A multilevel analysis of neighbourhood effects on the use of antenatal care in Nigeria

With an estimated 59,000 maternal deaths annually, Nigeria contributes about 10 percent of the world’s maternal deaths. Antenatal care is one of the major interventions recommended to reduce maternal mortality. Previous studies on antenatal care have focused on individual level determinants, but the role of community factors has been largely ignored. The study examined community contextual factors influencing the use of antenatal care in Nigeria using data from 2008 Nigeria Demographic and Health Survey. We employed multilevel logistic regression techniques at the individual and community levels. Results showed that women from communities with high proportion of women that delivered in a health facility (OR=4.2, p<0.001) and high proportion of educated women (OR=3.4, p<0.001) were more likely to attend four or more antenatal care visits, and in the first trimester compared with those residing in disadvantaged communities. Neighbourhood factors also acted as moderators on the association between individual level factors and antenatal care. Findings suggest the need to tailor interventions at the community context. Specifically, interventions aimed at improving antenatal care visits and in the first trimester, should focus on increasing women’s education and health facility delivery in disadvantaged communities.