{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T04:15:19Z","timestamp":1793333719099,"version":"4.5.0"},"reference-count":46,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Provision of quality antenatal care (ANC) to pregnant women is essential for reducing maternal and newborn mortality. ANC provides an opportunity for early identification of conditions that increase the risk of adverse pregnancy outcomes. However, there is limited evidence regarding the quality of ANC received by women in Malawi. This study aimed to assess the quality of ANC and associated factors in Malawi.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Materials and methods<\/jats:title>\n<jats:p>National representative data from the 2019\u20132020 Malawi Multiple Indicator Cluster Survey was used for this cross\u2013sectional study. A total of 6,287 weighted sample of women aged 15 to 49 years who had a live birth and received ANC at least once within two years preceding the survey were included in the analysis. Descriptive statistics were used to estimate the magnitude of quality ANC and multivariable logistic regression was computed to identify associated factors.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Of the 6,287 women, only 12.6% (95% CI: 11.4\u201313.9) received quality ANC. The likelihood of receiving quality ANC was significantly higher among women who had four to seven ANC contacts (AOR = 2.10; 95% CI: 1.79\u20132.49), made at least eight ANC contacts (AOR\u2009 = \u20093.40; 95% CI:\u20091.90\u20136.09) and started ANC within the first trimester (AOR\u2009 = \u20091.30; 95% CI:\u20091.10\u20131.53). On the other hand, women who had only primary education (AOR = 0.62; 95% CI:0.48\u20130.82) and had five or more births (AOR\u2009 = \u20090.56; 95% CI:\u20090.40\u20130.78) were less likely to receive quality ANC.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>The findings reveal that quality of ANC in Malawi is low. These findings suggest the need for targeted interventions aimed at improving access to and utilization of ANC services among women with lower education and higher parity. Strengthening efforts to promote early ANC initiation and increasing the number of ANC contacts could significantly enhance the quality of ANC received by women in Malawi.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0305294","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T17:36:54Z","timestamp":1718213814000},"page":"e0305294","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Assessment of quality of antenatal care services and associated factors in Malawi: Insights from a nationwide household survey"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0951-8562","authenticated-orcid":true,"given":"Chrispin","family":"Mandiwa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernadetta","family":"Namondwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,12]]},"reference":[{"key":"pone.0305294.ref001","volume-title":"Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF,UNFPA, World Bank Group and UNDESA\/Population Division: executive summary.","author":"World Health Organization","year":"2023"},{"key":"pone.0305294.ref002","unstructured":"UNICEF. Never Forgotten. The situation of stillbirth around the globe. Report of the United Nations inter-agency group for child mortality estimation 2022. New York: 2023."},{"issue":"11","key":"pone.0305294.ref003","doi-asserted-by":"crossref","first-page":"e017122","DOI":"10.1136\/bmjopen-2017-017122","article-title":"Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries","volume":"7","author":"J Kuhnt","year":"2017","journal-title":"BMJ open"},{"key":"pone.0305294.ref004","unstructured":"World health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, Switzerland. 2016."},{"issue":"5","key":"pone.0305294.ref005","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1007\/s40258-014-0103-z","article-title":"Examining the influence of antenatal care visits and skilled delivery on neonatal deaths in Ghana","volume":"12","author":"MP Lambon-Quayefio","year":"2014","journal-title":"Applied health economics and health policy"},{"issue":"9542","key":"pone.0305294.ref006","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1016\/S0140-6736(06)69385-9","article-title":"Safe motherhood initiative: 20 years and counting","volume":"368","author":"AM Starrs","year":"2006","journal-title":"The Lancet"},{"key":"pone.0305294.ref007","author":"UNION I-P","year":"2008","journal-title":"The Millennium Development Goals Report 2007."},{"issue":"2","key":"pone.0305294.ref008","doi-asserted-by":"crossref","first-page":"e152","DOI":"10.1016\/S2214-109X(17)30472-2","article-title":"Monitoring universal health coverage within the Sustainable Development Goals: development and baseline data for an index of essential health services","volume":"6","author":"DR Hogan","year":"2018","journal-title":"The Lancet Global Health"},{"issue":"1","key":"pone.0305294.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-019-0745-2","article-title":"Late initiation of antenatal care and associated factors among pregnant women in Addis Zemen primary hospital, South Gondar, Ethiopia.","volume":"16","author":"HF Wolde","year":"2019","journal-title":"Reproductive health."},{"issue":"1","key":"pone.0305294.ref010","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-020-2746-0","article-title":"Perceptions of pregnant women of reasons for late initiation of antenatal care: a qualitative interview study.","volume":"20","author":"D Warri","year":"2020","journal-title":"BMC pregnancy and childbirth."},{"issue":"1","key":"pone.0305294.ref011","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-018-3928-y","article-title":"Focused antenatal care utilization and associated factors in Debre Tabor Town, northwest Ethiopia, 2017.","volume":"11","author":"TW Ayalew","year":"2018","journal-title":"BMC research notes."},{"issue":"2","key":"pone.0305294.ref012","doi-asserted-by":"crossref","first-page":"e56713","DOI":"10.1371\/journal.pone.0056713","article-title":"Early antenatal care: does it make a difference to outcomes of pregnancy associated with syphilis? A systematic review and meta-analysis","volume":"8","author":"SJ Hawkes","year":"2013","journal-title":"PloS one"},{"issue":"1","key":"pone.0305294.ref013","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12872-015-0110-5","article-title":"Prevalence of pregnancy induced hypertension and pregnancy outcomes among women seeking maternity services in Harare, Zimbabwe","volume":"15","author":"M Muti","year":"2015","journal-title":"BMC cardiovascular disorders"},{"issue":"4","key":"pone.0305294.ref014","doi-asserted-by":"crossref","first-page":"636","DOI":"10.1007\/s00125-017-4206-6","article-title":"Gestational diabetes and adverse perinatal outcomes from 716,152 births in France in 2012","volume":"60","author":"C Billionnet","year":"2017","journal-title":"Diabetologia"},{"key":"pone.0305294.ref015","volume-title":"WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience: Summary","author":"World Health Organization (WHO).","year":"2018"},{"key":"pone.0305294.ref016","volume-title":"Malawi Demographic and Health Survey 2015\u201316","author":"National Statistical Office\/Malawi, ICF","year":"2017"},{"key":"pone.0305294.ref017","volume-title":"Malawi Multiple Indicator Cluster Survey 2019\u201320, Survey Findings Report","author":"National Statistical Office","year":"2021"},{"issue":"10","key":"pone.0305294.ref018","doi-asserted-by":"crossref","first-page":"e0275933","DOI":"10.1371\/journal.pone.0275933","article-title":"An assessment of the quality of antenatal care and pregnancy outcomes in a tertiary hospital in Ghana.","volume":"17","author":"S Amponsah-Tabi","year":"2022","journal-title":"Plos one"},{"issue":"1","key":"pone.0305294.ref019","doi-asserted-by":"crossref","first-page":"2197294","DOI":"10.1080\/07853890.2023.2197294","article-title":"Independent and joint contributions of inadequate antenatal care timing, contacts and content to adverse pregnancy outcomes","volume":"55","author":"M Saaka","year":"2023","journal-title":"Annals of Medicine"},{"key":"pone.0305294.ref020","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1007\/s10995-020-02895-6","article-title":"Determinants of low birth weight in Ghana: Does quality of antenatal care matter?","volume":"24","author":"E Banchani","year":"2020","journal-title":"Maternal and Child Health Journal"},{"issue":"1","key":"pone.0305294.ref021","doi-asserted-by":"crossref","first-page":"1328796","DOI":"10.1080\/16549716.2017.1328796","article-title":"Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data.","volume":"10","author":"M Arunda","year":"2017","journal-title":"Global health action."},{"issue":"1","key":"pone.0305294.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12936-018-2360-z","article-title":"Association between timing and number of antenatal care visits on uptake of intermittent preventive treatment for malaria during pregnancy among Malawian women","volume":"17","author":"O Nkoka","year":"2018","journal-title":"Malaria journal"},{"issue":"1","key":"pone.0305294.ref023","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-018-0605-5","article-title":"Understanding barriers preventing pregnant women from starting antenatal clinic in the first trimester of pregnancy in Ntcheu District-Malawi.","volume":"15","author":"CS Chimatiro","year":"2018","journal-title":"Reproductive health."},{"issue":"1","key":"pone.0305294.ref024","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-4130-1","article-title":"Examining the impact of WHO\u2019s Focused Antenatal Care policy on early access, underutilisation and quality of antenatal care services in Malawi: a retrospective study.","volume":"19","author":"M Mchenga","year":"2019","journal-title":"BMC health services research."},{"key":"pone.0305294.ref025","first-page":"17455065221076731","article-title":"Quality of antenatal care and associated factors among pregnant women in East Africa using Demographic and Health Surveys: A multilevel analysis.","volume":"18","author":"TB Raru","year":"2022","journal-title":"Women\u2019s Health."},{"issue":"1","key":"pone.0305294.ref026","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-019-4476-4","article-title":"Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions.","volume":"19","author":"PA Afulani","year":"2019","journal-title":"BMC health services research."},{"issue":"1","key":"pone.0305294.ref027","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-021-01275-9","article-title":"Timing of first antenatal care visits and number of items of antenatal care contents received and associated factors in Ethiopia: multilevel mixed effects analysis.","volume":"18","author":"BT Woldeamanuel","year":"2021","journal-title":"Reproductive health."},{"issue":"2","key":"pone.0305294.ref028","doi-asserted-by":"crossref","first-page":"e0117996","DOI":"10.1371\/journal.pone.0117996","article-title":"Rural\/urban and socioeconomic differentials in quality of antenatal care in Ghana.","volume":"10","author":"PA Afulani","year":"2015","journal-title":"PloS one"},{"issue":"2","key":"pone.0305294.ref029","doi-asserted-by":"crossref","first-page":"e0263650","DOI":"10.1371\/journal.pone.0263650","article-title":"Socio-demographic factors associated with early antenatal care visits among pregnant women in Malawi: 2004\u20132016.","volume":"17","author":"WF Ng\u2019ambi","year":"2022","journal-title":"PloS one"},{"issue":"1","key":"pone.0305294.ref030","first-page":"1","article-title":"Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries.","volume":"5","author":"LD Howe","year":"2008","journal-title":"Emerging themes in epidemiology."},{"issue":"6","key":"pone.0305294.ref031","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1093\/heapol\/czl029","article-title":"Constructing socio-economic status indices: how to use principal components analysis.","volume":"21","author":"S Vyas","year":"2006","journal-title":"Health policy and planning."},{"issue":"8","key":"pone.0305294.ref032","doi-asserted-by":"crossref","first-page":"907","DOI":"10.1016\/0895-4356(96)00025-X","article-title":"Inappropriate use of bivariable analysis to screen risk factors for use in multivariable analysis","volume":"49","author":"G-W Sun","year":"1996","journal-title":"Journal of clinical epidemiology"},{"issue":"1","key":"pone.0305294.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12905-021-01487-y","article-title":"Do women empowerment indicators predict receipt of quality antenatal care in Cameroon? Evidence from a nationwide survey.","volume":"21","author":"EK Ameyaw","year":"2021","journal-title":"BMC Women\u2019s Health."},{"issue":"1","key":"pone.0305294.ref034","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-022-08169-x","article-title":"Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan demographic health survey 2020.","volume":"22","author":"Q Sserwanja","year":"2022","journal-title":"BMC health services research."},{"issue":"7","key":"pone.0305294.ref035","doi-asserted-by":"crossref","first-page":"e063426","DOI":"10.1136\/bmjopen-2022-063426","article-title":"Multilevel analysis of quality of antenatal care and associated factors among pregnant women in Ethiopia: a community based cross-sectional study","volume":"12","author":"WD Negash","year":"2022","journal-title":"BMJ open"},{"issue":"1","key":"pone.0305294.ref036","first-page":"1","article-title":"Quality of antenatal care in Zambia: a national assessment.","volume":"12","author":"NN Kyei","year":"2012","journal-title":"BMC pregnancy and childbirth."},{"key":"pone.0305294.ref037","doi-asserted-by":"crossref","first-page":"953","DOI":"10.2147\/IJWH.S261705","article-title":"Determinants of frequency and content of antenatal care in postnatal mothers in Arba Minch Zuria District, SNNPR, Ethiopia, 2019","volume":"12","author":"D Haile","year":"2020","journal-title":"International Journal of Women\u2019s Health"},{"issue":"1","key":"pone.0305294.ref038","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-016-0979-8","article-title":"The timing of antenatal care initiation and the content of care in Sindh, Pakistan.","volume":"16","author":"S Agha","year":"2016","journal-title":"BMC pregnancy and childbirth."},{"issue":"3","key":"pone.0305294.ref039","doi-asserted-by":"crossref","first-page":"21582440221117807","DOI":"10.1177\/21582440221117807","article-title":"Association Between Compliance With the New WHO-Recommended Frequency and Timing of Antenatal Care Contacts and Receiving Quality Antenatal Care in Cameroon.","volume":"12","author":"M Boah","year":"2022","journal-title":"SAGE Open."},{"issue":"1","key":"pone.0305294.ref040","first-page":"1","article-title":"Quality of antenatal care and its sociodemographic determinants: results of the 2015 Pelotas birth cohort, Brazil.","volume":"21","author":"LS Mor\u00f3n-Duarte","year":"2021","journal-title":"BMC health services research."},{"key":"pone.0305294.ref041","doi-asserted-by":"crossref","DOI":"10.1155\/2020\/5436324","article-title":"Assessment of quality of antenatal care services and its determinant factors in public health facilities of Hossana town, Hadiya zone, Southern Ethiopia: A Longitudinal Study.","volume":"2020","author":"T Tadesse Berehe","year":"2020","journal-title":"Advances in Public Health."},{"issue":"1","key":"pone.0305294.ref042","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-017-1488-0","article-title":"Quality of antenatal care services and completion of four or more antenatal care visits in Ethiopia: a finding based on a demographic and health survey.","volume":"17","author":"KF Muchie","year":"2017","journal-title":"BMC pregnancy and childbirth."},{"issue":"11","key":"pone.0305294.ref043","doi-asserted-by":"crossref","first-page":"788","DOI":"10.12968\/bjom.2020.28.11.788","article-title":"Factors associated with underutilisation of antenatal care services in Limpopo, South Africa.","volume":"28","author":"SA Mulondo","year":"2020","journal-title":"British Journal of Midwifery"},{"issue":"1","key":"pone.0305294.ref044","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-14-94","article-title":"Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data.","volume":"14","author":"C Joshi","year":"2014","journal-title":"BMC pregnancy and childbirth."},{"issue":"1","key":"pone.0305294.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12978-015-0081-0","article-title":"Assessment of quality of antenatal care services in Nigeria: evidence from a population-based survey.","volume":"12","author":"AF Fagbamigbe","year":"2015","journal-title":"Reproductive health."},{"issue":"1","key":"pone.0305294.ref046","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1186\/s12884-023-05497-6","article-title":"Perceptions on acceptability of the 2016 WHO ANC model among the pregnant women in Phalombe District, Malawi\u2013a qualitative study using Theoretical Framework of Acceptability.","volume":"23","author":"P Nyumwa","year":"2023","journal-title":"BMC Pregnancy and Childbirth"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0305294","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T17:37:40Z","timestamp":1718213860000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0305294"}},"subtitle":[],"editor":[{"given":"Douglas Aninng","family":"Opoku","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,6,12]]},"references-count":46,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0305294","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,12]]}}}