Abstract:
Introduction: Timely antenatal care is essential to reduce maternal and neonatal mortality by
facilitating early detection of pregnancy complications. However, high parity increases the
risk of adverse maternal and fetal outcomes. In sub-Saharan Africa many women experience
delays in seeking their first antenatal care visit. While studies have explored predictors of
antenatal care utilization in the region, spatial distribution of early antenatal care among high
parity women is understudied.
Objective: This study aimed to assess the spatial distribution of delayed antenatal care and
its associated factors among high parity women in sub-Saharan Africa.
Methods: A cross-sectional study design was used to collect data from a weighted sample of
47,958 high-parity women. The data were sourced from the Demographic and Health Survey
dataset, conducted between 2016 and 2023 across 26 Sub-Saharan African countries.
Analysis was performed using STATA version 17, SaTScan 10.2.5 and ArcGIS Desktop
10.7.1. Global Moran’s I was employed to assess the spatial distribution of delayed antenatal
care, whereas Getis-Ord Gi* identified significant hotspots. Ordinary kriging predicted
values for unmeasured locations. Ordinary least squares regression and geographically
weighted regression were applied to explore spatial heterogeneity in predictors of delayed
antenatal care. Model fit was evaluated using the Akaki information criterion and adjusted
R². A p value threshold of 0.05 was used to determine statistically significant spatial
predictors, with the corresponding local coefficients mapped for visualization.
Result: The pooled prevalence of delayed antenatal care among high parity women in SSA
was 58.77%(95% CI: 52.84%, 64.69%).Significant hotspots were found in southern
Ethiopia, Uganda, Kenya, Tanzania, Malawi, Mozambique, Zambia, Madagascar, Coti d
ivore and Nigeria. Women without formal education, being employed, having health
insurance, lack of media exposure, and rural residence was spatially varying predictors of
delayed antenatal care among high parity women in sub – Saharan Africa.
Conclusion: The proportion of delayed antenatal care visit among high parity women was
high and geographically varied across SSA. without formal education, being employed,
lacking media exposure, having health insurance and being rural resident had significant
influences on the spatial variation of delayed ANC. Governments of hotspot countries should
prioritize high-parity women with targeted policies, improved maternal health education, and
better healthcare access. Partner organizations like WHO, UNICEF and World bank can
align strategies and direct resources to high-need areas
