Factors Influencing Antenatal Care Utilisation among Primary Health Care Centre Attendees in Obio/Akpor Local Government Area, Rivers State, Nigeria

Abstract

Introduction: Antenatal care (ANC) reduces maternal and neonatal morbidity and mortality by enabling early detection of complications and promoting skilled birth attendance. Despite the presence of primary health care centres (PHCs) in Nigeria, utilisation remains inadequate, with many women missing the recommended number of visits. Aims: This study assessed determinants of ANC utilisation among women in Obio/Akpor Local Government Area (LGA), Rivers State. Methods: A facility-based analytical cross-sectional study was conducted among 620 pregnant women attending four PHCs in Obio/Akpor LGA, recruited using a multistage sampling technique. Data were collected using structured interviewer-administered questionnaires covering sociodemographic characteristics, obstetric history, and health system factors, including distance to the facility, health insurance status, and perceived quality of care. Adequate ANC utilisation was defined as ≥8 contacts in accordance with WHO recommendations. Binary logistic regression was applied to identify independent predictors of ANC utilisation, and model diagnostics were performed, including the Hosmer–Lemeshow goodness-of-fit test and the area under the receiver operating characteristic curve (AUROC). Results: The mean age was 28.6 years (SD = 6.1), with most participants aged 20–29 years. Educational attainment was predominantly at the secondary level. ANC utilisation fell below the WHO eight-contact recommendation. Only 38.4% of women initiated ANC in the first trimester; 61.6% booked late. Adequate utilisation (≥ 8 contacts) was 28%. Education strongly predicted utilisation: women with tertiary education were 2.5 times more likely to achieve adequate ANC (OR = 2.5, 95% CI: 1.6–3.9). Health insurance coverage increased adequate utilisation by 70% (OR = 1.7, 95% CI: 1.1–2.6). Living more than 5 km from a PHC reduced the odds of adequate utilisation by nearly half (OR = 0.55, 95% CI: 0.3–0.9). Perceived quality of care also mattered: satisfied women were 2.6 times more likely to attend adequately (AOR = 2.6, 95% CI: 1.8–3.7). The model showed good predictive accuracy (AUROC = 0.81). Conclusion: ANC utilisation in Obio/Akpor remains inadequate, shaped by socioeconomic and health system factors. Expanding insurance coverage, improving transport and service decentralisation, and enhancing provider–client interactions are essential for better maternal health outcomes.