Determinants of subnational disparities in antenatal care utilisation : a spatial analysis of demographic and health survey data in Kenya

Wairoto, Kefa G. and Joseph, Noel K. and Macharia, Peter M. and Okiro, Emelda A. (2020) Determinants of subnational disparities in antenatal care utilisation : a spatial analysis of demographic and health survey data in Kenya. BMC Health Services Research, 20 (1): 665. ISSN 1472-6963

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Background: The spatial variation in antenatal care (ANC) utilisation is likely associated with disparities observed in maternal and neonatal deaths. Most maternal deaths are preventable through services offered during ANC; however, estimates of ANC coverage at lower decision-making units (sub-county) is mostly lacking. In this study, we aimed to estimate the coverage of at least four ANC (ANC4) visits at the sub-county level using the 2014 Kenya Demographic and Health Survey (KDHS 2014) and identify factors associated with ANC utilisation in Kenya. Methods: Data from the KDHS 2014 was used to compute sub-county estimates of ANC4 using small area estimation (SAE) techniques which relied on spatial relatedness to yield precise and reliable estimates at each of the 295 sub-counties. Hierarchical mixed-effect logistic regression was used to identify factors influencing ANC4 utilisation. Sub-county estimates of factors significantly associated with ANC utilisation were produced using SAE techniques and mapped to visualise disparities. Results: The coverage of ANC4 across sub-counties was heterogeneous, ranging from a low of 17% in Mandera West sub-county to over 77% in Nakuru Town West and Ruiru sub-counties. Thirty-one per cent of the 295 sub-counties had coverage of less than 50%. Maternal education, household wealth, place of delivery, marital status, age at first marriage, and birth order were all associated with ANC utilisation. The areas with low ANC4 utilisation rates corresponded to areas of low socioeconomic status, fewer educated women and a small number of health facility deliveries. Conclusion: Suboptimal coverage of ANC4 and its heterogeneity at sub-county level calls for urgent, focused and localised approaches to improve access to antenatal care services. Policy formulation and resources allocation should rely on data-driven strategies to guide national and county governments achieve equity in access and utilisation of health interventions.

Item Type:
Journal Article
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BMC Health Services Research
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Funding Information: Funding was provided to EAO as part of her Wellcome Trust Intermediate Fellowship (number 201866); KGW, NKJ, PMM, and EAO, acknowledge the support of the Wellcome Trust to the Kenya Major Overseas Programme (number 203077); PMM and KGW acknowledges support for their PhD and PgDip respectively through the DELTAS Africa Initiative [DEL-15-003]. The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)'s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [number 107769/Z/10/Z] and the UK government. Additional support provided by Wellcome Trust Principal fellowship to Professor Robert W Snow (numbers 103602 and 212176). The views expressed in this publication are those of the authors and not necessarily those of AAS, NEPAD Agency, Wellcome Trust or the UK government. The funder of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Publisher Copyright: © 2020 The Author(s).
Uncontrolled Keywords:
?? antenatal caredeterminantskenyamappingspatial variationsub-nationalhealth policy ??
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22 Aug 2022 10:50
Last Modified:
15 Jul 2024 22:51