Factors Associated with the Continuum of Prenatal Care in the Post-Ebola Context in Guinea

Background: The 2018 demographic and health survey reports low coverage in the continuum of antenatal care over the period 2013 to 2018. However, little remains known about this indicator since the Ebola epidemic crisis was over. This epidemic has been reported to decrease utilization of maternal health services. This study aims to determine the coverage and factors associated with four or more antenatal care visits in Guinea in the post-Ebola context. Methods: This was a cross-sectional study using secondary data from the most recent (2018) Guinea Demographic and Health Survey. Women aged 15 to 49 years constituted our study population. Our sample included women who had their most recent birth over the last 24 months preceding data collection and whether or not they had performed 4 antenatal care (ANC) visits. Factors associated with performing four or more antenatal visits were assessed through a multivariate logistic regression analysis using Stata software version 15.1. The final model was constructed using the bottom-up stepwise method. Hosmer and Leeshawn’s goodness-of-fit test was used for model specification. Results: Among the 2634 women in the sample, 41% had four or more ANC visits. Factors associated with attending four or more ANC visits included education level, poverty quintile and region. Women with a secondary or higher education were 44% more likely to attend four or more ANC visits (OR = 1.44, 95% CI = [1.07 - 1.92]. Those whose spouses had secondary or education level were 1.66 times more likely to attend four or more ANC visits. Women from moderately wealthy households were 76% more likely to attend four or more ANC visits (OR = 1.76, 95% CI = [1.30 - 2.39]. Women from wealthier households were 2.52 times more likely to attend four or more ANC visits (OR = 2.52, 95% CI = [1.30 - 2.39]). Women living in Boké and Nzérékoré regions were 44% and 47% less likely to attend four or more ANC visits, respectively (OR = 0.56, IC 95% = [0.35 - 0.94]) and (OR = 0.53, IC 95% = [0.31 - 0.89]). Conclusion: Attending four or more ANC visits declined in the post-Ebola epidemic context in Guinea from 57% in 2012 to 41% in 2018. To improve coverage in four or more ANC visits in this context, there is a need for policies and programs to address education, poverty and administrative region factors.