Delayed Antenatal Attendance in Africa: A Systematic Review of Prevalence and Risk Factors

between a pregnant woman and a skilled health professional. The World Health Organization (WHO) recommends that all pregnant women begin antenatal care (ANC) by 12 weeks of pregnancy (Alem et al., 2022; De et al., 2017; Tunçalp et al., 2017). Early ANC provides an opportunity for timely identification of risk, disease prevention, health promotion, nutritional counselling and appropriate management of pregnancy related complications (Alem et al., 2022; Id et al., 2024) It also enables early diagnosis and management of maternal and fetal problems leading to better pregnancy results and a decrease in preventable maternal and neonatal morbidity and mortality. Pregnancy is a critical period and should be followed up continuously by trained health care providers. Among the many interventions that improve maternal and newborn health, timely initiation of ANC remains one of the most effective and cost-efficient strategies. Unfortunately, many women in low- and middle-income countries begin ANC after the first trimester. They thus lack important preventive, diagnostic and therapeutic interventions that are essential for a healthy pregnancy and childbirth (Black et al., 2015). These delays still pose a barrier to progress towards the achievement of the Sustainable Development Goals (SDGs) worldwide including the third goal of reducing maternal and neonatal mortality. Africa continues to shoulder disproportionate burden of late antenatal attendance. Despite progress in access to maternal health care services over the last 20 years, timely ANC initiation remains suboptimal in many African countries (Khekade et al., 2023; Rodríguez-muñoz et al., 2023). The need for timely maternal health care is especially important in Africa. The region continues to experience a very high burden of maternal mortality. The aim of this systematic review is synthesize evidence on prevalence and determinants of late antenatal attendance in Africa. The evidence generated from this review could guide policymakers, maternal health programme managers, healthcare providers, and development partners in designing evidence-based and context-specific interventions to promote early ANC initiation. The findings may contribute to better maternal and newborn health outcomes and to faster progress towards the targets set to improve maternal and neonatal health.