Determinants of adequate antenatal care among immediate postpartum mothers in Eastern Uganda: a multicenter cross-sectional study

Abstract

Background: Antenatal care is essential for reducing maternal and neonatal mortality, particularly in low-income regions. However, the adequacy of the care provided is crucial for achieving maternal health goals. Maternal mortality rates in Uganda are still among the highest globally. Thus, evaluating the adequacy of antenatal care (ANC) services, especially in high-risk regions is imperative. Objective: To determine the prevalence of adequate ANC and associated factors in Eastern Uganda. Design: A multicenter quantitative cross-sectional study was conducted at four healthcare facilities in Eastern Uganda from July to August 2022. Methods: We included immediate postpartum mothers who had given birth within 48 h with a record of their ANC information on a card or book. Adequate ANC was measured by a composite index of 10 core components per WHO guidelines on ANC for a positive pregnancy experience. Data were collected using a structured questionnaire designed with Kobo Toolbox and analyzed using Stata 15.0. Bivariable and multivariable logistic regression analyses assessed factors associated with receiving adequate ANC. Statistical significance was determined by a p value <0.05. Results: We recruited 1104 postnatal mothers, most aged 20–34 years ( n = 805, 72.9%). Only 5.9% received adequate ANC, with most mothers receiving an average of 6.9 (±2.0) of the 10 assessed ANC components. Receiving adequate ANC was associated with urban residency (AOR: 2.3; 95% CI: 1.16–4.38, p = 0.017), age between 20 and 34 years (AOR: 3.5; 95% CI: 1.07–11.30, p = 0.038), current or previous complications (AOR: 1.8; 95% CI: 1.02–3.29, p = 0.043), and delivery at a general hospital (AOR: 4.8; 95% CI: 2.60–8.83, p < 0.001). Conclusion: There is a critical gap in providing adequate ANC in Eastern Uganda, especially for rural and younger mothers. Policy efforts should focus on expanding access, enhancing maternal education, and strengthening healthcare infrastructure to meet the recommended ANC standards.