Antenatal Care Coverage in Tropical and Non-Tropical Countries: The Role of Economic and Health System Indicators
Keywords:
ANC, GDP, health system, hospital facility, UHCAbstract
Background: Antenatal care (ANC) coverage is a key indicator of maternal health system performance. Geographic and socioeconomic factors are often hypothesized to influence ANC utilization, yet evidence remains inconsistent. Objective: to examine the association between geographic classification (tropical and non-tropical countries), socioeconomic indicators, and health system characteristics with ANC coverage at the global level. Method: Global health data from countries with complete records were analyzed. Countries were classified by geographic zone (fully tropical, partially tropical, non-tropical) and health system indicators, including GDP per capita, health expenditure, medical doctors (physicians) density, nurse and midwife density, and hospital facility density. Descriptive statistics and comparative analysis were conducted, with mean differences, 95% CI, and p-value reported. Results: More than half (52.20%) of the countries analyzed were fully tropical, with lower ANC coverage (M = 72.95%, SD = 19.70%), though geographic classification was not significantly correlated (p = 0.588). GDP per capita was significantly associated with ANC coverage, with high-income countries showing a mean difference of 23.16 (95% CI = 6.98–39.33; p = 0.022) compared to the lowest-income countries. Physician density demonstrated a significant inverse association: countries with fewer than 23 doctors per 10,000 population had a mean difference of ANC coverage 16.84 higher (95% CI = 1.99–31.69; p < 0.001) than those with ≥44.5 doctors per 10,000 population. By contrast, nurse and midwife density (p = 0.255), health expenditure (p = 0.066), and hospital facility density (p = 0.112) were not significantly associated with ANC coverage. Conclusion: Economic capacity, rather than geographic classification or resource availability, is a significant determinant of ANC coverage. The inverse association with physician density highlights the role of workforce distribution and reliance on non-physician providers.
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