Late start of antenatal care in Burundi: Effect of socio-demographic, socio-cultural, and health system-related factors

Despite intensive international efforts to extend the coverage of primary healthcare services for women, pregnancy and childbirth still represent a high-risk period for both mother and child, particularly in low- and middle-income countries. Lack of access to antenatal care and its inadequate use during pregnancy contribute to maternal mortality. This study aimed to establish the factors associated with late start of antenatal care (ANC) in Muramvya health district, Burundi. A cross- sectional study was carried out in six randomly selected health facilities of the Muramvya district. The study population consisted of pregnant women who attended antenatal clinics. A total of 280 women were included in the study. Data were collected through face-to-face interviews. Descriptive statistics, bivariate and multivariate logistic regression models were used to measure the determinants of the late start of ANC after 12 weeks of gestation. ANC was initiated after 12 weeks of pregnancy in 72.50% of women, 58.6% and 13.9% respectively in the second and last trimester. Based on Multivariate logistic regression: Women between 20 and 35 years of age have a lower risk of starting ANC late than adolescents (AOR = 0.18; 95%CI:0.03-0.83). Lack of knowledge about the interventions offered during ANC (AOR = 2.37; 95%CI:1.32-4.25), late recognition of pregnancy status (AOR= 6.7; 95%CI:2.41-18.66), unplanned pregnancy (AOR = 1.85 95%CI:1.01-3.40) and the time for women to reach the health facility: between 30minutes to 1 hour (AOR = 2.40 95%CI:1.25-4.59) and more than 1 hour of walking (AOR = 2.15; 95%CI:1.01-4.60) are associated with the late start of ANC. The results of the study show that most women start ANC late. There is a need for effective behavioral interventions and public awareness and education targeting adolescents and women to improve early initiation of ANC