Spatial distribution and predictive factors of antenatal care in Burundi: a multilevel analysis and spatial baseline for the third Burundian demographic health survey

BackgroundThe use of antenatal care by pregnant women enables them to receive good pregnancy monitoring. This monitoring includes counseling, health instructions, examinations and tests to avoid pregnancy-related complications or death during childbirth. To avoid these complications, the World Health Organization (WHO) recommends at least four antenatal visits. Therefore, this study sought to understand the spatial distribution and predictive factors of antenatal care (ANC) among women aged 15 to 49 years with a medical doctor in Burundi. MethodsWe used data from the Second Burundi Demographic and Health Survey (DHS). A descriptive and spatial analysis of ANC prevalence were done. The ANC prevalence was mapped by region and by province. In unsampled data points, a cluster based interpolation of ANC prevalence was done using the kernel method with an adaptive window. Predictive factors of ANC were assessed using a fixed effects binary logistic regression. The dependent variable was antenatal care with a medical doctor and the explanatory variables were place of residence, age, education level, religion, marital status of the woman, household wealth index and delivery place of the woman. Data processing and data analysis were done using R software, version 3.5.0. ResultsThe ANC prevalence varied from 0.0 to 16.2% with a median of 0.5%. A highest predicted ANC prevalence was observed at Muyinga and Kirundo provinces junction. Low prevalence was observed in several locations in all regions and provinces. The womans education level and delivery place were significantly associated with antenatal care with a medical doctor. ConclusionGlobally, the ANC prevalence is low in Burundi. It varies across the country. There is an intra-regional or intra-provincial heterogeneity in term of ANC prevalence. Womans education level and delivery place are significantly associated antenatal care.