clustering. Multivariable logistic regression models using generalized estimating equations were used to identify the determinants of four or more ANC uptakes. A p-value < 0.05 was considered statistically significant in the adjusted model.

Results
Overall, 1590 women participated (780 in Mali; 810 in Burkina Faso) in the study. Women in Burkina Faso were older and less educated than women in Mali. The proportions of women with at least four ANC visits were 80% and 54%, and that of ANC in the first trimester was 38.7% and 43.8% in Burkina Faso and Mali respectively. Factors significantly associated with a greater probability of women attending ANC4 + visits were found only in Mali: a history of stillbirth and time spent at ANC. Factors reducing the use of ANC4 + were the lack of transportation/distance in Burkina Faso, travel time of less than 1 h to reach the maternity clinic, women’s nonrecognition of the importance of ANC visits, and the perceived high cost of the ANC visit in both countries.

Conclusion
ANC was lower in Mali than in Burkina Faso. Health policies aimed at achieving the WHO recommendation of 8 ANC contacts should prioritize health information and sensitization of pregnant women to improve their knowledge of the importance of attending ANC several times.

Item Type:	Article
Subjects:	WA Public Health > WA 30 Socioeconomic factors in public health (General) WA Public Health > Health Problems of Special Population Groups > WA 310 Maternal welfare
Faculty: Department:	Biological Sciences > Vector Biology Department Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1186/s12884-025-07568-2
SWORD Depositor:	JISC Pubrouter
Depositing User:	JISC Pubrouter
Date Deposited:	28 Apr 2025 11:05
Last Modified:	28 Apr 2025 11:05
URI:	https://archive.lstmed.ac.uk/id/eprint/26549

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