Background: Initiating antenatal care within the first trimester and making at least four visits during pregnancy are recommended to enable screening and support for healthy lifestyles, well-being, and self-care in pregnancy. Due to glaring evidence on inequalities in access to antenatal care, this study assessed the effect of engaging community health structures on utilization of antenatal care services during pregnancy in resource-constrained rural settings in Uganda.
Methods: A quasi-experimental evaluation study was conducted among mothers in Eastern Uganda. The intervention components included community dialogues and empowering community health workers to sensitize expectant mothers on the use of maternal health services, and health facility strengthening. The primary outcomes were early initiation of antenatal care and completion of at least 4 ANC visits. We used Difference in Differences (DiD) analysis and multivariate regression to assess the effect of the intervention on ANC attendance.
Results: Early initiation of antenatal care increased from 35.7% to 48.1% in the intervention area and 26.9% to 40.7% in the control area but with a non-significant net change of -1.3% (DID, p = 0.733) in the intervention area with respect to changes in the control area. The DiD results revealed the intervention resulted in a 5.5% net significant improvement in attendance of at least 4 ANC visits (p= 0.037). Higher education level of husband (PR1.19,95%CI 1.02–1.39), higher household size (PR=0.81, 95%CI 0.70–0.95), and higher wealth index (PR1.19,95%CI 1.03–1.37) predicted early initiation. Making at least 4 visits for antenatal care was influenced by post-primary education (PR1.14, 95%CI 1.02–1.30), higher wealth quintile (PR1.17, 95%CI 1.06 – 1.30), early initiation (PR1.58, 95%CI 1.49–1.68), and the community intervention (PR1.16, 95%CI 1.01–1.33).
Conclusion: Although the community intervention improved the attendance of at least four antenatal care visits, effect estimates are low hence raising scepticisms on the feasibility of at least 8 visits as per the new WHO recommendations. Women with less education should be prioritized in maternal and child health (MCH) interventions as their families need economic empowerment to reduce financial barriers when access MCH services.