A multilevel modelling approach to understanding antenatal care utilisation in Uganda

BACKGROUND: This study aims to investigate the factors influencing the adequacy of antenatal care service utilisation among women in Uganda, a country with the high maternal mortality rate in East Africa (336 deaths per 100,000 live births). One of the causes maternal morbidity and mortality is the underutilisation of antenatal care services, posing a significant challenge to achieving SDG 3.1, which aims to reduce maternal mortality to 70 deaths per 100,000 live births by 2030. METHOD: The study utilised secondary data from the 2016 Uganda Demographic and Health Survey (UDHS), focusing on women aged 15 to 49 who had given birth in the five years preceding the survey. Data analysis involved univariate, bivariate and multilevel binary logistic regression models. RESULTS: The findings from the adjusted model revealed that the adequacy of antenatal care services was 6.4% among women in Uganda. Moreover, individual and community-level factors influenced the adequacy of antenatal care service utilisation. Employment status emerged as a significant factor at the individual level, with employed women more likely to use antenatal care services adequately (AOR = 1.53, 95% CI: 1.13-2.08). Region of residence and community media saturation were influential at the community level, with women in the Northern and Western regions (AOR = 2.35, 95% CI: 1.34-3.43; AOR = 1.85, 95% CI: 1.29-2.67) and those in media-saturated communities more likely to utilise antenatal care services adequately (AOR = 1.85, 95% CI: 1.29-2.67). CONCLUSIONS: The study underscores the limited utilisation of ANC services among women. Factors such as employment status, region of residence, and community media saturation play pivotal roles in determining the adequacy of antenatal care service utilisation. The government is urged to strengthen community media campaigns targeting underperforming regions which underutilizing antenatal care services, so as to improve service quality and access.