Prevalence and risk factors for non-use of antenatal care visits: analysis of the 2010 South Sudan household survey

Background: Antenatal care (ANC) is a preventive public health intervention to ensure healthy pregnancy outcomes and improve survival and health of newborns. In South Sudan, about 40% of pregnant women use ANC, however, the frequency of the ANC checks falls short of the recommended four visits. Hence, this study examined potential risk factors associated with non-use of ANC in South Sudan. Method: Data for this analysis was from the 2010 South Sudan Household Survey second round, which was a nationally representative stratified cluster sample survey. The study included information from 3504 women aged 15-49 years who had given birth within two years preceding the survey. Non-use of ANC was examined against sixteen potential risk factors, using simple and multiple logistic regression analyses adjusted for cluster sampling survey design. Results: The prevalence of non-use of ANC was 58% [95% confidence interval (CI): (55.7, 59.8)], the prevalence of 1-3 ANC visits was 24% [95% CI: (22.7, 26.7)] and that for 4 or more visits was 18% [95% CI: (16.3, 19.3)]. After adjusting for potential confounding factors, geographic regions, polygamy status [adjusted odds ratio (AOR) = 1.23; 95% CI: (1.00, 1.51), p = 0.047 for a husband with more than one wife], mother's literacy [AOR = 1.79; 95% CI: (1.31, 2.45), p = 0.001 for illiterate mothers], and knowledge on a newborns' danger signs [AOR = 1.77; 95% CI (1.03, 3.05), p = 0.040 for mothers who had limited knowledge of a newborns' danger signs] were significantly associated with non-use of ANC. Conclusions: Overall improvement of women's access to the recommended number of ANC visits is needed in South Sudan. Strategies to encourage Southern Sudanese women to pursue education as well as to raise awareness about the importance of ANC services are essential. It is also important to prioritize strategies to increase access to health care services in rural areas as well as developing strategies to reduce the financial burden associated with maternal health services.