Date of Conferral





Health Services


Scott O. McDoniel


Lack of universal coverage of proven, low-cost, high-impact interventions—particularly for underserved and rural populations—remains a key reason for the high rates of maternal deaths in Uganda. Antenatal care (ANC) ensures early detection and treatment of pregnancy-related complications. Completion of recommended ANC visits remains suboptimal, particularly for rural women in Uganda. The purpose of this quantitative, cross-sectional study was to assess facility-level factors affecting completion of ANC attendance among women of reproductive age in a rural district in Uganda. The Dutton theory for initial and continued health services utilization was used to analyze the relationship between facility level factors and ANC service utilization. ANC service provision in eight health facilities was assessed using a service level index tool and 378 client ANC records from the eight health facilities were reviewed. The relationship between ANC completion and continued utilization, and facility service level index scores were analysed using logistic regression. The results demonstrate that the service level index tool is a potential alternative to the ANC module of the service provision assessment tool for reviewing ANC services. Completion of ANC attendance was primarily predicted by better timing of ANC service provision and, to a lesser extent, by availability of medicines and medical supplies. With the exception of timing of ANC service provision, service-level factors do not have predictive value for continued use of ANC services after the initial visit. These findings can be used to improve availability, content, and organization of ANC services with the aim of motivating clients to complete the recommended number of ANC visits.