Int J Health Geogr - Spatial autocorrelation in uptake of antenatal care and relationship to individual, household and village-level factors: results from a community-based survey of pregnant women in six districts in western Kenya.


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CKGROUND: The majority of maternal deaths, stillbirths, and neonatal deaths are concentrated in a few countries, many of which have weak health systems, poor access to health services, and low coverage of key health interventions. Early and consistent antenatal care (ANC) attendance could significantly reduce maternal and neonatal morbidity and mortality. Despite this, most Kenyan mothers initiate ANC care late in pregnancy and attend fewer than the recommended visits.METHODS: We used survey data from 6,200 pregnant women across six districts in western Kenya to understand demand-side factors related to use of ANC. Bayesian multi-level models were developed to explore the relative importance of individual, household and village-level factors in relation to ANC use.RESULTS: There is significant spatial autocorrelation of ANC attendance in three of the six districts and considerable heterogeneity in factors related to ANC use between districts. Working outside the home limited ANC attendance. Maternal age, the number of small children in the household, and ownership of livestock were important in some districts, but not all. Village proportions of pregnancy in women of child-bearing age was significantly correlated to ANC use in three of the six districts. Geographic distance to health facilities and the type of nearest facility was not correlated with ANC use. After incorporating individual, household and village-level covariates, no residual spatial autocorrelation remained in the outcome.CONCLUSIONS: ANC attendance was consistently low across all the districts, but factors related to poor attendance varied. This heterogeneity is expected for an outcome that is highly influenced by socio-cultural values and local context. Interventions to improve use of ANC must be tailored to local context and should include explicit approaches to reach women who work outside the home.

Resumo Limpo

ckground major matern death stillbirth neonat death concentr countri mani weak health system poor access health servic low coverag key health intervent earli consist antenat care anc attend signific reduc matern neonat morbid mortal despit kenyan mother initi anc care late pregnanc attend fewer recommend visitsmethod use survey data pregnant women across six district western kenya understand demandsid factor relat use anc bayesian multilevel model develop explor relat import individu household villagelevel factor relat anc useresult signific spatial autocorrel anc attend three six district consider heterogen factor relat anc use district work outsid home limit anc attend matern age number small children household ownership livestock import district villag proport pregnanc women childbear age signific correl anc use three six district geograph distanc health facil type nearest facil correl anc use incorpor individu household villagelevel covari residu spatial autocorrel remain outcomeconclus anc attend consist low across district factor relat poor attend vari heterogen expect outcom high influenc sociocultur valu local context intervent improv use anc must tailor local context includ explicit approach reach women work outsid home

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