Compliance with WHO-recommended ≥8 antenatal contacts and associated factors among women at primary health facilities in Mbarara district, Uganda

Abstract

Background: The World Health Organisation (WHO) recommends ≥8 antenatal care (ANC) contacts to improve detection of pregnancy risks and maternal newborn outcomes. However, uptake of the 8-contact model remains low in many low-resource settings. Objectives: To assess compliance with the WHO-recommended ≥8 ANC contacts and associated factors among women attending primary health facilities in Mbarara District, south-western Uganda. Design: Facility-based cross-sectional study. Methods: Postnatal women attending postnatal and immunisation clinics at five randomly selected primary health facilities in Mbarara district were recruited between April and May 2025. Data were collected using interviewer-administered questionnaires and verified with antenatal cards. Data were analysed using Stata version 18 software. Descriptive statistics summarised participant characteristics. Bivariate and multivariable logistic regression analyses identified factors associated with compliance with the WHO-recommended ≥8 ANC contacts. Results: Of 433 participants enrolled (median age 27 years; interquartile range 23-31 years), the majority (67%; 290/433) were aged 21-34 years. Overall compliance with WHO-recommended ≥8 ANC Contacts was 15.0% (65/433; 95% CI: 11.8%–18.7%). The factors significantly associated with compliance with the WHO-recommended ≥8 Antenatal Contacts were initiating ANC in the first trimester of the index pregnancy (aOR = 43.08; 95% CI:14.84-124.97; p<0.001), staying within a distance of less than 5 km (aOR = 2.00; 95% CI:1.05-3.77; p=0.034), and monthly income of ≥100,000 Uganda shillings (aOR = 1.13; 95% CI:1.03-4.33; p=0.041). Conclusion: Compliance with the WHO-recommended ≥8 ANC contacts was low. Higher compliance was observed among women who initiated ANC early, lived closer to health facilities, and had higher incomes. Future strategies focus on factors associated with compliance, including early ANC initiation, geographic accessibility, and socioeconomic barriers.