Maternal screening coverage and determinants during facility-based antenatal care in Nigeria: Analysis of the 2018 Demographic and Health Survey

Background Antenatal care (ANC) provides an opportunity for early identification and treatment of pregnancy-related conditions to prevent adverse maternal and foetal outcomes. The influence of socioeconomic and health system factors on maternal screening during ANC remains unclear. We evaluated the coverage and determinants of facility-based ANC use and components related to maternal screening for common pregnancy-related conditions in Nigeria. Methods Using data from the 2018 Nigeria Demographic and Health Survey, we estimated the percentage of women aged 15-49 years who reported facility-based ANC for their most recent live birth in the 5 years preceding the survey. Among them, we estimated the percentage who received care components related to maternal screening (blood pressure measured, and urine and blood samples taken) at least once. We used logistic regression to examine the association between household wealth and 1) facility-based ANC utilisation and 2) screening components of care received. Facility type (private or public sector) was considered as an effect modifier. Results Among the sample of 21,792 women, 72.8% reported facility-based ANC. Most ANC users reported having had their blood pressure measured (95.2%), and their blood (89.3%) and urine samples taken (88.0%). All three screening components were received by 83.4% of facility-based ANC users. Compared to women from the poorest quintile, the richest had significantly higher adjusted odds of having facility-based ANC (aOR 4.25, 95% CI: 3.23 – 5.59) and, among ANC users, of receiving all three screening components (aOR = 3.43, 95% CI: 2.52 – 4.68). The adjusted odds of receiving all three components were 49% lower among women who used private ANC compared to those who used only public providers (aOR = 0.51, 95% CI: 0.43 – 0.61). There was no evidence of interaction by facility type. Conclusion Wealth inequality is associated with disparities in utilisation of facility-based ANC and maternal screening. Socio-economically disadvantaged women, who are most in need of maternal health services, face a ‘double penalty’ of deprived ANC use and maternal screening during ANC. Interventions focused on mitigating these disparities can help improve maternal outcomes. Concerted efforts are required to regulate the private facilities and strengthen the public facilities to provide high-quality maternal healthcare.