ReviewJournal of public health in Africa2026
A systematic review of implementation strategies to improve timely initiation of antenatal care among pregnant women in sub-Saharan Africa.
Review in Journal of public health in Africa, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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12 authors.
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Abstract
Background: Despite the availability of antenatal care (ANC) services, fewer than 40% of pregnant women in sub-Saharan Africa initiate ANC within the first trimester, indicating suboptimal early utilisation of maternal health services in the region. Aim: This review aimed to identify and synthesise evidence on interventions that improve the timely initiation of ANC among pregnant adolescents and women in sub-Saharan Africa. Setting: All studies included in the review were conducted in sub-Saharan Africa. Method: A systematic search guided by Preferred Reporting Items for Systematic Review and Meta-Analyses across seven databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Scopus, and the Cochrane Database of Systematic Reviews - and grey literature sources including ProQuest Dissertations & Theses Global and African Journals Online [AJOL]) identified eligible English-language studies (1990-2022), including randomised and non-randomised trials, controlled before-and-after studies, and interrupted time-series. The review was conducted between September 2022 and October 2022, and the protocol was registered with PROSPERO (CRD42022380283). Results: Eleven studies met the inclusion criteria. Three types of intervention approaches were identified: community-based, facility-based, and a combination of both. Facility-based interventions, such as mobile phone reminders, for instance, the wired mothers innovation and quality improvement initiatives, showed improvements in early ANC attendance ranging from a 5% increase to more than triple the uptake. Community-based interventions also proved effective, with gains of up to 200%, as in Malawi, where early ANC increased from 10% to 29%. These mechanisms included home visits, education, male involvement, and engagement with traditional leaders. Conclusion: Integrated community and facility-based interventions offer promising strategies to improve timely ANC. Future efforts should consider cost-effectiveness and implementation research to enhance decision-making. Contribution: This study demonstrates the potential of underutilised interventions to enhance first-trimester ANC attendance and maternal health outcomes across sub-Saharan Africa.
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