American Journal of Public Health Research
ISSN (Print): 2327-669X ISSN (Online): 2327-6703 Website: Editor-in-chief: Jing Sun
Open Access
Journal Browser
American Journal of Public Health Research. 2017, 5(4), 115-123
DOI: 10.12691/ajphr-5-4-4
Open AccessArticle

Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9

James Ouma1, and Collins Otieno Asweto2

1Department of Environmental Health, University of Kabianga, Kericho, Kenya

2School of Public Health, Maseno University, Kisumu, Kenya

Pub. Date: September 08, 2017

Cite this paper:
James Ouma and Collins Otieno Asweto. Maternal Vulnerabilities and Disparities in Availability of Antenatal Care Content in Kenya: Analysis of KDHS 2008/9. American Journal of Public Health Research. 2017; 5(4):115-123. doi: 10.12691/ajphr-5-4-4


Background: ANC provides the opportunity to detect and treat anomalies of pregnancy and access to preventive maternal and child healthcare. However, detailed information about the actual quality and content of ANC in practice is scanty, especially in developing countries. We analyzed the pattern and content of antenatal care service in Kenya in order to assess the quality of ANC. Methods: We used data from the 2008/9 KDHS, a nationally representative survey of women aged 15-49 years in Kenya. Proportion was used for description purpose while association was determined by bivariate and multivariate analysis in which odds ratio with a 95% confidence interval values were calculated. Results: About 50.9% of women sought ANC services either in health centers or dispensaries but these lower level health facilities had more content gaps. Multivariate analysis indicated that maternal age, regional residence, urban residence, wealth index, education and the media influenced ANC initiation and at least 4 ANC visits. There was a coverage gap existing in terms of iron-folate supplementation (66.1%), tetanus toxoid (66.5%), presumptive/preventive treatment for malaria with SP (38.7%) and education on pregnancy complication (44.3%). Nearly a third of women missed the screening for complication during pregnancy. Conclusion: Disparities exist in provision of ANC components, by type of facility attended, rural-urban and low versus higher income biases. Consequently vulnerable women attending ANC miss important care including screening for complication during pregnancy and labor. Efforts should be designed to improve on supplies to government health centers and dispensaries. Well stocked outreach village clinics with the requirements of a comprehensive antenatal care resource allocation should be used to eliminate service disparities. Government policy should help to increase media penetration amongst the masses and sensitize mothers on the importance of ANC.

antenatal care health facility ANC components Kenya

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


Figure of 2


[1]  WHO, Maternal and Child Health Fact Sheet. 2012.
[2]  UNFPA, 2013 Fact Sheet. 2013.
[3]  UN, The Millennium Development Goals Report 2012. 2012, New York: United Nations.
[4]  AUC, UN. Report on Progress in Achieving the Millennium Development Goals in Africa, 2013. in Abidjan: Côte d'Ivoire Meeting of the Committee of Experts of the Sixth Joint Annual Meetings of the ECA Conference of African Ministers of Finance, Planning and Economic Development and AU Conference of Ministers of Economy and Finance. 2012. Abidjan, Côte d'Ivoire: United Nations Economic and Social Council, Economic Commission for Africa & African Union Comission.
[5]  WHO, UNFPA & UNICEF, Trends in maternal mortality 1990-2010. 2012, WHO: Geneva, Switzerland.
[6]  Kenya National Bureau of Statistics (KNBS), Kenya Demographic and Health Survey 2008-09. 2010, Calverton, MD, USA: KNBS and ICF International.
[7]  UNICEF, State of the Worlds children 2006. 2006, New York: United Nations Children's Fund.
[8]  Koblinsky M., Mathews Z., Hussein J., The Lancet Maternal Survival Series steering group: Maternal Survival 3: Going to scale with professional skilled care. Lancet, 2006(368): p. 1377-1386.
[9]  AbouZahr C., Wardlaw T., Maternal mortality at the end of a decade: signs of progress? Bulletin of the World Health Organisation, 2001. 6(79): p. 561-568.
[10]  Urassa D.P., Carlstedt A., Nystrom L., Quality assessment of the antenatal program for anaemia in rural Tanzania. International Journal for Quality Health Care, 2002(14): p. 441-448.
[11]  Mattar C.N., Chong Y.S. Chew A., Simple antenatal preparation to improve breastfeeding practice: a randomized controlled trial. 2007. p. 73-80.
[12]  Campbell O.M.R., Graham W.J., The Lancet Maternal Survival Series steering group: Maternal survival 2: Strategies for reducing maternal mortality: getting on with what works. Lancet, 2006(368): p. 1284-99.
[13]  Carroli G., Rooney C., Villar J., How effective is antenatal care in preventing maternal mortality and serious morbidity? An overview of the evidence. Paediatr Perinat Epidemiol, 2001. 1(15): p. 1-42.
[14]  Haws R.A., Thomas A.L., Bhutta Z., Impact of packaged interventions on neonatal health: a review of the evidence. Health Policy and Planning, 2007(22): p. 193-215.
[15]  WHO & UNICEF, Antenatal Care in developing Countries: Promises, Achievements and Missed Opportunities: An Analysis of Trends, Levels, and Differentials: 1990-2001. 2003, Geneva, New York: WHO & UNICEF.
[16]  Villar J, Ba A.H.P., WHO Antenatal Care Randomized Trial: Manual for the Implementation of the New Model. 2002, Geneva: WHO.
[17]  Abou-Zahr CL, Wardlaw T., Antenatal care in developing countries: Promises achievements and missed opportunities: An analysis of trends, level and differentials, 1990-2001. 2003, Geneva: WHO and UNICEF.
[18]  Kiwuwa M.S., Mufubenga P., Use of antenatal care, maternity services, intermittent presumptive treatment and insecticide treated bed nets by pregnant women in Luwero district, Uganda. Malaria Journal, 2008(7): p. 44.
[19]  Magadi M.A., Madise N.J., Rodrigues R.N., Frequency and timing of antenatal care in Kenya: explaining the variations between women of different communities. Soc Sci Med, 2000(51): p. 551-561.
[20]  Ndidi E.P., OseremenI. G., Reasons given by pregnant women for late initiation of antenatal care in the niger delta, Nigeria. Ghana Med J, 2010(44): p. 47-51.
[21]  Central Bureau Of Statistics (CBS) M.O.H. and ORC Macro, Kenya Demographic and Health Survey 2003. 2004, Calverton, MD, USA: CBS, MOH, and ORC Macro.
[22]  Division, Maternal and Child Health, Focused Antenatal Care: Providing integrated, individualized care during pregancy. 2007, Office of Health, Infectious DIseases and Nutrition, Bureau for Global Health U.S. Agency for International Development.
[23]  Matsuoka S, Aiga H., Rasmey L.C., Perceived barriers to utilization of maternal health services in rural Cambodia. Health Policy, 2010(95): p. 255–263.
[24]  Pell C., Men Aca A. Were, Factors Affecting Antenatal Care Attendance: Results from Qualitative Studies in Ghana, Kenya and Malawi. PLoS ONE, 2013. 1(8): p. e53747.
[25]  Asweto, C.O. Aluoch J.O.,Obonyo C.O., Ouma J.O., Maternal Autonomy, Distance to Health Care Facility and ANC Attendance: Findings from Madiany Division of Siaya County, Kenya. American Journal of Public Health Research, 2014. 2(4): p. 153-158.
[26]  Toan K.T., Chuc T.K. Hinh N., Urban - Rural Disparities in Antenatal Care Utilization: a study of two cohorts of pregnant women in Vietnam. BMC Health Services Research, 2011(11): p. 120.
[27]  Celik, Y. & Hotchkiss D., socioeconomic determinants of maternal health care utilization in Turkey. Social Science Medicine, 2000. 12(50): p. 1797-1806.
[28]  Nkonki L.L., Chopra M., Doherty T., Explaining household socio-economic related child health inequalities using multiple methods in three diverse settings in South Africa. Int J Equity Health, 2011(10): p. 13.
[29]  Myer L & Harrison A., Why do women seek antenatal care late? Perspectives from rural South. Africa. J Midwifery Womens Health, 2003. 4(48): p. 268-272.
[30]  Eleonora RO Ribeiro, Alzira M.D.N.G., Heloisa B., Danilo D.F.L., Maria L.D.A., Luiz de Souza, Antonio A.M.S., Ricardo Q.G., Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil. BMC Pregnancy and Childbirth, 2009. 31(9): p. 1-8.
[31]  Babalola S., Fatusi A., Determinants of use of maternal health services in Nigeria - looking beyond individual and household factors. BMC Pregnancy Childbirth, 2009(9): p. 43.
[32]  Health-Evidence-Network, What is the effectiveness of antenatal care? 2005, Copenhagen: WHO Regional Office for Europe.