Factors Associated with Adequate Antenatal Care Use Among Women of Childbearing Age in Burkina Faso: Finding From the 2010 and 2021 Demographic and Health Surveys

doi:10.21203/rs.3.rs-4693848/v1

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Factors Associated with Adequate Antenatal Care Use Among Women of Childbearing Age in Burkina Faso: Finding From the 2010 and 2021 Demographic and Health Surveys

https://doi.org/10.21203/rs.3.rs-4693848/v1

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Introduction: Antenatal care (ANC) is a critical determinant of maternal and infant well-being and is a reliable method for reducing maternal and infant mortality. This study aimed to determine individual, family and community factors associated with the ANC use in 2010 and 2021.

Method: The data used in this study is procured from the Demographic and Health Surveys carried out in Burkina Faso in 2010 and 2021. Binary logistic regression analysis was used to analyse factors associated with the use of prenatal care. Adjusted odds ratios (AOR) were estimated to assess the strength of associations, and 95% confidence intervals were used for significance testing. A proportion test was used to examine differences in ANC utilisation between 2010 and 2021 in Burkina Faso. The data were cleaned, coded and analysed using Stata version 16.1 software.

Results: In our study sample, 22.92% of the respondents in 2010 had adequate ANC use, compared to 46.34% in 2021. The results demonstrate the influence of the woman’s individual characteristics, the household and the community characteristics on the adequate ANC use in Burkina Faso. Regarding the woman’s individual characteristics, age, educational level, marital status, occupation and modern contraceptive methods use were significantly associated with adequate ANC use in 2010 and 2021. In terms of the woman's living environment, the household well-being quintile, the degree of exposure to the media and the region of residence were significantly associated with adequate prenatal care use in 2010 and 2021.

Conclusion: This study notes that Burkina Faso has made enormous progress in improving the coverage of prenatal care between 2010 and 2021, and indicates several factors influencing adequate ANC use. These factors, including individual, family and community factors. For optimal efficacy, interventions promoting the adoption of antenatal care services must take these outcomes into account.

Antenatal care

health service use

associated factors

Burkina Faso

Maternal health, both globally in general and in developing countries in particular, is at the heart of national and international health sector policies. According to the World Health Organization (WHO), approximately 287,000 women died during or after pregnancy or childbirth in 2020 [1]. Nearly 95% of these maternal deaths in 2020, most of which were preventable, occurred in low- and middle-income countries [1]. In African countries, maternal mortality is one of the leading causes of death among women and newborns. The main complications and causes of pregnancy-related death are haemorrhage, sepsis, unsafe abortion, hypertension problems and dystocia [2, 3]. Most of these deaths and complications could largely be avoided or treated during antenatal care, which aim to prevent, detect early and manage any complications that could affect the health of the mother and the unborn child, as well as support the woman throughout her pregnancy [2, 4]. Available data indicate that countries with low ANC coverage tend to have high maternal mortality rates [5, 6]. Additionally, it has been demonstrated that early use of prenatal care, starting in the first trimester of pregnancy, plays a critical role in the early detection and treatment of maternal health problems during pregnancy [7]. This approach also constitutes a solid basis for adequate care during and after childbirth. Given the importance of ANC, the WHO recommends four prenatal visits and at least eight contacts for pregnant women.

In Burkina Faso, the maternal mortality ratio (MMR) is experiencing a downward trend, going from 341 deaths per 100,000 live births between 2003 and 2010 to 232 deaths per 100,000 live births between 2014 and 2021 [8–10]. Despite this progress, difficulties persist regarding certain key indicators of maternal and child health. Indeed, according to reports from demographic and health surveys (DHS), since 2003, the proportion of women having completed at least four prenatal consultations during their pregnancy has increased from 17.6% in 2003 to 33.7% in 2010 and 72.1% in 2021. Furthermore, the proportion of women having undergone their first antenatal consultation during the first trimester of pregnancy also increased from 26.9% in 2003 to 41.2% in 2010 and 47.7% in 2021 [8, 9, 11]. Despite this progress, these data show that WHO recommendations are far from being respected in Burkina Faso. Based on these findings and the results of several studies carried out on the use of prenatal care in Burkina Faso [12–16], we propose a study on the factors associated with the adequate use of prenatal care in Burkina Faso in 2010 and 2021, with the aim of contributing to the reduction of maternal and neonatal mortality in this country.

The main objective of this study is therefore to gain a better understanding of the factors associated with the use of prenatal care in Burkina Faso. It is based on the hypothesis that sociocultural and economic factors (women's living environment, reproductive behaviour and individual characteristics) have a notable influence on the use of prenatal care in developing countries. An improvement in the social status of women (literacy, level of information, economic power, involvement in decision-making, etc.), an improvement in reproductive behaviour (family planning, use of health services) and an improvement in behaviour related to maternal health could significantly improve the use of ANC. In a country where public health services face a serious lack of equipment, medicines and competent personnel, this study could contribute to providing better guidance, information and awareness-raising activities for women in matters related to the use of prenatal care.

Study setting

With a gross domestic product (GDP) of approximately 768.8 USD per capita in 2020 [17], Burkina Faso is one of the countries with the lowest level of economic development. More than 40% of its population live below the poverty line. The 2021–2022 report of the Human Development Index (HDI) of the United Nations Development Program (UNDP), ranks Burkina Faso 184th out of 191 countries [18]. Burkina Faso's economy is mainly based on agriculture and mining. Agriculture, which occupies nearly 82% of the active population, is currently hampered by the security context, which limits access to rural areas [17].

The health situation in Burkina Faso, although improving, is characterised by high general and specific mortality rates. Mothers and children constitute the most vulnerable groups. Fortunately, according to various DHSs carried out in Burkina Faso, the maternal mortality rate is experiencing a downward trend, going from 440 deaths per 100,000 live births in 1998 to 232 deaths per 100,000 live births in 2021 [8, 9, 11, 19, 20]. According to the same sources, the infant mortality rate decreased regularly between 1998 and 2021, going from 105–30%. Life expectancy at birth continues to increase. Overall, it increased from 42.2 years in 1975 to 61.9 years in 2019, an increase of 19.7 years [8, 9, 11, 19, 20].

Data Sources

The data used in this study is procured from the demographic and health survey (DHS) carried out in 2010 and 2021 in Burkina Faso. These data were collected from a representative sample of women of childbearing age (15–49 years), collected during these two household surveys. The DHS reports carried out in 2010 and 2021 provide more details on these surveys [8, 11].

Study Population

The population studied consists of women of childbearing age, i.e., those aged from 15 to 49 years, who have had at least one live birth during the last five years preceding each of these two surveys. Only the latest births were considered for those who had several children. The DHS sample only includes ordinary households, thus excluding populations in collective households such as hospitals, prisons, refugee camps and internally displaced people.

Study Variables

The variables under study were taken from the household questionnaire and the individual women's questionnaire used during these two surveys.

Dependent Variable

The dependent variable is adequacy of antenatal care use, which is the measure of compliance with prescribed recommendations in terms of timing and frequency of antenatal use. Antenatal care use is considered adequate when the first ANC takes place in the first trimester and the woman completes at least four ANC in accordance with WHO recommendations during her pregnancy. This variable was measured dichotomously and coded as 0 for inadequate and 1 for adequate.

Independent Variables

The independent variables used in the study were selected based on the results of previous research on the determinants of antenatal care utilisation [21–26]. At the individual level, this study considered the mothers’ age at the time of delivery, the use of modern contraceptive methods, the mothers’ education level, the mothers’ occupation, the mothers’ marital status, the mothers’ average parity and the interval between pregnancies. At the household level, this study considered the gender of the household head, the household well-being quintile, the size of the household and decision-making regarding the woman's health. At the community level, variables on the degree of exposure to the media, the place of residence and the region of residence were considered.

Statistical Analysis

Regarding the objectives of this study, the analytical approach includes both a descriptive part and an explanatory part. In the descriptive part, a bivariate analysis made it possible to describe the relationships between the independent variables and the dependent variable. The chi-square test was used to identify possible statistical links between the dependent variable and the independent variables.

To analyse factors associated with adequate ANC utilisation, multivariate binary logistic regression analyses were used. AORs were estimated to assess the strength of associations and, 95% confidence intervals were used for significance testing. The proportion test was used to examine differences in adequate ANC utilisation between 2010 and 2021 in Burkina Faso. The data were cleaned, coded and analysed using Stata version 16.1 software.

Sample Description

This study included 10,346 women in 2010 and 6,402 women aged 15 to 49 years who had at least one live birth during the last five years preceding these two surveys. Among them, 2481 lived in urban areas and 7865 in rural areas in 2010. Likewise, 1855 lived in urban areas and 4547 in rural areas in 2021. In our study sample, 22.92% of women in 2010 compared to 46.34% in 2021 had adequate ANC use, this is to say that their first ANC took place during the first trimester of pregnancy and that they had at least four NAC. An increase in the rate of adequate ANC use is therefore noted between 2010 and 2021.

Bivariate Descriptive Analysis of the Factors of Use of Antenatal Services

Table 1 presents the percentages of women aged 15–49 who carried out adequate ANC use during their last pregnancy in 2010 and 2021. We note that, whatever the year, the individual characteristics of the woman (age, educational level, marital status, occupation, religion, average parity and pregnancy interval), household characteristics (size, Household well-being quintile and decision-making regarding the health of the woman) and community characteristics (place of residence, region of residence and degree of exposure to the media) were significantly associated with adequate ANC use. However, gender of household head in 2010 and average parity in 2021 were not significantly associated with adequate ANC use.

Table 1

*Descriptive results of the use of prenatal care among women aged 15–49 based on data from the 2010 and 2021 demographic and health surveys in Burkina Faso*
Features	2010			2021			Proportion test of decrease (P-value)
Features	n	ANC adequate (%)	P-value	n	ANC adequate (%)	P-value	Proportion test of decrease (P-value)
Mothers’ individual characteristics
Mothers’ age
15–19	592	18.75	0.002	529	38.56	0.0027	p < 0.001***
20–24	2,404	24.96		1,613	44.64		p < 0.001***
25–29	2,574	24.16		1,506	48.21		p < 0.001***
30–34	2,165	22.73		1,340	48.66		p < 0.001***
35–39	1,476	21.82		910	46.92		p < 0.001***
40–44	873	20.05		414	47.34		p < 0.001***
45–49	262	18.70		90	46.67		p < 0.001***
Mothers' educational level
None	8,431	20.47	0.000	4,260	44.53	0.0000	p < 0.001***
Primary	1,243	29.04		933	45.02		p < 0.001***
Secondary & more	672	42.26		1,209	53.76		p < 0.001***
Mothers’ marital status
Never married	168	17.86	0.057	191	31.41	0.0001	0.003**
In union	9,949	22.89		6,108	46.84		p < 0.001***
Divorced/ Separated	229	27.95		103	44.66		0.003**
Average parity of women
1 child	1,783	27.76	0.000	1,356	46.53	0.3934	p < 0.001***
2 children	1,772	24.89		1,202	46.51		p < 0.001***
3 children	1,576	24.24		1,116	47.58		p < 0.001***
4 children & more	5,215	20.19		2,709	45.81		p < 0.001***
Birth interval
< 2 years	823	18.47	0.000	385	37.4	0.0000	p < 0.001***
2–3 years	3,025	19.57		1,309	42.32		p < 0.001***
3 years & above	6,498	25.04		4,708	48.19		p < 0.001***
Mothers’ religion
Without religion	118	15.25	0.000	78	48.72	0.0010	p < 0.001***
Muslim	6,394	21.94		4,156	45.74		p < 0.001***
Christian	2,892	27.35		1,879	49.02		p < 0.001***
Animist	942	16.88		289	37.02		p < 0.001***
Mothers' occupation
Unemployed	1,802	20.98	0.000	2,342	44.06	0.0000	p < 0.001***
Qualified job	156	56.41		235	61.7		0.297
Trade	2,208	24.64		1,163	46.6		p < 0.001***
Agriculture	5,333	21.7		2,317	46.53		p < 0.001***
Manual job	774	23.0		319	48.59		p < 0.001***
Use of contraceptive methods
No method	8,605	21.13	0.000	3,777	43.74	0.0000	p < 0.001***
Methods traditional	110	37.27		178	34.27		0.605
Methods modern	1,631	31.39		2,447	51.25		p < 0.001***
Household characteristics
Gender of household head
Male	9,632	22.81	0.339	5,848	45.96	0.0473	p < 0.001***
Female	714	24.37	0.339	554	50.36	0.0473	p < 0.001***
Household size
1–3 persons	1,196	25.33	0.045	515	50.29	0.0086	p < 0.001***
4–5 persons	2,533	23.92		1,340	48.28		p < 0.001***
6–9 persons	3,933	21.97		2,474	46.77		p < 0.001***
10 persons & above	2,684	22.28		2,073	43.61		p < 0.001***
Household well-being quintile
Very poor	1,896	16.35	0.000	1,249	43.23	0.0000	p < 0.001***
Poor	2,096	17.99		1,279	45.11		p < 0.001***
Average	2,225	22.29		1,399	45.03		p < 0.001***
Rich	2,264	25.27		1,365	44.98		p < 0.001***
Very rich	1,865	33.03		1,110	54.59		p < 0.001***
Decision-making regarding the health of women in the household
Mother alone	712	26.54	0.008	655	42.9	0.0001	p < 0.001***
Mother and her partner	1,553	24.98		1,121	52.63		p < 0.001***
Partner alone	7,605	22.12		4,249	45.87		p < 0.001***
Others	79	22.78		83	49.4		p < 0.001***
Characteristics of the living environment
Place of residence
Urban	2481	29.75	0.000	1855	48.36	0.0393	p < 0.001***
Rural	7865	20.76	0.000	4547	45.52	0.0393	p < 0.001***
Region of residence
Boucle du Mouhoun	893	16.46	0.000	519	43.55	0.0000	p < 0.001***
Cascades	665	19.1		311	54.02		p < 0.001***
Centre	696	35.34		598	43.31		0.003**
Central-Est	807	38.79		618	52.43		p < 0.001***
Central-Nord	779	19		466	59.66		p < 0.001***
Central-Ouest	909	20.35		541	38.26		p < 0.001***
Central-Sud	707	30.98		392	41.07		0.001***
Est	979	25.03		418	55.5		p < 0.001***
Hauts-Bassins	870	22.76		651	48.08		p < 0.001***
Nord	818	19.93		518	54.25		p < 0.001***
Plateau Centrale	723	18.67		577	46.45		p < 0.001***
Sahel	784	9.82		263	19.01		p < 0.001***
Sud-Ouest	716	23.46		530	37.74		p < 0.001***
Degree of media exposure
Null	2,667	19.05	0.000	2,079	44.2	0.0009	p < 0.001***
Weak	5,772	21.66		2,674	45.44		p < 0.001***
Average	1,604	28.99		1,529	50.36		p < 0.001***
Hight	303	48.84		120	52.5		0.498
Together	10,346	22.92	-	6,402	46.34	-	p < 0.001***

In addition, apart from women employed in skilled jobs, those using a traditional contraceptive method and those with a high degree of exposure to the media, a significant increase between 2010 and 2021 in the proportion of women having completed an adequate ANC use during their last pregnancy was noted, in all other groups. For example, among mothers aged 45–49 (18.70% in 2010 compared to 46.67% in 2021), mothers with four or more children (20.19% in 2010 compared to 45.81% in 2021), mothers without religion (15.25% in 2010 compared to 48.72% in 2021), mothers in manual employment (23.00% in 2010 compared to 48.59% in 2021), mothers living in households headed by a woman (24.37% in 2010 compared to 50.36% in 2021), mothers living in very poor households (16.35% in 2010 compared to 43.23% in 2021), mothers who are not at all exposed to the media (19.05% in 2010 compared to 44.20% in 2021), the proportion of those have had adequate ANC use during their last pregnancy more than doubled between 2010 and 2021.

Factors Associated With Adequate Antenatal Care Utilisation

The results of the multivariate logistic regression are presented in Table 2.

Table 2

*Factors associated with the use of prenatal care among women aged 15–49 based on data from the 2010 and 2021 demographic and health surveys in Burkina Faso*
Features	2010		2021
Features	n	AOR (95% CI)	n	AOR (95% CI)
Mothers’ individual characteristics
Mothers’ age
15–19	592	1	529	1
20–24	2,404	1.385** (1,072–1,791)	1,613	1.256* (0.990–1.593)
25–29	2,574	1.393 ** (1,048–1,852)	1,506	1.549*** (1,182–2.031)
30–34	2,165	1.317* (0.966–1.797)	1,340	1.675*** (1,245–2.254)
35–39	1,476	1.315 (0.946–1.83)	910	1.600*** (1,162–2.201)
40–44	873	1.233 (0.867–1.755)	414	1.681*** (1,177–2.399)
45–49	262	1.135 (0.725–1.778)	90	1.630*(0.958–2.773)
Mothers’ educational level
None	8,431	1	4,260	1
Primary	1,243	1.206** (1.034–1,407)	933	1.036 (0.884–1.214)
Secondary & above	672	1.76*** (1.161–1,878)	1,209	1.382*** (1.164–1.640)
Mothers’ marital status
Never married	168	1	191	1
In union	9,949	1.365 (0.917–2.032)	6,108	1.929*** (1.415–2.629)
Divorced/Separated	229	1.784** (1.094–2.910)	103	1.762** (1.075–2.888)
Mothers’ average parity
1 child	1,783	1	1,356	1
2 children	1,772	0.842* (0.693–1.022)	1,202	0.951 (0.776–1.164)
3 children	1,576	0.827* (0.664–1.030)	1,116	0.882 (0.700–1.110)
4 children & above	5,215	0.772** (0.609–0.979)	2,709	0.853 (0.663–1.096)
Birth interval
< 2 years	823	1	385	1
2–3 years	3,025	1.026 (0.835–1.261)	1,309	1.203 (0.942–1.536)
3 years & above	6,498	1.200* (0.982–1.465)	4,708	1.453*** (1.160–1,821)
Mothers’ religion
Without religion	118	1	78	1
Muslim	6,394	1.493 (0.881–2.53)	4,156	0.673 (0.413–1.097)
Christian	2,892	1.624* (0.958–2.752)	1,879	0.780 (0.476–1.276)
Animist	942	1.069 (0.613–1.863)	289	0.622 (0.363–1.066)
Mothers’ occupation
Unemployed	1,802	1	2342	1
Qualified job	156	2.066*** (1.376–3.103)	235	1.484** (1,079–2.042)
Trade	2,208	0.991 (0.838–1.172)	1163	1.011 (0.861–1.188)
Agriculture	5,333	1.172** (1.00–1.373)	2317	1.045 (0.915–1.193)
Manual job	774	1.181 (0.93–1.499)	319	1.137 (0.878–1.471)
Use of contraceptive methods
No method	8,605	1	3,777	1
Traditional methods	110	1.424 (0.932–2.177)	178	0.667** (0.479–0.930)
Modern methods	1,631	1.294*** (1.132–1.479)	2.447	1.339*** (1.197–1.498)
Household characteristics
Gender of household head
Male	9,632	1	5,848	1
Female	714	0.962 (0.774–1.195)	554	1.260** (1,026–1,548)
Household size
1–3 persons	1,196	1	515	1
4–5 persons	2,533	1.032 (0.850–1.251)	1,340	0.940 (0.743–1.190)
6–9 persons	3,933	1.050 (0.867–1.271)	2,474	0.921 (0.734–1.154)
10 persons & above	2,684	1.103 (0.901–1.350)	2,073	0.889 (0.705–1.122)
Household well-being quintile
Very poor	1,896	1	1,249	1
Poor	2,096	1.104 (0.928–1.314)	1,279	0.979 (0.827–1.160)
Average	2,225	1.300*** (1.096–1.542)	1,399	1.028 (0.865–1.221)
Rich	2,264	1.483*** (1.246–1.766)	1,365	1.039 (0.857–1.259)
Very rich	1,865	1.560*** (1.24–1.962)	1,110	1.603*** (1,236–2,079)
Decision-making regarding the mother health in the household
Mother alone	712	1	655	1
mother and her partner	1,553	1.046 (0.842–1.300)	1,121	1.490*** (1.214–1,830)
Partner alone	7,605	1.011 (0.835–1.224)	4,249	1.173* (0.983–1.400)
Others	79	1.108 (0.623–1.969)	83	1.169 (0.721–1.896)
Characteristics of the living environment
Place of residence
Urban	2,481	1	1,855	1
Rural	7,865	1.093 (0.938–1.275)	4,547	1.226** (1.041–1.445)
Region of residence
Boucle du Mouhoun	893	1	519	1
Cascades	665	1.073 (0.814–1.414)	311	1.351* (0.990–1.844)
Centre	696	1.845*** (1.422–2.393)	598	0.674*** (0.512–0.887)
Central-Est	807	3.315*** (2.607–4.215)	618	1.423*** (1.105–1.833)
Central-Nord	779	1.144 (0.88–1.488)	466	2.112*** (1.615–2.762)
Central-Ouest	909	1.247* (0.969–1.604)	541	0.758 (0.583–0.987)
Central-Sud	707	2.085*** (1.62–2.683)	392	0.786* (0.592–1.045)
Est	979	1.951*** (1.526–2.495)	418	1.677*** (1.272–2.213)
Hauts-Bassins	870	1.23 (0.954–1.586)	651	1.128 (0.875–1.455)
Nord	818	1.24 (0.958–1.605)	518	1.517*** (1.169–1.970)
Plateau Centrale	723	1.032 (0.789–1.35)	577	1.118 (0.865–1.444)
Sahel	784	0.681** (0.495–0.938)	263	0.302*** (0.207–0.441)
Sud-Ouest	716	1.915*** (1.435–2.555)	530	0.800 (0.599–1.067)
Degree of media exposure
Null	2,667	1	2,079	1
Weak	5,772	1.226*** (1.083–1.387)	2,674	0.986 (0.869–1.120)
Average	1,604	1.406*** (1.173–1.685)	1,529	1.080 (0.920–1.269)
Hight	303	1.767*** (1.263–2.474)	120	0.782 (0.512–1.195)
*p < .01, p < .05, *p < .1

The results of the saturated model show that in 2010, regarding the individual characteristics of the mother being aged 20–24 years, 25–29 years and 30–34 years, having primary or secondary and above education level, being divorced/separated, having a skilled job or working in agriculture and using modern contraceptive methods, were significantly associated with adequate ANC utilisation. Regarding households or community characteristics, living in a household with an average, rich and very rich household well-being quintile, being exposed to the media, living in the region of Centre, Centre-Est, Centre-Ouest, Centre-Sud, Est, Sahel or Sud-Ouest were significantly associated with adequate ANC use during their last pregnancy.

However, in 2021, with regard to the mother’s individual characteristics, being aged 20–24 years, 25–29 years, 30–34 years, 35–39 years and 40–44 years, having a secondary and above education level, being in a union or divorced/separated, having a qualified job and using a traditional or modern contraceptive method, were significantly associated with adequate ANC use. Regarding households and community characteristics, living in a household headed by a woman, living in a household with a very rich household well-being quintile, living in a rural area, living in a household where the decision-making regarding the mother's health is made by the mother and her spouse or her spouse alone, living in the region of Cascades, Centre, Centre-Est, Centre-Nord, Centre-Sud, Est, Nord and Sahel, were significantly associated with adequate ANC utilisation.

Mothers aged 20–24 years (AOR: 1,385, 95% CI 1,072–1,791 in 2010 and AOR: 1,256, 95% CI: 0.99–1,593 in 2021), 25–29 years (AOR: 1,385, 95% CI 1,048–1,852 in 2010 and AOR: 1,549, 95% CI 1,182–2,031 in 2021) or 30–34 years (AOR: 1,317, 95% CI 0.966–1,797 in 2010 and AOR: 1,675, 95% CI 1,245–2,254 in 2021) were more likely to have adequate ANC use than those aged 15–19 years. Likewise, mothers with secondary and above education level were more likely to use prenatal care adequately (AOR: 1,476, 95% CI 1,161–1,878 in 2010 and AOR: 1,382, 95% CI 1,164–1,640 in 2021) than those with no educational level. Moreover, women who were using a modern contraceptive method, were more likely to have adequate ANC use (AOR: 1,294, 95% CI 1,132–1,479 in 2010 and AOR: 1,339. 95% CI 1,197–1,498 in 2021), than those not using any contraceptive method.

Additionally, women living in very wealthy households were more likely to have adequate ANC use (AOR: 1,560, 95% CI 1.24–1,962 in 2010 and AOR: 1,603, 95% CI 1,236–2,079 in 2021) than those living in very poor households.

On the other hand, women living in the Sahel region in 2010 (AOR: 0.681, 95% CI 0.495–0.938), in the Centre region (AOR: 0.674, 95% CI 0.512–0.887), in the Centre-Sud region (AOR: 0.786 95% CI 0.592–1.045) and in the Sahel region (AOR: 0.302 95% CI 0.207–0.441) in 2021, were less likely to had adequate ANC use than their counterparts living in the region of Boucle du Mouhoun.

The objective of this study was to identify the factors that can influence the adequate ANC use by pregnant women in Burkina Faso by analysing their evolution between 2010 and 2021. The results demonstrate the influence of mothers’ individual characteristics, household and community characteristics on the adequate ANC use in Burkina Faso. Concerning the mothers’ individual characteristics, her age, educational level, marital status, occupation and use of modern contraceptive methods were significantly associated with adequate ANC use in 2010 and 2021. The results of this study show a significant association between household characteristics (household well-being quintile, degree of media exposure and region of residence) and adequate ANC utilisation in 2010 and 2021. The gender of the household head, decision-making regarding the mother’s health and the place of residence were significantly associated with adequate ANC use in 2021 only.

It is well recognised that women's age plays an important role in the utilisation of maternal health services [27, 28]. In this study, middle-aged mothers were more likely to have adequate ANC use visits than younger and older mothers.

It appears in this study and in others [21, 27, 29–33] that women who have a low education level, encounter more difficulties in ensuring adequate use of prenatal care. This can be explained by the fact that less educated women have more difficulty finding out about their health, understanding the medical system and how prenatal care works, which is an important reason for delay with respect to the first ANC, as many of them are not informed about the timing and goals of ANC [34].

Mothers’ occupation appears to have a very strong influence on their use of ANC services. The results of this study showed that working mothers were more likely to make multiple prenatal visits than unemployed mothers. This conclusion is consistent with that of Assefa and Tadesse [35], Tawiah [36], Sharma et al. [37], as well as Badolo et al. [13]. These results could be explained by the fact that working pregnant women have a larger social network which could allow them to access more information relating to pregnancy, including prenatal care. The information provided by their coworkers and that obtained in their workplace increased their knowledge about pregnancy, which ultimately enabled them to perform antenatal visits as recommended [38].

Household well-being quintile was strongly and positively associated with the use of ANC services. The study showed that women living in poor households were less likely to have adequate ANC use than women living in rich households. Similar results were reported in previously studies conducted in Uganda [39], Ethiopia [21] and Nepal [27]. These studies indicated that women living in very poor or poor households adopted for ANC lesser than those living in rich households.

This study has some limitations. The data used is procured from the DHS, which use a robust multistage probability sampling methodology to select clusters and households. The first limitation lies in the cross-sectional nature of the data collected, which means that the dependent and explanatory variables were measured simultaneously and therefore cannot guarantee any causality of the associations. Additionally, the five-year recall period may seem long and could question the validity of the responses but limiting it to the most recent births would reduce this risk. However, in African contexts, some births occur before the age of 15 years. The operational definition of reproductive age limited by default to the interval of 15 to 49 years, limits the actual population subject to maternity events. Some cultural variables, potentially relevant to explaining the adequacy of prenatal care, were not considered in this study because they were missing from the database.

In sum, we note that Burkina Faso has made enormous progress in improving the coverage of prenatal care between 2010 and 2021. This has highlighted factors that influence the adequate ANC use, both at the individual, household and community level. At the individual level, age, occupation, education level and use of modern contraceptive methods were factors significantly associated with adequate ANC use. At the household and community level, living in a female-headed household, living in a wealthy household, living in a rural area, decision-making in the household in relation to the mother’s health and region of residence, were significantly associated with adequate ANC monitoring.

To achieve optimal efficacy, interventions aimed at promoting the adequate ANC use must take these finding into account. The findings of this study have important implications for the design of health policy regarding maternal health in Burkina Faso. Policies that encourage women's use of modern contraceptive methods and promote women's participation in the labour market could likely help increase attendance at antenatal care services. Therefore, government policies should target uneducated, unemployed and economically disadvantaged women to increase the rate of adequate ANC use.

ANC Antenatal care

AOR Adjusted odds ratios

CI Confidence intervals

DHS Demographic and health surveys

HDI Human Development Index

INSD National Institute of Statistics and Demography

OR Odds ratios

WHO World Health Organization

Ethics approval and consent to participate

This study was conducted in compliance with the ethical principles of health research and good clinical practices. Burkina Faso National Ethics Committee have approved the study and the verbal informed-consent form, before sample collection.

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analyzed during this study are available on the DHS Program website

Competing interests

The authors declare that they have no competing interests.

Funding

The two DHS data collection were supported by the Government of Burkina Faso, the United States Agency for International Development (USAID), the United States Presidential Malaria Initiative (PMI), the Bank World, the Global Fund through PADS, UNICEF and UNFPA.

Authors' contributions

HB and ARB conceived and designed the paper and developed the analysis strategy. HB analyzed the data and wrote the first draft. All authors reviewed, made inputs to and approved the final paper. All authors read and approved the final manuscript.

Acknowledgements

We would like to express our gratitude to the Government of Burkina Faso, the United States Agency for International Development (USAID), the United States Presidential Malaria Initiative (PMI), the Bank World, the Global Fund through PADS, UNICEF and UNFPA for funding these two DHS data collection. We sincerely thank the ICF for permission to use the Demographic and Health Survey data of Burkina Faso. We gratefully acknowledge all the fieldworkers, supervisors, and data managers for their work in the field. Finally, we thank the study population.

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No competing interests reported.

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Factors Associated with Adequate Antenatal Care Use Among Women of Childbearing Age in Burkina Faso: Finding From the 2010 and 2021 Demographic and Health Surveys

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Abstract

Introduction

Materials and Methods

Study setting

Data Sources

Study Population

Study Variables

Dependent Variable

Independent Variables

Statistical Analysis

Results

Sample Description

Bivariate Descriptive Analysis of the Factors of Use of Antenatal Services

Factors Associated With Adequate Antenatal Care Utilisation

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

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