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Background <p>Antenatal care (ANC) is critical for optimizing the health of pregnant women and their newborns. The World Health Organization (WHO) initially recommended ≥4 ANC visits that was later revised in 2016 to ≥8 visits for adequate coverage. Adequate ANC utilization remains low in sub-Saharan Africa, including Kenya. We examined ANC coverage and timely initiation among pregnant women residing in Kibera, a large urban informal settlement with limited access to healthcare located in Nairobi, Kenya.</p> Methods <p>We analyzed data on women who gave birth during January 2016–December 2019 from the Population Based Infectious Disease Surveillance (PBIDS) platform in Kibera. We calculated the proportion of women with ≥1, ≥4, and ≥8 ANC visits. Adequate coverage was defined as completing ≥4 visits and timely as initiating ANC with in the first trimester of pregnancy. We used multivariable logistic regression to identify factors associated with adequate coverage and timely initiation of ANC and quantified the effect with adjusted odds ratio (aOR). </p> Results <p>Among 1652 women with known birth outcomes (&gt; 28 weeks gestation), 1645(99.6%) reported ≥1 ANC visit. A total of 1104 (66.8%) had ≥4 visits, and 74 (4.5%) had ≥8 visits; 495 (30.0%) started ANC in the first trimester. Post-secondary level of education (adjusted odds ratio, aOR, 4.13; 95% confidence interval [95% CI], 1.92 – 8.93) and Kisii community (aOR 1.80; 95% CI 1.02 – 3.17) were positively associated with having ≥4 ANC visits. Being not married was negatively associated with timely ANC initiation (aOR 0.70, 95% CI 0.51 – 0.97). Young women (&lt;20 years aOR 2.26 95% CI, 1.23 – 4.14; 20-24 years aOR 2.05, 95% CI 1.23 - 3.42) had greater odds of timely initiation compared to women aged ≥35 years.</p> Conclusions <p>While two-thirds of women had ≥4 ANC visits, very few had ≥8 visits, and delayed ANC initiation was common. As Kenya moves towards adopting the WHO recommendation of ≥8 visits, efforts to optimize the utilization of ANC services in urban informal settlements for improved management of pregnancy complications, maternal, fetal and child health.</p>

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Utilization of antenatal care services among pregnant women in an urban informal settlement in Nairobi, Kenya

  • 期刊论文

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  • 发表日期：

    2026年2月18日

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  • Alice Ouma,
  • Clifford Oduor,
  • George O. Agogo,
  • Robert Mutinda,
  • Samwel Kiplangat,
  • Florina Serbanescu,
  • Patrick K. Munywoki,
  • Godfrey Bigogo,
  • Jennifer R. Verani

摘要

Background

Antenatal care (ANC) is critical for optimizing the health of pregnant women and their newborns. The World Health Organization (WHO) initially recommended ≥4 ANC visits that was later revised in 2016 to ≥8 visits for adequate coverage. Adequate ANC utilization remains low in sub-Saharan Africa, including Kenya. We examined ANC coverage and timely initiation among pregnant women residing in Kibera, a large urban informal settlement with limited access to healthcare located in Nairobi, Kenya.

Methods

We analyzed data on women who gave birth during January 2016–December 2019 from the Population Based Infectious Disease Surveillance (PBIDS) platform in Kibera. We calculated the proportion of women with ≥1, ≥4, and ≥8 ANC visits. Adequate coverage was defined as completing ≥4 visits and timely as initiating ANC with in the first trimester of pregnancy. We used multivariable logistic regression to identify factors associated with adequate coverage and timely initiation of ANC and quantified the effect with adjusted odds ratio (aOR).

Results

Among 1652 women with known birth outcomes (> 28 weeks gestation), 1645(99.6%) reported ≥1 ANC visit. A total of 1104 (66.8%) had ≥4 visits, and 74 (4.5%) had ≥8 visits; 495 (30.0%) started ANC in the first trimester. Post-secondary level of education (adjusted odds ratio, aOR, 4.13; 95% confidence interval [95% CI], 1.92 – 8.93) and Kisii community (aOR 1.80; 95% CI 1.02 – 3.17) were positively associated with having ≥4 ANC visits. Being not married was negatively associated with timely ANC initiation (aOR 0.70, 95% CI 0.51 – 0.97). Young women (<20 years aOR 2.26 95% CI, 1.23 – 4.14; 20-24 years aOR 2.05, 95% CI 1.23 - 3.42) had greater odds of timely initiation compared to women aged ≥35 years.

Conclusions

While two-thirds of women had ≥4 ANC visits, very few had ≥8 visits, and delayed ANC initiation was common. As Kenya moves towards adopting the WHO recommendation of ≥8 visits, efforts to optimize the utilization of ANC services in urban informal settlements for improved management of pregnancy complications, maternal, fetal and child health.