Prevalence and factors associated with late initiation of antenatal care among pregnant women in Rulindo district, Rwanda

Abstract: Background: Rwanda’s maternal mortality rate has declined modestly over the past decade, yet timely antenatal care (ANC) initiation remains suboptimal, with 41% of pregnant women initiating ANC late. Timely ANC is critical to improving maternal and neonatal outcomes. This study aimed to assess the prevalence and determinants of late ANC initiation among pregnant women in Rulindo District, Rwanda. Methods: A cross-sectional quantitative design was used, surveying 416 pregnant women attending seven health centers from March to May 2025. Data were collected using structured, pre-tested questionnaires administered in Kinyarwanda and analyzed using descriptive statistics, chi-square tests, and multivariate logistic regression (p ≤ 0.05). Results: Late ANC initiation (after the first trimester) was reported by 27.6% of participants. The majority were young (50% aged 20–29), rural residents (98.3%), and had low educational attainment, with 63.5% having only primary education and most working as farmers (71.6%). Bivariate analysis identified several significant factors associated with delayed ANC. These included partner alcohol consumption (χ² = 11.697, p = 0.003), woman’s occupation (χ² = 25.439, p = 0.001), Lack of health insurance at conception (χ² = 21.197, p = 0.001), absence of decision-making power at home (χ² = 6.262, p = 0.012), unwanted pregnancy (χ² = 44.935, p = 0.001), poor knowledge about ANC timing (χ² = 153.354, p = 0.001), perceived service quality (χ² = 7.992, p = 0.018), experience of domestic strife (χ² = 16.999, p = 0.001), and the number of household members (χ² = 9.177, p = 0.01). Multivariate analysis further revealed that being a farmer (AOR = 5.754, 95% CI: 2.473–13.392, p = 0.001), having a partner who do not consume alcohol are less likely (AOR = 0.084, 95% CI: 0.013–0.554, p = 0.01), desiring pregnancy later (AOR = 3.470, 95% CI: 1.113–10.814, p = 0.032), perceiving care as only “good” rather than “very good” (AOR = 0.383, 95% CI: 0.166–0.881, p = 0.024), and living in households with 3–4 members (AOR = 2.511, 95% CI: 1.190–5.299, p = 0.016) were all independently associated with delayed ANC initiation. Conclusion: This study revealed significant prevalence of delayed initiation of antenatal care in Rulindo District. Key determinants include farmer employment, partner alcohol use, negative perceptions of care, and desire of later pregnancy, and number of household members, highlighting the need for targeted community-based interventions. Keywords: Prevalence, Antenatal Care, Rulindo, Rwanda Title: Prevalence and factors associated with late initiation of antenatal care among pregnant women in Rulindo district, Rwanda Author: Jean Damascene Dusabimana, Emile Sebera, Emile Twagirumukiza, Michael Habtu International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 13, Issue 2, October 2025 - March 2026 Page No: 74-88 Research Publish Journals Website: www.researchpublish.com Published Date: 28-October-2025 DOI: https://doi.org/10.5281/zenodo.17462450 Paper Download Link (Source) https://www.researchpublish.com/papers/prevalence-and-factors-associated-with-late-initiation-of-antenatal-care-among-pregnant-women-in-rulindo-district-rwanda