Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya
Abstract 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 (s...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-07-01
|
| Series: | BMC Health Services Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12913-020-05531-9 |
| _version_ | 1819049396819460096 |
|---|---|
| author | Kefa G. Wairoto Noel K. Joseph Peter M. Macharia Emelda A. Okiro |
| author_facet | Kefa G. Wairoto Noel K. Joseph Peter M. Macharia Emelda A. Okiro |
| author_sort | Kefa G. Wairoto |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-21T11:31:30Z |
| format | Article |
| id | doaj.art-07b29bea6a7747ed9c35c821c0b9cd27 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-21T11:31:30Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-07b29bea6a7747ed9c35c821c0b9cd272022-12-21T19:05:32ZengBMCBMC Health Services Research1472-69632020-07-0120111210.1186/s12913-020-05531-9Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in KenyaKefa G. Wairoto0Noel K. Joseph1Peter M. Macharia2Emelda A. Okiro3Population Health Unit, Kenya Medical Research Institute-Wellcome Trust Research ProgrammePopulation Health Unit, Kenya Medical Research Institute-Wellcome Trust Research ProgrammePopulation Health Unit, Kenya Medical Research Institute-Wellcome Trust Research ProgrammePopulation Health Unit, Kenya Medical Research Institute-Wellcome Trust Research ProgrammeAbstract 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.http://link.springer.com/article/10.1186/s12913-020-05531-9Antenatal careDeterminantsMappingSpatial variationSub-nationalKenya |
| spellingShingle | Kefa G. Wairoto Noel K. Joseph Peter M. Macharia Emelda A. Okiro Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya BMC Health Services Research Antenatal care Determinants Mapping Spatial variation Sub-national Kenya |
| title | Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya |
| title_full | Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya |
| title_fullStr | Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya |
| title_full_unstemmed | Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya |
| title_short | Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya |
| title_sort | determinants of subnational disparities in antenatal care utilisation a spatial analysis of demographic and health survey data in kenya |
| topic | Antenatal care Determinants Mapping Spatial variation Sub-national Kenya |
| url | http://link.springer.com/article/10.1186/s12913-020-05531-9 |
| work_keys_str_mv | AT kefagwairoto determinantsofsubnationaldisparitiesinantenatalcareutilisationaspatialanalysisofdemographicandhealthsurveydatainkenya AT noelkjoseph determinantsofsubnationaldisparitiesinantenatalcareutilisationaspatialanalysisofdemographicandhealthsurveydatainkenya AT petermmacharia determinantsofsubnationaldisparitiesinantenatalcareutilisationaspatialanalysisofdemographicandhealthsurveydatainkenya AT emeldaaokiro determinantsofsubnationaldisparitiesinantenatalcareutilisationaspatialanalysisofdemographicandhealthsurveydatainkenya |