{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T19:10:56Z","timestamp":1782155456703,"version":"3.54.5"},"reference-count":56,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T00:00:00Z","timestamp":1773878400000},"content-version":"unspecified","delay-in-days":18,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Pan African University, Life and Earth Science Institute"},{"DOI":"10.13039\/501100022253","name":"Pan African University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100022253","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,2,26]]},"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Antenatal care (ANC) plays a critical role in improving maternal and neonatal health outcomes. However, incomplete ANC attendance in Somaliland is associated with adverse maternal and birth outcomes. Barriers to ANC attendance may increase the risk of pregnancy-related complications, including maternal morbidity, mortality and poor neonatal health outcomes. Understanding the effect of ANC attendance on maternal and birth outcomes is crucial for informing policies and interventions aimed at reducing these risks. Hence, this study aimed to assess the effect of ANC attendance on maternal and birth outcomes in Somaliland.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A prospective cohort study was conducted among 1205 pregnant women enrolled by systematic sampling method.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting and participants<\/jats:title>\n                    <jats:p>The study was conducted in the Republic of Somaliland, which is situated in the Horn of Africa. Baseline data were collected at recruitment, and participants were followed up to delivery for the collection of outcome variables. The number of ANCs was considered to be a dichotomous independent variable; incomplete attendance (\u2264 3 visits) and complete attendance (\u22654 visits). The risk of pregnancy outcome among those with incomplete ANC was assessed using multi-variable logistic regression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Variables<\/jats:title>\n                    <jats:p>The outcome variables of the study were the maternal and birth outcomes. The independent variables included socio-demographic characteristics, such as age, residence, educational status, occupation, family size, wealth index and marital status, and reproductive factors, such as parity, gestational age at first ANC visit, current pregnancy desirability and previous pregnancy history.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Out of the total participants, 43.3% of women had complete attendance. The incidence of postpartum haemorrhage was 10.0% (95% CI 8.6 to 12.3); antepartum haemorrhage, 3.6% (95% CI 2.6 to 4.7); caesarean section, 14.8% (95% CI 12.9 to 16.8); preterm delivery, 13.7% (95% CI 11.7 to 15.4); low birth weight, 25.8% (95% CI 23.4 to 28.1); and stillbirth, 3.2% (95% CI 2.3 to 4.2). Complete attendance to ANC significantly reduced the risk of antepartum haemorrhage, caesarean section, preterm delivery and admission to the neonatal intensive care unit and stillbirth.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Nearly more than half of women in Somaliland had less than four ANC visits. The incidence of maternal and birth complications is higher among pregnant women who attended &lt;4 ANC visits than among those who attended \u22654 ANC visits. Promoting access and quality ANC services would help in reducing maternal and neonatal complications in the country.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-104470","type":"journal-article","created":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T15:35:31Z","timestamp":1773934531000},"page":"e104470","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Effect of antenatal care attendance on maternal and birth outcomes in Somaliland: a cohort study"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5143-6574","authenticated-orcid":false,"given":"Saad Ahmed","family":"Abdiwali","sequence":"first","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, University of Hargeisa, Hargeisa, Somaliland"},{"name":"Department of Reproductive Health, School of Graduate Studies, University of Hargeisa, Hargeisa, Somaliland"},{"name":"Pan African University Life and Earth Sciences Institute (including Health and Agriculture), University of Ibadan, Ibadan, Oyo State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7259-208X","authenticated-orcid":false,"given":"Teshome Gensa","family":"Geta","sequence":"additional","affiliation":[{"name":"Department of Public Health, College of Medicine and Health Sciences, Wolkite University, Wolkite, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olubukola A","family":"Adesina","sequence":"additional","affiliation":[{"name":"Pan African University Life and Earth Sciences Institute (including Health and Agriculture), University of Ibadan, Ibadan, Oyo State, Nigeria"},{"name":"Department of Obstetrics & Gynaecology, University College Hospital, University of Ibadan, Ibadan, Oyo State, Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gedefaw Abeje","family":"Fekadu","sequence":"additional","affiliation":[{"name":"Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,3,19]]},"reference":[{"key":"2026031908352209000_16.3.e104470.1","unstructured":"World Health Organization . 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