Association between quality of antenatal care service utilisation and adverse birth outcomes among adolescent women in 22 Sub-Saharan African countries. A mixed-effects multilevel analysis.

Objectives: This study aimed to assess the association between the quality of antenatal care (ANC) service utilisation and adverse birth outcomes among adolescent women in Sub-Saharan Africa (SSA).

Methods: A two-level mixed-effects model was employed using the recent Demographic Health Survey (DHS) data from 22 SSA countries. Both bivariable and multivariable multilevel analyses were conducted to assess the association between individual and community level factors with adverse birth outcomes. The results of the fixed effects model were interpreted in the form of adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs).

Results: In SSA, 23.5 % of adolescent mothers experienced adverse birth outcomes. This study found that receiving high quality ANC was associated with a 28 % reduction in the likelihood of adverse birth outcomes (AOR = 0.72, 95 % CI: 0.63, 0.83). Among the individual-level factors, middle-aged adolescence (AOR = 1.23, 95 % CI: 1.11, 1.36), being a female newborn (AOR = 1.15, 95 % CI: 1.05, 1.26), single marital status (AOR = 0.87, 95 % CI: 0.78, 0.96) and higher educational status (AOR = 0.83, 95 % CI: 0.74, 0.93) were significantly associated with adverse birth outcomes. From the community-level variables, women from Eastern Africa had positive significant association with adverse birth outcomes (AOR = 1.30, 95 % CI: 1.15, 1.46).

Conclusions: Nearly one-fourth of adolescent women in SSA experienced at least one type of adverse birth outcome. Low quality of ANC was significantly associated with adverse birth outcomes. Policymakers need to consider a comprehensive, essential, and minimal package of ANC to enhance the quality of ANC, which is crucial for better adolescent birth outcomes.