title: Utilization of focused antenatal care in Zambia: examining individual- and community-level factors using a multilevel analysis.
abstract: OBJECTIVE
  We examine the individual- and community-level factors associated with the utilization of antenatal care, following the adoption of the focused antenatal care (FANC) approach in Zambia.
  
  
  METHODS
  Using the 2007 Zambia Demographic and Health Survey, linked with administrative and health facility census data, we specify two multilevel logistic models to assess the factors associated with (1) the inadequate use of antenatal care (ANC) (defined as three or fewer visits) and (2) the non-use of ANC in the first trimester of pregnancy.
  
  
  RESULTS
  Although all women in the selected sample had at least one ANC visit, 40% did not have the minimum number required (four), whereas more than 80% of the initial check-ups did not occur in the first trimester. At the individual level, the woman's employment status, quality of ANC received and the husband's educational attainment are negatively associated, while parity, the household childcare burden and wealth are positively associated with inadequate utilization of ANC. Both individual- and community-level characteristics influence inadequate use and non-use of ANC in the first trimester; however, community-level factors are relatively stronger in rural areas.
  
  
  CONCLUSIONS
  The results suggest that improving the content of care during ANC visits may foster adequate use of ANC and encourage early initiation of ANC visits. Furthermore, health promotion programmes need to further encourage male involvement in pregnant women's decision to seek ANC to encourage adequate use of services.
authors.affiliation: Department of Economics, University of Pretoria, Pretoria 0002, South Africa.
authors.forename: Chitalu M
authors.initials: CM
authors.lastname: Chama-Chiliba
authors.affiliation: Department of Economics, University of Pretoria, Pretoria 0002, South Africa steve.koch@up.ac.za.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Koch
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011295:Prenatal Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia
keywords: Focused antenatal care; Zambia; maternal health services; multilevel analysis