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Association of Higher Educational Attainment on Antenatal Care Utilization Among Pregnant Women in East Africa Using Demographic and Health Surveys (DHS) from 2010 to 2018: A Multilevel Analysis
Open accessAbstract
INTRODUCTION: The use of antenatal care (ANC) plays a major role in minimizing maternal and child mortality through effective and appropriate screening, preventive, or treatment intervention. Even though almost all pregnancy-related mortalities are largely preventable through adequate use of ANC, sub-Saharan Africa (SSA), particularly East African Countries, continues to share the largest share of global maternal, and newborn mortality. Therefore, this study assesses if educational attainment is associated with optimal ANC utilization in East Africa. METHODS: A secondary data analysis was done based on Demographic and Health Surveys (DHS) from 2010 to 2018 in the 11 East African Countries. A total weighted sample of 84,660 women who gave birth in the 5 years preceding each country's DHS survey and had ANC visits were included in this study. Data processing and analysis were performed using STATA 15 software. A multilevel mixed-effect logistic regression model was fitted to examine the association of educational attainment and ANC utilization. Variables with a p-value <0.05 were declared as significant factors associated with ANC utilization. Model comparison was done based on Akaike and Bayesian Information Criteria (AIC and BIC). RESULTS: The magnitude of optimal ANC utilization in East African Countries was 56.37% with 95% CI (56.03, 56.69) with the highest optimal ANC utilization in Zimbabwe (80.96%) and the lowest optimal ANC utilization in Rwanda (44.31%). Women who had higher education levels were more likely to have optimal ANC utilization, compared to those with no education (AOR = 2.34; 95 and CI; 2.11-2.59). Women who had media exposure were more likely to have optimal ANC utilization than those who have no media exposure (AOR = 1.07; 95% CI; 1.03, 1.10). CONCLUSION: Antenatal care utilization was low in East African countries. Educational attainment, maternal age, wealth index, birth order, media exposure, and living countries were factors associated with ANC utilization. Efforts to improve antenatal care and other maternal health service utilization in East Africa must take into account these factors. Specifically, working on the access to mass media by women may also improve antenatal care utilization.
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“In low-income countries and fragile and conflict areas, pregnant women’s formal education [6, 11–15] and their partner’s education [13, 14, 16] significantly predicted adequate utilization of ANC.”
From Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh (2025) · cites this paper as [11]
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“Studies show that SES or wealth enable people to utilize ANC [11, 12, 14].”
From Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh (2025) · cites this paper as [11]
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Cited by
Sorted by citations
A multilevel analysis of educational transition rates at secondary level in sub-Saharan Africa
Delprato, M., & Farieta, A. (2024) · Prospects · doi:10.1007/s11125-023-09644-x · Cited by 9
“Girls who have married early largely do not have control over their earnings, are isolated from support networks, and do not have any social help to sustain their emotional well-being (Duflo, 2012; Raru et al., 2022).”
Simon, D., Michael, D., Rahman, M. S., Hiott, M. C., Rahim, A., Sanin, K. I., Tofail, F., & Wuermli, A. J. (2025) · Conflict and Health · doi:10.1186/s13031-025-00733-6 · Cited by 2
“We expected to find relations between the woman’s years of formal education with ANC behaviors given the robust association in literature [6, 11, 13, 14, 46].”
Influential
Metadata
- Authors
- Raru, T. B., Ayana, G. M., Zakaria, H. F., & Merga, B. T.
- Affiliations
- Haramaya University (ET)
- Corresponding author
- Raru, Temam Beshir
- Venue
- International Journal of Women's Health
- Publisher
- Informa UK Limited
- Published
- 2022-02
- Volume
- Volume 14
- Pages
- 67-77
- ISSN
- 1179-1411 (ISSN-L)
- PMC
- PMC8819274
- OpenAlex
- W4210776967
- Cited by
- 81
- References
- 2
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 18 · 2023: 15 · 2022: 10
- FWCI
- 18.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Women s Health (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- antenatal care utilization, maternal education, pregnant women, East Africa, maternal health service utilization, media exposure, maternal age, wealth index, birth order, maternal mortality, neonatal mortality, sub-Saharan Africa
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