Spatial distribution and predictive factors of antenatal care in Burundi: a multilevel analysis and spatial baseline for the third Burundian demographic health survey

Background The use of antenatal care by pregnant women enables them to receive good pregnancy monitoring. This monitoring includes counseling, health instructions, examinations and tests to avoid pregnancy-related complications or death during childbirth. To avoid these complications, the World Health Organization (WHO) recommends at least four antenatal visits. Therefore, this study sought to understand the spatial distribution and predictive factors of antenatal care (ANC) among women aged 15 to 49 years with a medical doctor in Burundi. Methods We used data from the Second Burundi Demographic and Health Survey (DHS). A descriptive and spatial analysis of ANC prevalence were done. The ANC prevalence was mapped by region and by province. In unsampled data points, a cluster based interpolation of ANC prevalence was done using the kernel method with an adaptive window. Predictive factors of ANC were assessed using a fixed effects binary logistic regression. The dependent variable was antenatal care with a medical doctor and the explanatory variables were place of residence, age, education level, religion, marital status of the woman, household wealth index and delivery place of the woman. Data processing and data analysis were done using R software, version 3.5.0. Results The ANC prevalence varied from 0.0 to 16.2% with a median of 0.5%. A highest predicted ANC prevalence was observed at Muyinga and Kirundo provinces’ junction. Low prevalence was observed in several locations in all regions and provinces. The woman’s education level and delivery place were significantly associated with antenatal care with a medical doctor. Conclusion Globally, the ANC prevalence is low in Burundi. It varies across the country. There is an intra-regional or intra-provincial heterogeneity in term of ANC prevalence. Woman’s education level and delivery place are significantly associated antenatal care. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: We used secondary data I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Not Applicable The data underlying the results presented in the study are available from (). * ANC : antenatal care aOR : adjusted odds ratio CI : confidence interval DHS : demographic and health survey EAs : Enumeration areas HC : health center SDG : sustainable goals development QGIS : quantum geographic information system