Early antenatal care initiation and associated factors in Hohoe Municipality, Ghana: A five-year multi-facility repeated cross-sectional record review study.

backgroundEarly initiation of antenatal care (ANC) is a critical strategy for improving maternal and neonatal health outcomes, as it enables timely detection and management of pregnancy-related risks. However, women in low- and middle-income countries initiate ANC late. This study estimated the proportion of women initiating ANC within the first trimester in three health facilities in the Hohoe Municipality, Ghana, over a five-year period (2020-2024). It also assessed trends across years and examined factors associated with early ANC initiation.

methodsWe conducted a multi-facility repeated cross-sectional record review of ANC records from three health facilities in Hohoe Municipality from January 2020 to December 2024. Of 7,660 records identified, 1,381 were excluded because the first ANC contact had occurred at another facility, leaving 6,279 for analysis. Background characteristics were summarised using frequencies and percentages, and the proportion of women initiating ANC within the first trimester was calculated overall and for each year. Multivariable binary logistic regression was used to examine the factors associated with early ANC initiation; age-by-parity interaction terms tested, and facility-by-predictor interaction models were fitted to assess effect heterogeneity. Results were presented as odds ratios with 95% confidence intervals (CIs), and statistical significance was set at p < 0.05.

resultsEarly ANC initiation increased slightly from 45.3% in 2020 to 46.4% in 2023 before declining to 44.3% in 2024, with an overall proportion of 45.1% across the study period. Patterns differed by facility between the COVID-19 (2020-2021) and post-COVID-19 (2022-2024) periods. Early initiation declined at Gbi-Wegbe Health Center (54.3% to 46.0%; p = 0.008) but increased at Adabraka Health Center (31.5% to 42.0%; p < 0.001) and at the Volta Regional Hospital (45.4% to 47.6%; p = 0.002). The odds of early ANC initiation was higher among women aged 31-40 years (aOR = 1.15; 95% CI: 1.01-1.31) than those aged 14-30, and among women with high-end of the acceptable range blood pressure (aOR = 1.44; 95% CI: 1.26-1.65), and those with above acceptable/Grade 1 hypertension (aOR = 1.95; 95% CI: 1.34-2.83) relative to those with acceptable hypertension status. Odds were lower with increasing parity, and lower at Adabraka Health Center and Volta Regional Hospital than at Gbi-Wedbe Health Center. The interaction analysis between maternal age and parity showed that multiparous women aged 31-40 had lower odds of early ANC initiation (OR = 0.61; 95% CI: 0.41-0.91), and lower among grand multiparous women of the same age (OR = 0.29; 95% CI: 0.11-0.77). In the facility-stratified analyses, grand multiparity was the only factor associated with early ANC initiation, which was consistent across all three facilities.

conclusionFewer than half of women initiated ANC early in the Hohoe Municipality, with less variations across the study period and divergent trajectories between facilities. Early initiation was more likely among women aged 31-40 years and those with raised blood pressure, and less likely with increasing parity, with age and parity interacting. Facility-specific interventions prioritising women with high parity and reproductive education and needed to increase ANC initiation, whiles improving access to health facilities.