Reprod Health. 2025 Dec 10. doi: 10.1186/s12978-025-02236-2. Online ahead of print.
ABSTRACT
BACKGROUND: Antenatal care (ANC) is essential for improving maternal and child health outcomes, as it helps prevent pregnancy complications and reduces maternal and child mortality. Ensuring that all pregnant women receive comprehensive, high-quality ANC is critical for a positive pregnancy experience. This study aimed to identify the determinants of quality ANC visits among pregnant adolescent girls and women in Sierra Leone.
METHODS: We analyzed data from the 2019 Sierra Leone Demographic and Health Survey, including 7,276 adolescent girls and women who had a live birth or stillbirth in the two years preceding the survey. Quality antenatal care was defined as receipt of all essential ANC components: at least four ANC visits, receipt of tetanus toxoid injection, blood pressure measurement, urine and blood sample collection, and counseling on pregnancy complications. Binary logistic regression was used to identify factors associated with quality ANC, adjusting for demographic and socioeconomic variables. Survey weights were applied to account for the sampling design.
RESULTS: Overall, 79.7% of adolescent girls and women received quality antenatal care services. In the fully adjusted mixed effects model, attending four or more ANC visits (aOR: 1.92; 95% CI: 1.42-2.59) and receiving care from a skilled provider (aOR: 1.80; 95% CI: 1.40-2.31) were both strongly associated with increased odds of receiving quality ANC. Conversely, initiating ANC in the second trimester was linked to lower odds of receiving quality care (aOR: 0.61; 95% CI: 0.51-0.74) compared to those who began care in the first trimester. Socioeconomic factors also played an important role: adolescent girls and women in the richest wealth quintile (aOR: 1.89; 95% CI: 1.12-3.19) and those residing in the Western region (aOR: 3.78; 95% CI: 2.26-6.31) were significantly more likely to receive quality ANC visits. Furthermore, urban residence was associated with lower odds of receiving quality ANC visits (aOR: 0.68; 95% CI: 0.47-0.97) compared to rural areas. While higher education level, being married, and having media access were positively associated with quality ANC visits, these relationships did not reach statistical significance.
CONCLUSION: While most adolescent girls and women in Sierra Leone received quality antenatal care, significant disparities persist based on demographic, socioeconomic, and healthcare-related factors. These findings underscore the urgent need for targeted interventions by the national directorate of reproductive and child health, reproductive health and family planning, and school and adolescent health programmes. Strategies should prioritize improving early ANC initiation, expanding access to skilled providers, and addressing barriers faced by the poorest and urban populations. Tailored community outreach, education campaigns are essential to reduce inequities and ensure that all pregnant adolescent girls and women receive comprehensive, high-quality ANC services.
PMID:41372898 | DOI:10.1186/s12978-025-02236-2
