Interventions That Improve the Uptake of Antenatal Care Services in Sub-saharan Africa: a Systematic Review and Meta-analysis

Introduction : Despite 70% of global maternal deaths occurring in sub-Saharan Africa (SSA), antenatal care (ANC) still remains underutilized with diverse, inconsistent impact from interventions. This systematic review identifies the most effective interventions to improve ANC uptake in the region, aiming to inform policy decisions and ultimately reduce maternal and perinatal mortality. Methods : A systematic review of studies published between 2000 and 2022 was conducted to identify effective interventions that improve ANC uptake in SSA. Studies were screened using Rayyan software ^â , and data was extracted by two reviewers. Interventions included ICT interventions, financial incentives, mobile clinics, and pharmacological interventions. Studies were included if they were conducted in SSA, and if they reported on maternal-fetal outcomes. Data was synthesized using a narrative and graphic approach and meta-analysis was conducted using the empirical Bayes method. Publication bias was assessed using Egger's and Begg's tests and addressed using the Trim and Fill method. Results: In an analysis of 17 studies, which all either had the cluster-randomized controlled trial or randomized controlled trial study design, we investigated the effectiveness of diverse interventions in increasing ANC attendance. Our findings revealed an overall increase in ANC utilization across all interventions (OR=3.94, RR=1.16). Sub-group analysis further identified studies jointly reported from Kenya and Nigeria as demonstrating the highest impact. However, a crucial caveat emerged with the detection of publication bias, prompting cautious interpretation, and emphasizing the need for further research. Conclusion : Our analysis offers valuable insights for policymakers aiming to optimize interventions and maximize ANC uptake, potentially paving the way for improved maternal and perinatal outcomes in SSA.