{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T04:38:12Z","timestamp":1790656692929,"version":"4.1.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T00:00:00Z","timestamp":1738281600000},"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>Although late initiation of antenatal care has been linked with adverse pregnancy outcomes, a significant number of pregnant women in resource-limited regions are seeking this care late. There has been a lack of information on the extent and factors influencing late initiation of antenatal care in the African context following the implementation of the new antenatal care model in 2016. Thus, we aimed to determine the pooled prevalence of late antenatal care visit and its determinants among women in Sub-Saharan Africa (SSA) using national surveys conducted after the implementation of new guidelines.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We analyzed data from the recent demographic and health survey (DHS) conducted in 16 SSA between 2018 and 2022 using a weighted sample of 101,983 women who had antenatal care follow-up during their index pregnancy. A multilevel logistic regression models were fitted and likelihood and deviance values were used for model selection. In the regression model, we used adjusted odds ratios along with their corresponding 95% confidence intervals to determine the factors associated with late antenatal care visit.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>The pooled prevalence of late antenatal care visit among pregnant women in SSA was 53.8% [95% CI: 46.2% - 61.3%], ranging from 27.8% in Liberia to 75.8% in Nigeria. Women\u2019s age and education, working status, partner\u2019s education, health insurance coverage, birth order, household wealth, age at marriage, decision on health care, residence, and community-level women\u2019s illiteracy were the factors associated with late antenatal care visit.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>More than half of pregnant women in SSA initiated attending antenatal care during late pregnancy, with significant differences seen among countries. These results underscore the necessity for focused interventions to tackle these issues and enhance prompt access to antenatal services for better maternal and child health outcomes in the area. Moreover, creating tailored interventions for younger women, those with multiple previous births, employed women, and those who experienced early marriage to address their specific challenges and obstacles in seeking care is crucial.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0316671","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:41:51Z","timestamp":1738348911000},"page":"e0316671","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":8,"title":["Late initiation of antenatal care visit amid implementation of new antenatal care model in Sub-Saharan African countries: A multilevel analysis of multination population survey data"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8522-1504","authenticated-orcid":true,"given":"Kusse Urmale","family":"Mare","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gashaye Gobena","family":"Andargie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkerim Hassen","family":"Moloro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed Adem","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Osman Ahmed","family":"Mohammed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beriso Furo","family":"Wengoro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7986-6442","authenticated-orcid":true,"given":"Begetayinoral Kussia","family":"Lahole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfahun Simon","family":"Hadaro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simeon Meskele","family":"Leyto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros Orkaido","family":"Mamo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulhakim Hora","family":"Hedato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beminate Lemma","family":"Seifu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Temesgen Gebeyehu","family":"Wondmeneh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oumer Abdulkadir","family":"Ebrahim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kebede Gemeda","family":"Sabo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,31]]},"reference":[{"key":"pone.0316671.ref001","volume-title":"WHO recommendations on antenatal care for a positive pregnancy experience: summary: highlights and key messages from the World Health Organization\u2019s 2016 global recommendations for routine antenatal care.","author":"World Health Organization","year":"2018"},{"key":"pone.0316671.ref002","volume-title":"WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience, in WHO Guidelines Approved by the Guidelines Review Committee.","author":"World Health 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Puthussery","year":"2023","journal-title":"European Journal of Public Health"},{"issue":"1","key":"pone.0316671.ref006","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1186\/s12884-023-05442-7","article-title":"Risk of low birthweight associated with the timing and frequency of antenatal care visits in Lao PDR: a retrospective cohort study.","volume":"23","author":"S Nagatani","year":"2023","journal-title":"BMC Pregnancy and Childbirth."},{"key":"pone.0316671.ref007","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2458-7-268","article-title":"Under-attending free antenatal care is associated with adverse pregnancy outcomes.","volume":"7","author":"K Raatikainen","year":"2007","journal-title":"BMC public health."},{"issue":"Supplement_3","key":"pone.0316671.ref008","doi-asserted-by":"crossref","first-page":"ckac130","DOI":"10.1093\/eurpub\/ckac130.243","article-title":"Late antenatal care initiation and neonatal outcomes in an ethnically diverse maternal 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Analysis from a population-based birth cohort","volume":"388","author":"NA Alwan","year":"2016","journal-title":"The Lancet"},{"issue":"1","key":"pone.0316671.ref010","doi-asserted-by":"crossref","first-page":"S384","DOI":"10.1016\/j.ajog.2015.10.780","article-title":"Impact of late initiation of prenatal care on pregnancy outcomes among women who use drugs","volume":"214","author":"JL Eriksen","year":"2016","journal-title":"American Journal of Obstetrics & Gynecology"},{"issue":"11","key":"pone.0316671.ref011","doi-asserted-by":"crossref","first-page":"e0000584","DOI":"10.1371\/journal.pgph.0000584","article-title":"Late antenatal care utilization in Ethiopia: the effect of socio-economic inequities and regional disparities.","volume":"2","author":"B Mengist","year":"2022","journal-title":"PLOS Global Public Health."},{"issue":"1","key":"pone.0316671.ref012","article-title":"Late antenatal care initiation and its contributors among pregnant women at selected public health institutions in Southwest Ethiopia","volume":"39","author":"M Tesfaye","year":"2021","journal-title":"Pan African Medical Journal"},{"issue":"8","key":"pone.0316671.ref013","doi-asserted-by":"crossref","first-page":"e0000534","DOI":"10.1371\/journal.pgph.0000534","article-title":"Trends and determinants of late antenatal care initiation in three East African countries, 2007\u20132016: A population based cross-sectional analysis.","volume":"2","author":"C Mlandu","year":"2022","journal-title":"PLOS Global Public Health"},{"issue":"2","key":"pone.0316671.ref014","doi-asserted-by":"crossref","first-page":"623","DOI":"10.4314\/ahs.v23i2.72","article-title":"Prevalence of late antenatal care booking among pregnant women attending public health facilities of Kigamboni Municipality in Dar es Salaam region, Tanzania.","volume":"23","author":"A Ndomba","year":"2023","journal-title":"African Health Sciences."},{"issue":"1","key":"pone.0316671.ref015","first-page":"5423413","article-title":"Determinants of antenatal care attendance among pregnant women living in endemic malaria settings: experience from the Democratic Republic of Congo.","volume":"2016","author":"CN Nsibu","year":"2016","journal-title":"Obstetrics and gynecology international."},{"issue":"1","key":"pone.0316671.ref016","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s12884-023-06214-z","article-title":"Determinants of late antenatal care attendance among high parity women in Uganda: analysis of the 2016 Uganda demographic and health survey.","volume":"24","author":"K. Tumwizere G","year":"2024","journal-title":"BMC Pregnancy and Childbirth."},{"key":"pone.0316671.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-14-290","article-title":"Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010.","volume":"14","author":"A Manzi","year":"2014","journal-title":"BMC pregnancy and childbirth."},{"issue":"11","key":"pone.0316671.ref018","doi-asserted-by":"crossref","first-page":"e0241185","DOI":"10.1371\/journal.pone.0241185","article-title":"Status of the WHO recommended timing and frequency of antenatal care visits in Northern Bangladesh.","volume":"15","author":"BK Sarker","year":"2020","journal-title":"Plos one."},{"issue":"1","key":"pone.0316671.ref019","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s12905-022-02148-4","article-title":"Late initiation of antenatal care among pregnant women in Addis Ababa city, Ethiopia: a facility based cross-sectional study.","volume":"23","author":"N Girma","year":"2023","journal-title":"BMC Women\u2019s Health."},{"key":"pone.0316671.ref020","doi-asserted-by":"crossref","first-page":"866030","DOI":"10.3389\/fpubh.2022.866030","article-title":"Level of late initiation of antenatal care visit and associated factors amongst antenatal care attendant mothers in Gedo General Hospital, West Shoa Zone, Oromia Region, Ethiopia.","volume":"10","author":"BT Debelo","year":"2022","journal-title":"Frontiers in public health."},{"issue":"1","key":"pone.0316671.ref021","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1186\/s12913-022-08055-6","article-title":"Late initiation of antenatal care and associated factors among pregnant women in Jimma Zone Public Hospitals, Southwest Ethiopia, 2020.","volume":"22","author":"F Tadele","year":"2022","journal-title":"BMC Health Services Research."},{"key":"pone.0316671.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2393-13-121","article-title":"Timing and reasons for coming late for the first antenatal care visit by pregnant women at Mulago hospital, Kampala Uganda.","volume":"13","author":"I Kisuule","year":"2013","journal-title":"BMC pregnancy and childbirth."},{"issue":"12","key":"pone.0316671.ref023","doi-asserted-by":"crossref","first-page":"e0188279","DOI":"10.1371\/journal.pone.0188279","article-title":"Antenatal care and opportunities for quality improvement of service provision in resource limited settings: A mixed methods study.","volume":"12","author":"A Solnes Miltenburg","year":"2017","journal-title":"PloS one."},{"issue":"1","key":"pone.0316671.ref024","doi-asserted-by":"crossref","first-page":"e4","DOI":"10.1016\/S2214-109X(17)30471-0","article-title":"Improving quality of antenatal care through provision of medical supply kits","volume":"6","author":"CJ Uneke","year":"2018","journal-title":"The Lancet Global Health"},{"issue":"1","key":"pone.0316671.ref025","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1186\/s12884-022-04778-w","article-title":"Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation.","volume":"22","author":"C Gamberini","year":"2022","journal-title":"BMC Pregnancy and Childbirth."},{"issue":"12","key":"pone.0316671.ref026","article-title":"Health system and community level interventions for improving antenatal care coverage and health outcomes.","author":"L Mbuagbaw","year":"2015","journal-title":"Cochrane Database of Systematic Reviews."},{"issue":"1","key":"pone.0316671.ref027","doi-asserted-by":"crossref","first-page":"2141312","DOI":"10.1080\/16549716.2022.2141312","article-title":"Effect of community-level intervention on antenatal care attendance: a quasi-experimental study among postpartum women in Eastern Uganda.","volume":"15","author":"ST Wafula","year":"2022","journal-title":"Global health action."},{"issue":"10","key":"pone.0316671.ref028","doi-asserted-by":"crossref","first-page":"e0309300","DOI":"10.1371\/journal.pone.0309300","article-title":"Predictors of antenatal care services utilization by pregnant women in Afghanistan: evidence from the Afghanistan Health Survey 2018.","volume":"19","author":"MH Stanikzai","year":"2024","journal-title":"Plos one."},{"key":"pone.0316671.ref029","doi-asserted-by":"crossref","first-page":"475","DOI":"10.2147\/IJWH.S399544","article-title":"Sociodemographic predictors of initiating Antenatal Care visits by pregnant women during first trimester of pregnancy: findings from the Afghanistan Health Survey 2018","volume":"31","author":"E Tawfiq","year":"2023","journal-title":"International Journal of Women\u2019s Health"},{"key":"pone.0316671.ref030","unstructured":"Besho M, Bokora MC, Solomon T, Gemeda H, Bayisa D, Olani A. Late antenatal care initiation and associated factors among pregnant mothers attending Hawassa Public Health Facilities, South Ethiopia."},{"key":"pone.0316671.ref031","doi-asserted-by":"crossref","first-page":"101054","DOI":"10.1016\/j.ehb.2021.101054","article-title":"Early marriage and maternal health care utilisation: Evidence from sub-Saharan Africa","volume":"43","author":"C Li","year":"2021","journal-title":"Economics & Human Biology"},{"key":"pone.0316671.ref032","doi-asserted-by":"crossref","first-page":"1994","DOI":"10.3390\/healthcare10101994","article-title":"Child marriage and problems accessing healthcare in adulthood: evidence from India.","volume":"10","author":"B Datta","year":"2022","journal-title":"InHealthcare"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316671","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T18:42:09Z","timestamp":1738348929000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0316671"}},"subtitle":[],"editor":[{"given":"Muhammad Haroon","family":"Stanikzai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,1,31]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1,31]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0316671","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,31]]}}}