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Table 4 Antenatal care (ANC), facility, and macro-level factors identified in relation to facility-based delivery in sub-Saharan Africa

From: Drivers and deterrents of facility delivery in sub-Saharan Africa: a systematic review

Antenatal care factor

Country in which it was studied

Direction of influence

Cites

Attended ANC

Kenya

ANC attendance linked to higher likelihood of FBD

[31]

Timing of first ANC visit (early onset of ANC)

Tanzania; Ghana

Earlier ANC initiation linked to greater likelihood of FBD; Later ANC linked to FBD

[49, 50]

Number of ANC visits

Burkina Faso; Ghana; Ivory Coast; Kenya; Malawi; Tanzania

Fewer ANC visits linked to lower likelihood of FBD; 3+, 4+ visits linked to higher rates of FBD

[14, 15, 25, 27–30, 51]

Saw doctor at ANC

Ghana

Seeing a doctor at ANC linked to greater FBD

[49, 54]

Quality of ANC

Ghana

Higher perceived quality linked to greater FBD

[54]

Being advised to deliver in a facility during ANC

Ghana; Kenya; Tanzania

Higher likelihood of FBD

[21, 28, 30, 34, 50]

FACILITY FACTOR

   

Distance to facility

Burkina Faso; Ghana; Kenya; Malawi; Mali; Nigeria; Senegal; Tanzania; Uganda; Zambia

Greater distance, lower likelihood of FBD

[15, 21, 22, 25, 34, 36, 44, 48],[50, 51, 59, 69, 70]

Cost

Ghana; Nigeria; Uganda

Greater cost associated with lower likelihood of FBD

[48, 63–65, 70, 71]

Promptness of care

Nigeria

Perception of promptness of care linked to greater utilization

[48]

Perceived quality of delivery care

Ghana; Nigeria; Tanzania

Individual perceptions about higher quality of care linked to higher FBD rates. One study showed no relationship between community perceptions of quality and individual FBD

[34, 48, 60, 65, 71]

Presence of any provider, presence of OB/GYN, 24-hour availability of provider

Nigeria

Higher likelihood of FBD

[48, 71]

Availability of medicine, equipment, emergency obstetric care

Nigeria; Tanzania; Uganda; Zambia

Increased FBD when medicine, equipment, higher level of emergency obstetric care available

[48, 53, 69, 72]

Staff attitudes / behavior

Nigeria; Swaziland; Tanzania; Uganda

Negative staff attitudes, abusive treatment at hands of HCPs related to lower FBD

[48, 63, 66, 67, 72]

Culturally unacceptable

Nigeria; Swaziland

Less likely to deliver in a facility

[63, 66]

Previous delivery with male provider

Senegal

Less likely to deliver in a facility

[62]

Electricity, running water, radio communication at facility

Uganda

Presence of infrastructure linked to higher FBD rates

[53]

MACRO-LEVEL FACTOR

   

Government share of health care spending

42 low-income countries

Greater percentage of government spending, greater likelihood of SBA

[23]

Female literacy rates (education)

42 low-income countries

Higher rates of female literacy in a country associated with higher rates of SBA

[23, 26]

Total health expenditures per capita

42 low-income countries

Higher total health expenditures per capita associated with higher rates of SBA

[23, 37]

Gross national income per capita

21 sub-Saharan African countries

Higher gross national income per capita linked to FBD

[20]