South Africa - The long journey towards optimal uptake of antenatal care in high HIV prevalence settings: an example from three population-based surveys in South Africa

The long journey towards optimal uptake of antenatal care in high HIV prevalence settings: an example from three population-based surveys in South Africa

Short title: Uptake of antenatal care in high antenatal HIV prevalence settings

Abstract

In 2016, the World Health Organization recommended a shift from four antenatal care (ANC) visits to eight ANC contacts and emphasised on first ANC booking by 12-weeks' gestation to prevent poor pregnancy outcomes. This paper describes uptake of routine ANC and its associated factors in South Africa prior to 2016 recommendations, to bring to light potential challenges to achieving the current recommendations.

Data from three facility-based, cross-sectional, national surveys, conducted to measure six-week mother-to-child transmission of HIV (MTCT) in South Africa, were used. Mother-infant pairs attending selected public primary healthcare facilities for their infants' six-week immunization in 2010, 2011-12 and 2012-13 were recruited. Quantitative questionnaires were used to gather socio-demographic and antenatal-peripartum information from infant health booklets and maternal recall. A multivariable logistic regression model was used to identify (i) factors associated with ANC visits and (ii)how ANC visits relate to the extent of ANC care.

Of the 9470, 9646 and 8763 women who attended at least one ANC visit, only 47.5%[95% confidence interval 45.4-49.6], 55.6%[53.2-58.0] and 56.7%[54.3-59.1] were compliant with =4 ANC visits and 36.0%[34.5-37.5], 43.5%[42.0-45.1] and 50.8%[49.3-52.2] booked ANC early (before 20 weeks gestation) in 2010, 2011-12 and 2012-13, respectively. Multi-parity and lower socio-economic status were significantly associated with non-compliance, while later survey year, higher education, being married, older than 19 years, HIV-positive, planned pregnancy and knowledge about modes of HIV vertical transmission were strongly related to ANC visits compliance. The extent of ANC care improved significantly with survey, =4 ANC visits and self-reported pre-natal HIV-positive status, but was not associated with timing of ANC booking.

Despite improved increases in ANC visit compliance and early ANC booking between 2010 and 2013, these practices remain suboptimal. More ANC visits improve receipt of extended care but strengthened efforts are still needed to increase the uptake of at least four-to-eight ANC contacts.