{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T03:05:13Z","timestamp":1773716713713,"version":"3.50.1"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T00:00:00Z","timestamp":1646006400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Antenatal care (ANC) is an important intervention that has been linked to reduce maternal and newborn adverse outcomes. However, the long years of war in Liberia may have contributed to the poor health indices including the uptake of maternal health care services. The objective of this study was to determine the marginal interaction effects between booking time and socioeconomic factors in eight or more ANC contacts. A total sample of 4,185 women who had given birth were included in this study. The 2020 Liberia Demographic and Health Survey (LDHS) dataset was analyzed. The outcome variable was eight or more ANC contacts. Percentage and Chi-square test were used in univariate and bivariate analyses respectively. The marginal interaction effects between booking time and socioeconomic factors of eight or more ANC contacts were estimated. The statistical significance was determined at 5%. The weighted prevalence of eight or more ANC contacts was 26.6% (95% CI: 23.8%, 29.6%). The uptake of eight or more ANC contacts increased steadily by increasing women\u2019s level of education and household wealth index. Women with higher educational attainment had a prevalence of 49.0% (95%CI: 36.5%, 61.6%) and those in the richest households had an estimated prevalence of 31.4% (95%CI: 24.9%, 38.8%) respectively. Furthermore, the urban dwellers had a weighted eight or more ANC contacts prevalence of 29.0% (95%CI: 24.6%, 34.0%). The key finding is increased marginal interaction effects for higher education and early booking (48.4%), richest households and early booking (35.4%), and urban residential status and early booking (36.2%) respectively. Overall, the prevalence of eight or more ANC contacts was low. However, we found higher coverage of eight or more ANC contacts among women who initiated ANC within the first trimester and among those with higher socioeconomic status. We recommend the Liberian government to design and\/or support programmes targeted at promoting early ANC initiation and supporting the disadvantaged women such as the uneducated, poor and those living in rural or remote settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000136","type":"journal-article","created":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:22:05Z","timestamp":1646072525000},"page":"e0000136","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":13,"title":["Effects of socioeconomic factors and booking time on the WHO recommended eight antenatal care contacts in Liberia"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2372-3020","authenticated-orcid":true,"given":"Michael","family":"Ekholuenetale","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6308-4278","authenticated-orcid":true,"given":"Chimezie Igwegbe","family":"Nzoputam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6006-9355","authenticated-orcid":true,"given":"Amadou","family":"Barrow","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2022,2,28]]},"reference":[{"key":"pgph.0000136.ref001","volume-title":"Trends in maternal mortality 2000 to 2017: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division","author":"World Health Organization","year":"2019"},{"key":"pgph.0000136.ref002","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s42506-020-00041-2","article-title":"Women\u2019s enlightenment and early antenatal care initiation are determining factors for the use of eight or more antenatal visits in Benin: further analysis of the Demographic and Health Survey","volume":"95","author":"M Ekholuenetale","year":"2020","journal-title":"J Egypt Public Health Assoc"},{"key":"pgph.0000136.ref003","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1111\/1471-0528.14599","article-title":"WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival","volume":"124","author":"\u04e6. Tun\u00e7alp","year":"2017","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"pgph.0000136.ref004","doi-asserted-by":"crossref","first-page":"197","DOI":"10.9745\/GHSP-D-17-00141","article-title":"Integrated Person-Centered Health Care for All Women During Pregnancy: Implementing World Health Organization Recommendations on Antenatal Care for a Positive Pregnancy Experience","volume":"5","author":"S de Masi","year":"2017","journal-title":"Glob Health Sci Pract"},{"key":"pgph.0000136.ref005","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience","author":"World Health Organization","year":"2016"},{"key":"pgph.0000136.ref006","volume-title":"WHO recommendation on antenatal care contact schedules","author":"WHO Reproductive Health Library","year":"2018"},{"key":"pgph.0000136.ref007","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/s41043-016-0078-5","article-title":"Trends, determinants and inequities of 4+ ANC utilisation in Bangladesh","volume":"36","author":"A Rahman","year":"2017","journal-title":"J Health Popul Nutr"},{"key":"pgph.0000136.ref008","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/S0140-6736(15)00838-7","article-title":"Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group","volume":"387","author":"L Alkema","year":"2016","journal-title":"The Lancet"},{"key":"pgph.0000136.ref009","doi-asserted-by":"crossref","first-page":"e023128","DOI":"10.1136\/bmjopen-2018-023128","article-title":"Women\u2019s autonomy and utilisation of maternal healthcare services in 31 Sub-Saharan African countries: results from the demographic and health surveys, 2010\u20132016","volume":"9","author":"C Chol","year":"2019","journal-title":"BMJ Open"},{"key":"pgph.0000136.ref010","doi-asserted-by":"crossref","DOI":"10.1891\/9780826190123","volume-title":"A New Era in Global Health","author":"W Rosa","year":"2017"},{"key":"pgph.0000136.ref011","article-title":"Maternal and Reproductive Health: An Epidemic of Inequality","author":"A Lucas","year":"2017","journal-title":"ISGlobal"},{"key":"pgph.0000136.ref012","doi-asserted-by":"crossref","first-page":"349","DOI":"10.2147\/IJWH.S306302","article-title":"Prevalence and Socioeconomic Inequalities in Eight or More Antenatal Care Contacts in Ghana: Findings from 2019 Population-Based Data","volume":"13","author":"M Ekholuenetale","year":"2021","journal-title":"Int J Womens Health"},{"key":"pgph.0000136.ref013","first-page":"2333392818781729","article-title":"Predictors of Optimal Antenatal Care Service Utilization Among Adolescents and Adult Women in Bangladesh","volume":"5","author":"N Ali","year":"2018","journal-title":"Health Serv Res Manag Epidemiol"},{"key":"pgph.0000136.ref014","doi-asserted-by":"crossref","first-page":"e0214848","DOI":"10.1371\/journal.pone.0214848","article-title":"Factors affecting utilization of antenatal care in Ethiopia: A systematic review and meta-analysis","volume":"14","author":"T Tekelab","year":"2019","journal-title":"PLOS ONE"},{"key":"pgph.0000136.ref015","doi-asserted-by":"crossref","first-page":"115","DOI":"10.11648\/j.sjph.20190704.12","article-title":"Factors Associated with Maternal Health Service Utilization in Cote d\u2019Ivoire: Analysis of the 2011 Ivorian Demographic and Health Survey","volume":"7","author":"K Djoukou Olga Denise","year":"2019","journal-title":"Sci J Public Health"},{"key":"pgph.0000136.ref016","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/j.aogh.2016.04.301","article-title":"Tackling maternal mortality in rural Liberia: a field and facility-based approach","volume":"82","author":"AS Landau","year":"2016","journal-title":"Ann Glob Health"},{"key":"pgph.0000136.ref017","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1001\/jama.300.6.676","article-title":"Association of combatant status and sexual violence with health and mental health outcomes in postconflict Liberia","volume":"300","author":"K Johnson","year":"2008","journal-title":"JAMA"},{"key":"pgph.0000136.ref018","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1093\/heapol\/czu065","article-title":"Can the health system deliver? Determinants of rural Liberians\u2019 confidence in health care.","volume":"30","author":"T Svoronos","year":"2015","journal-title":"Health Policy Plan"},{"key":"pgph.0000136.ref019","unstructured":"WHO WHO. Global Health Observatory, Liberia Health System. 2016 [cited 25 Sep 2021]. Available: https:\/\/www.who.int\/data\/gho\/data\/countries\/country-details\/GHO\/liberia?countryProfileId=cda05b49-7f7f-424f-bb80-4125392e9424."},{"key":"pgph.0000136.ref020","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1186\/s12913-016-1709-7","article-title":"Charting health system reconstruction in post-war Liberia: a comparison of rural vs. remote healthcare utilization.","volume":"16","author":"K Kentoffio","year":"2016","journal-title":"BMC Health Serv Res"},{"key":"pgph.0000136.ref021","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/S0140-6736(05)67140-1","article-title":"Buying results? Contracting for health service delivery in developing countries","volume":"366","author":"B Loevinsohn","year":"2005","journal-title":"Lancet Lond Engl"},{"key":"pgph.0000136.ref022","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/S0968-8080(08)31347-0","article-title":"A basic package of health services for post-conflict countries: implications for sexual and reproductive health services.","volume":"16","author":"B Roberts","year":"2008","journal-title":"Reprod Health Matters"},{"key":"pgph.0000136.ref023","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1093\/ije\/dys184","article-title":"Demographic and health surveys: a profile","volume":"41","author":"DJ Corsi","year":"2012","journal-title":"Int J Epidemiol"},{"key":"pgph.0000136.ref024","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1017\/S002193200300600X","article-title":"Independent effects of social position and parity on body mass index among Polish adult women","volume":"35","author":"A Szklarska","year":"2003","journal-title":"J Biosoc Sci"},{"key":"pgph.0000136.ref025","volume":"50","author":"S Walters","year":"2005","journal-title":"Socioeconomic inequalities in health and health care access in central and eastern Europe and the CIS"},{"key":"pgph.0000136.ref026","doi-asserted-by":"crossref","first-page":"e0159186","DOI":"10.1371\/journal.pone.0159186","article-title":"Women\u2019s Education and Health Inequalities in Under-Five Mortality in Selected Sub-Saharan African Countries, 1990\u20132015","volume":"11","author":"AR Bado","year":"2016","journal-title":"PLOS ONE"},{"key":"pgph.0000136.ref027","volume-title":"DHS Methodological Reports No. 9","author":"SO Rutstein","year":"2014"},{"key":"pgph.0000136.ref028","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1080\/09720502.2010.10700699","article-title":"Collinearity diagnostics of binary logistic regression model","volume":"13","author":"H Midi","year":"2010","journal-title":"J Interdiscip Math"},{"key":"pgph.0000136.ref029","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1080\/01621459.1992.10475190","article-title":"Generalized Collinearity Diagnostics","volume":"87","author":"J Fox","year":"1992","journal-title":"J Am Stat Assoc"},{"key":"pgph.0000136.ref030","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1177\/1536867X1201200209","article-title":"Using the Margins Command to Estimate and Interpret Adjusted Predictions and Marginal Effects","volume":"12","author":"R. Williams","year":"2012","journal-title":"Stata J Promot Commun Stat Stata"},{"key":"pgph.0000136.ref031","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2021\/6640495","article-title":"Renal Failure among Women of Reproductive Age in Burundi: Estimating the Prevalence and Associated Factors Using Population-Based Data","volume":"2021","author":"M Ekholuenetale","year":"2021","journal-title":"Int J Nephrol"},{"key":"pgph.0000136.ref032","article-title":"Prevalence of Eight or More Antenatal Care Contacts: Findings From Multi-Country Nationally Representative Data","volume":"8:","author":"M. Ekholuenetale","year":"2021","journal-title":"Glob Pediatr Health"},{"key":"pgph.0000136.ref033","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1186\/s13561-019-0228-8","article-title":"Out-of-pocket payments in the context of a free maternal health care policy in Burkina Faso: a national cross-sectional survey","volume":"9","author":"IB Meda","year":"2019","journal-title":"Health Econ Rev"},{"key":"pgph.0000136.ref034","first-page":"163","article-title":"Costs and Patterns of Financing Maternal Health Care Services in Rural Communities in Northern Nigeria: Evidence for Designing National Fee Exemption Policy","volume":"2","author":"NN Kalu-Umeh","year":"2013","journal-title":"Int J MCH AIDS"},{"key":"pgph.0000136.ref035","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1093\/heapol\/czp013","article-title":"Out-of-pocket costs for facility-based maternity care in three African countries","volume":"24","author":"M Perkins","year":"2009","journal-title":"Health Policy Plan"},{"key":"pgph.0000136.ref036","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12978-019-0768-8","article-title":"Socio-economic inequalities in ANC attendance among mothers who gave birth in the past 12 months in Debre Brehan town and surrounding rural areas, North East Ethiopia: a community-based survey","volume":"16","author":"G Shibre","year":"2019","journal-title":"Reprod Health"},{"key":"pgph.0000136.ref037","doi-asserted-by":"crossref","first-page":"e0239855","DOI":"10.1371\/journal.pone.0239855","article-title":"Individual-, household-, and community-level factors associated with eight or more antenatal care contacts in Nigeria: Evidence from Demographic and Health Survey","volume":"15","author":"M Ekholuenetale","year":"2020","journal-title":"PLOS ONE"},{"key":"pgph.0000136.ref038","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1186\/s12939-019-1043-x","article-title":"Socioeconomic inequalities in maternal health care utilization in Ghana","volume":"18","author":"J Novignon","year":"2019","journal-title":"Int J Equity Health"},{"key":"pgph.0000136.ref039","doi-asserted-by":"crossref","first-page":"1493","DOI":"10.1186\/s12889-019-7840-8","article-title":"Socioeconomic inequalities in maternal health service utilisation: a case of antenatal care in Nigeria using a decomposition approach","volume":"19","author":"CO Nwosu","year":"2019","journal-title":"BMC Public Health"},{"key":"pgph.0000136.ref040","doi-asserted-by":"crossref","first-page":"860","DOI":"10.1111\/1471-0528.14599","article-title":"WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival","volume":"124","author":"\u04e6. Tun\u00e7alp","year":"2017","journal-title":"BJOG Int J Obstet Gynaecol"},{"key":"pgph.0000136.ref041","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s42506-020-00064-9","article-title":"Inequalities in out-of-pocket health expenditure among women of reproductive age: after-effects of national health insurance scheme initiation in Ghana","volume":"96","author":"M Ekholuenetale","year":"2021","journal-title":"J Egypt Public Health Assoc"},{"key":"pgph.0000136.ref042","doi-asserted-by":"crossref","first-page":"537","DOI":"10.2471\/BLT.16.187476","article-title":"Strengthening health systems for universal health coverage and sustainable development","volume":"95","author":"MP Kieny","year":"2017","journal-title":"Bull World Health Organ"},{"key":"pgph.0000136.ref043","unstructured":"World Health Organization. Global health observatory data repository: Health expenditures ratios by country, 1995\u20132014. 2014 [cited 1 Oct 2019]. Available: http:\/\/apps.who.int\/nha\/database."},{"key":"pgph.0000136.ref044","doi-asserted-by":"crossref","DOI":"10.11604\/pamj.2015.21.321.6527","article-title":"Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria","volume":"21","author":"T Dahiru","year":"2015","journal-title":"Pan Afr Med J"},{"key":"pgph.0000136.ref045","doi-asserted-by":"crossref","first-page":"386","DOI":"10.3389\/fpubh.2019.00386","article-title":"Delays in Achieving Maternal, Newborn, and Child Health Targets for 2021 and 2030 in Liberia","volume":"7","author":"U Laaser","year":"2019","journal-title":"Front Public Health"},{"key":"pgph.0000136.ref046","doi-asserted-by":"crossref","first-page":"4292","DOI":"10.3390\/ijerph17124292","article-title":"Barriers to Accessing Maternal Care in Low Income Countries in Africa: A Systematic Review","volume":"17","author":"R Dahab","year":"2020","journal-title":"Int J Environ Res Public Health"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000136","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,28]],"date-time":"2022-02-28T18:22:48Z","timestamp":1646072568000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000136"}},"subtitle":[],"editor":[{"given":"Vanessa Moraes","family":"Bezerra","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2022,2,28]]},"references-count":46,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2022,2,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000136","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,28]]}}}