Spatial distribution, pooled prevalence of delayed antenatal care and its associated factors among high parity women in Sub-Saharan Africa: Evidence from recent demographic and health survey 2016-2023

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