Determinants of Antenatal Care Attendance among Pregnant Women Living in Endemic Malaria Settings: Experience from the Democratic Republic of Congo.

Background. Antenatal care (ANC) attendance helps pregnant women to benefit from preventive and curative services. Methods. Determinants for ANC attendance were identified through a cross-sectional survey in the Democratic Republic of Congo. Sociocultural bottlenecks were assessed via focus groups discussion of married men and women. Results. In this survey, 28 of the 500 interviewed pregnant women (5.6%) did not attend ANC services and 82.4% booked over the first trimester. The first visit is positively influenced by the reproductive age (OR: 0.52, 95% CI(0.28-0.95), p < 0.04), the educational level (OR: 0.41,95% CI(0.17-0.97), p < 0.04), the nearby health center (OR: 0.43, 95% CI(0.2-0.92), p < 0.03), and the presence of a male partner (OR: 10.48, 95% CI(2.1-52.23), p < 0.001). The barriers to early booking were (i) the cost of service; (ii) the appearance or individual income; (iii) the geographical inaccessibility or distance to health facilities; (iv) social and religious prohibitions; (v) the stigmatization from other women when conceiving in the late ages or young or while still lactating (parity); (vi) the time for waiting for services. Conclusion. The early ANC attendance is delayed among poor women with little education and living alone.