title: Assessing predictors of delayed antenatal care visits in Rwanda: a secondary analysis of Rwanda demographic and health survey 2010.
abstract: BACKGROUND
  Early initiation of antenatal care (ANC) can reduce common maternal complications and maternal and perinatal mortality. Though Rwanda demonstrated a remarkable decline in maternal mortality and 98% of Rwandan women receive antenatal care from a skilled provider, only 38% of women have an ANC visit in their first three months of pregnancy. This study assessed factors associated with delayed ANC in Rwanda.
  
  
  METHODS
  This is a cross-sectional study using data collected during the 2010 Rwanda DHS from 6,325 women age 15-49 that had at least one birth in the last five years. Factors associated with delayed ANC were identified using a multivariable logistic regression model using manual backward stepwise regression. Analysis was conducted in Stata v12 applying survey commands to account for the complex sample design.
  
  
  RESULTS
  Several factors were significantly associated with delayed ANC including having many children (4-6 children, OR = 1.42, 95% CI: 1.22, 1.65; or more than six children, OR = 1.57, 95% CI: 1.24, 1.99); feeling that distance to health facility is a problem (OR = 1.20, 95% CI: 1.04, 1.38); and unwanted pregnancy (OR = 1.41, 95% CI: 1.26, 1.58). The following were protective against delayed ANC: having an ANC at a private hospital or clinic (OR = 0.29, 95% CI: 0.15, 0.56); being married (OR = 0.85, 95% CI: 0.75, 0.96), and having public mutuelle health insurance (OR = 0.81, 95% CI: 0.71, 0.92) or another type of insurance (OR = 0.33, 95% CI: 0.23, 0.46).
  
  
  CONCLUSIONS
  This analysis revealed potential barriers to ANC service utilization. Distance to health facility remains a major constraint which suggests a great need of infrastructure and decentralization of maternal ANC to health posts and dispensaries. Interventions such as universal health insurance coverage, family planning, and community maternal health system are underway and could be part of effective strategies to address delays in ANC.
authors.affiliation: Partners In Health; Kigali, Rwanda and Boston, USA. mangano2020@gmail.com.
authors.forename: Anatole
authors.initials: A
authors.lastname: Manzi
authors.forename: Fabien
authors.initials: F
authors.lastname: Munyaneza
authors.forename: Francisca
authors.initials: F
authors.lastname: Mujawase
authors.forename: Leonidas
authors.initials: L
authors.lastname: Banamwana
authors.forename: Felix
authors.initials: F
authors.lastname: Sayinzoga
authors.forename: Dana R
authors.initials: DR
authors.lastname: Thomson
authors.forename: Joseph
authors.initials: J
authors.lastname: Ntaganira
authors.forename: Bethany L
authors.initials: BL
authors.lastname: Hedt-Gauthier
mesh_terms: D000293:Adolescent; D000328:Adult; D017438:Bisphenol A-Glycidyl Methacrylate; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D017533:Marital Status; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital; D010342:Patient Acceptance of Health Care; D011109:Polymethacrylic Acids; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D011295:Prenatal Care; D012432:Rwanda; D013997:Time Factors; D055815:Young Adult
chemical_list: C096479:Insure Cement; D011109:Polymethacrylic Acids; D017438:Bisphenol A-Glycidyl Methacrylate