Determinants of delayed antenatal visit attendance in rural Burkina Faso: a cross-sectional study

Abstract Introduction The World Health Organization recommends a minimum of eight antenatal care (ANC) contacts, with the first visit occurring before the 12th week of gestation, as a strategy to enhance the preparedness of women for institutional delivery and improve perinatal outcomes. The present study aims to assess the prevalence of delayed ANC attendance among pregnant women in rural Burkina Faso and identify associated risk factors. Methods This is a secondary analysis of clinical data collected from a randomised-controlled trial (clinicaltrials.gov ref: NCT03199547); conducted between 2018 and 2021 in rural Burkina Faso. We estimated gestational age (GA) at the first ANC visit based on recall information on the last menstrual period provided by study participants or, when such information was unavailable, symphysis-fundal height measurements taken by ANC nurses. We used descriptive methods followed by unadjusted and adjusted logistic regression, informed by an original conceptual framework, to determine the prevalence and risk factors associated with delayed first ANC visit, defined as occurring after the 12th week of gestation. A significance threshold was set at 0.05. Results Out of the 5250 women enrolled in the study, 2480 (47.2%) had data available from their first ANC visit, and 90.6% (2248/2480) of those women had gestational age estimates. Most women (n = 2037/2248, 90.6%) attended their first ANC after the 14th week of gestation. The main factors associated with this delay were multiparity ≥ 4 pregnancies (OR = 2.26, 95%CI [1.48 – 3.4], p < 0.001) and first ANC visit attended during the dry season (OR = 1.79, 95%CI [1.34 – 2.39], p < 0.001). Conclusion Our study highlights that most pregnant women in rural Burkina Faso attended their first ANC visit later than the WHO recommended timeline, increasing their risk of poor delivery outcome. Although we identified some factors that increased this risk of late ANC attendance, awareness raising interventions are required for the whole population as starting late seems to be the norm.