Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020

Japhet Ishimwe; Odille Niyibizi; Aphrodis Tuyishime; Joseph Imanishimwe; John Mugisha; Absolomon Gashaija; Raphael Ndahimana; Roger Muragire; Marie Colombe Munezero; Gad Binayisa; Kevin Nwanna Uchechukwu

doi:doi:10.11648/j.ajhr.20261401.14

Research Article |

| Peer-Reviewed

Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020

Japhet Ishimwe^*

, Odille Niyibizi

, Aphrodis Tuyishime

, Joseph Imanishimwe

, John Mugisha

, Absolomon Gashaija

, Raphael Ndahimana

, Roger Muragire

, Marie Colombe Munezero

, Gad Binayisa

, Kevin Nwanna Uchechukwu

Published in American Journal of Health Research (Volume 14, Issue 1)

Received: 12 December 2025 Accepted: 29 December 2025 Published: 29 January 2026

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Abstract

Background: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with almost 95% occurring in low and middle-income countries where Rwanda is located. Therefore, this study aimed to determine predictors of delayed first ANC visits in rural areas of Rwanda. Methods: This cross-sectional study utilized the Rwanda Demographic and Health Survey (RDHS) data, enrolling a weighted sample of 5,060 women who had been pregnant within the five years preceding the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits. Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment of variables in a multivariate regression model, factors associated with the delays included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against the delays of ANC. Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of the first antenatal care visit, as the study revealed socio-demographic and maternal factors that significantly influence delays in initiating antenatal care.

Published in	American Journal of Health Research (Volume 14, Issue 1)
DOI	10.11648/j.ajhr.20261401.14
Page(s)	21-32
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Antenatal Care, Rwanda Demographic and Health Survey (RDHS), Predictors

1. Introduction

Maternal death is a sensitive global concern for women’s health

[1, 2]

. Referring to data from the World Health Organization (WHO), 800 women died every day in 2020 due to avoidable complications related to pregnancy and delivery, and almost 95% of them were from low and middle-income countries

[3, 4]

. Effective antenatal care service provision is one of the great strategies to tackle the amplification of maternal morbidity that often leads to maternal death

[5]

. The leading causes of maternal mortality include abnormal implantation, infectious diseases, hemorrhage, iron deficiency anemia, and pregnancy-induced hypertension, which can be inhibited when detected early during antenatal care

[6, 7]

The use of maternal services as recommended provides a great room for prevention and limiting the complications that often arise during pregnancy, and improves its outcomes

[8, 9]

. The WHO acclaimed the effective antenatal care visits as a crucial policy to support the health of women during gestation

[10-12]

, and it recommends that every woman in normal gestation, coming from low and middle-income countries, should attend ANC visits four times or more by emphasizing the first visit

[13-15]

. The first ANC visit creates an opportunity for the crucial prenatal assessment, where various conditions can be detected and treated to sustain the mother's and fetus’s health

[16-19]

. However, there are still some constraints that are affecting first ANC attendance in low and middle-income countries, like socio-demographic, educational, cultural, socio-economic, and geographical challenges

[20]

The noticeable limited advancement toward Millennium Development Goal 5 in most low and middle-income countries, where only a 75% reduction in the maternal death ratio from 1990 to 2015, is linked with socio-economic barriers and ineffective high-quality health services, including ANC services

[20]

. In developed countries, almost all women in the gestational period receive prenatal care timely, and 94% of them deliver in the presence of skilled healthcare providers, and have access to the proper and effective treatments needed when an emergency arises

[21]

. Contrary, a huge number of pregnant women in Asia and Africa fail to obtain suitable prenatal care and sometimes give birth in the absence of skilled practitioners

[21, 22]

The multi-level analysis done in sub-Saharan Africa using demographic health surveys from 2006 up to 2018 revealed that the rate of prompt initiation of antenatal care is 38.0%, varying between 14.5% and 68.6% in Mozambique and Liberia, respectively. Also, this study revealed that maternal education, wealth index, and proximity to the healthcare setting were linked with timely ANC initiation

[23]

. The cross-sectional study done in Papua New Guinea revealed a 23% proportion of early ANC visit initiation

[24]

, while in Ghana, there was an increased trend of early antenatal care attendance proportion of 49.3% in 2006, with 49.98% in 2011, and 58.61% in 2018. Also, it is worth highlighting that this finding indicated that formal education, health insurance coverage, and increased household economic status were associated with attending ANC timely

[25]

Although the genocide against Tutsi has devastated Rwanda’s health system, the country has managed to achieve a reduction in maternal death from 750 to 210 deaths per 100,000 over five years, 2000-2015

[26]

. This achievement is attributable to the strengthened health system via sector partnerships, care provided at the community level, evidence-based policymaking, powerful corporations with local and national governments, and a powerful political commitment that all improved the package of maternal care. However, the Maternal mortality rate in the last five years, 2015-2020, seemed to be stagnant from 210 to 203 deaths per 100,000

[27]

. In this context, highlighted slight decrease occurred in the maternal mortality ratio (MMR) has been accompanied by a rise in the proportion of expectant mothers attending antenatal care visits, as reported by the RDHS in 2014 and 2015, particularly in rural areas

[6]

. However, despite 98% of pregnant mothers receiving ANC from skilled healthcare personnel, only 47% have completed the recommended four ANC visits by skilled healthcare providers, whereas 56% attended their initial ANC visit

[29]

. These proportions indicate a shortfall in meeting the guidelines outlined by the WHO and the Rwanda Ministry of Health

[28]

. Identifying and addressing the barriers hindering ANC attendance is essential at both the health system and community levels to enhance maternal health outcomes. This study aims to determine the predictors of postponing initial ANC visits in rural areas of Rwanda using RDHS, 2019-2020.

2. Methodology

2.1. Study Design

This is a cross-sectional study, and has employed the secondary data analysis from the recent sixth Rwanda Demographic Health Survey conducted in 2019-2020 (RDHS, 2019-2020). The Rwanda Demographic Health Survey is a comprehensive countrywide survey carried out every five years by the Rwandan authorities working together with global collaborators.

2.2. Study Sampling and Sample Size

The Rwanda Demographic Health Survey utilized a two-stage sampling design, with the aim of estimating crucial health indicators across various geographic levels, encompassing national and other regional levels. Initially, sample locations or clusters consisting of defined enumeration areas (EAs) were chosen. Of a total of 500 clusters selected, 112 were from urban areas, while 388 were from rural areas. Subsequently, the household listing was carried out in all the selected enumeration areas (EAs). Based on these listings, households were randomly chosen for participation in the survey. At each sample point, 26 households were selected, resulting in a total sample of 13,000 households. This study included a weighted total sample of 5060 women aged 15 and 49 years who experienced pregnancy during the five years preceding the survey.

2.3. Data Collection Method and Procedure

The data collection was facilitated by the National Institute of Statistics of Rwanda in collaboration with the Ministry of Health, and the interviews with women took place from November 9, 2019, to July 20, 2020. The Rwanda Demographic Health Survey collects data through different questionnaires; however, the Women's Questionnaire is of particular interest in this study. This questionnaire targeted women aged between 15 and 49, who conceived in the five years preceding the survey. It gathered detailed information from these women concerning themselves, their families, and their children.

2.4. Variables Definition

2.4.1. Dependent Variable

The primary outcome variable of this study is delayed first ANC, which is defined as the initial ANC visit that took place in the second or third trimester of gestation. In this context, women who did not attend initial ANC visits within the first 3 months of gestation are categorized as having delayed their first ANC visit. Women who started ANC in the first three months were coded as "No" and those who initiated ANC after the fourth month of pregnancy were coded as "Yes", resulting in a binary variable for analysis.

2.4.2. Explanatory Variable

Through the reviewed pieces of literature, we have identified factors that are associated with ANC delay in the first trimester. This research encompassed various socio-demographic and maternal factors among the women participants. Firstly, the age range of the women included in the research was divided into three categories: 15-24, 25-34, and 35-49.

Marital status was another crucial aspect examined, distinguishing between those who never married, currently married/live with a partner, and those who lost a spouse/legally or illegally separated. Additionally, the sex of the household head was noted, with distinctions made between male and female heads of households. Religion was also a variable of interest, with categories including Catholic, Protestant, Adventist, Muslim, and others.

Furthermore, the education status of the women was documented, dividing participants into those who lack formal education, primary education, with also secondary/higher education levels. The geographic location of women was indicated by their province of residence, with options such as Kigali, South, West, North, and East. The wealth index provided insight into the economic status of the households, classified as poor, middle, and rich. Additionally, the women's occupation status was captured, categorizing them as unemployed, engaged in agricultural work, professionally employed, or working in manual labor or services. The variable "Total number of children ever born" denotes the count of children within the household, categorized as 1, 2-4, or over 4, while "Knowledge of the ovulation cycle" is a binary variable indicating whether individuals possess sufficient understanding of the ovulation process, coded as either None/Not enough or Yes/Adequate. The study also examined whether women were covered by health insurance, distinguishing between those with and without coverage. Lastly, the distance to health facilities was also assessed, considering whether access was perceived as a significant problem or not. These factors collectively provided a comprehensive picture of the socio-demographic and maternal health-associated attributes of the women respondents. By examining these variables, the study aimed to identify potential associations and disparities that may exist within the population, contributing valuable insights about first delayed ANC among women residing in rural areas of Rwanda.

2.5. Study Participants

2.6. Inclusion and Exclusion Criteria

This study involved all rural women participants who had been interviewed in the Rwanda demographic health survey 2019-2020, from the selected families or those who slept in the selected families a night prior to the survey. This current study also specifically considered only women who were pregnant in the last 5 years prior to the RDHS. Contrary, this study excluded all women who were interviewed in surveys other than the RDHS 2019-2020, ones who did not conceive for 5 years before the survey, and the rest of the others from urban areas and those with incomplete data on the outcome variable.

Download: Download full-size image

Figure 1. Flow chart of the sample size estimation used in the study.

2.7. Statistical Analysis

The study utilized a series of analytical methods to investigate the predictors associated with delayed first ANC visits in rural areas of Rwanda. Initially, descriptive analysis was employed to assess the proportion to characterize the research sample. Bivariate analysis utilized the Chi-square test to explore potential associations between explanatory variables and delayed first antenatal care (ANC) visits. Subsequently, backward stepwise regression was employed manually to construct a multivariable logistic regression model, aiming to identify potential predictors for delayed first ANC among Rwandan women residing in rural areas. All variables demonstrating statistical significance (p<0.05) were enrolled within the final model. Results from the multiple logistic regression analysis were reported as adjusted odds ratios (aOR) along with corresponding 95% confidence intervals (CIs), providing insight into the precision of the findings. Assessment for collinearity among independent variables was conducted, revealing no evidence of collinearity with correlation coefficients below 0.6. To ensure the generalizability of the findings, sample weighting (wt) was applied using (svy), and the entire analysis used Stata version 17.

2.8. Ethical Consideration

This research involved a secondary data analysis extracted from the Rwanda Demographic Health Survey, endorsed by the International Statistics authorities, and the National Ethics Review Board of Rwanda. To gain access to the dataset, we underwent an online application process to ensure compliance with ethical guidelines and obtain necessary consent for data usage. It's also worth noting that the dataset was exclusively utilized for analytical purposes, and direct interaction with the respondents was not required.

3. Flow of Variable Extraction

Download: Download full-size image

Figure 2. Conceptual framework for predictors associated with delayed first antenatal care visit

[28]

4. Results

Table 1. Distribution of socio-demographic variables and maternal factors of the participants.

CHARACTERISTICS	Frequency	Weighted %
Sex of Household Head	(N=5,060)	(100%)
Male	3,935	77.8
Female	1,125	22.2
Wealth Index
Poor	2,470	48.8
Middle	1,126	22.3
Rich	1,464	28.9
Religion
Catholic	1,794	35.5
Protestant	2,434	48.1
Adventist	674	13.3
Muslim	60	1.2
Others	98	1.9
Province
Kigali	241	4.8
South	1,173	23.2
West	1,208	23.8
North	899	17.8
East	1,539	30.4
Women age category
15-24	884	17.5
25-34	2,336	46.1
35-49	1,840	36.4
Marital status
Never in Union	487	9.6
Married/Living with a partner	4,133	81.7
Widow/divorced/separated	440	8.7
Women's education level
No formal education	615	12.1
Primary	3,526	69.7
Secondary/higher education	919	18.2
Women’s Occupation
Unemployed	751	14.8
Agricultural	2,366	46.8
Profession/employed	113	2.2
Manuel/work/services	1,830	36.2
Distance to Health Facility
Big problem	1,347	26.6
Not a big problem	3,713	73.4
Covered by Health Insurance
No	912	18.0
Yes	4,148	82.0
Total Children Ever Born
One child	1,148	22.7
2-4	2,752	54.4
Over 4	1,160	22.9
Knowledge of the Ovulation Cycle
None/Not enough	2,159	42.7
Yes/Adequate	2,901	57.3

4.1. Social Demographic and Maternal-Related Characteristics

Of the 5060 weighted participants enrolled in this analysis, a big proportion of women living in rural areas were aged 25-34 years (46.1%, n=2,336), and 48.1% were from protestant domination. Nearly half (48.8%, n=2,470) were poor, and over three-fourths (81.7%, n=4,133) were married and living with a partner. The majority of (69.7%, n=3526) studied up to primary school, and (46.8%, n=2366) were in the agricultural sector. Furthermore, only (22.2%, n=1125) of household heads were female, and over half of the families had 2-4 children (Table 1).

4.2. Factors Associated with Delayed First Visit Antenatal Care in the Rural Areas of Rwanda

From the bivariate analysis the following factors were significantly associated with the delayed first antenatal care visit: wealth index (p=0.001), province (p<0.001), women’s age category (p=0.002), marital status (p<0.001), woman’s education (p<0.001), woman’s occupation (p<0.001), distance to a health facility (p=0.004) and insurance coverage (p<0.001). For maternal factors, significant associations were found in the total number of children ever born p<0.001) (Table 2).

In multivariate analysis, there were various factors which appeared to be associated with the delayed first ANC visit in rural areas of Rwanda including lower level of wealth index (poor) (AOR=1.47, 95% CI: 1.23,1.76); having 2-4 children and over 4 children (AOR=1.30, 95% CI: 1.11, 1.59 vs AOR=2.30, 95% CI: 1.79-3.04); not being in union (AOR=2.20, 95% CI: 1,70, 2.62).

The odds of late first ANC increased as the women’s increase in age, (AOR=1.20, 95% CI: 1.02-1.52 vs AOR=1.30, 95% CI: 1.04, 1,70 for age category of 25-34 and 35-49 respectively), and unemployed women were 2.1 more likely to delay first ANC visit compare to employed ones (AOR=2.10, 95%CI: 1.16-3.5); and also odds of late first ANC appeared to increase in those women who are doing agriculture and manual works (AOR=2.40 95% CI: 1.33-4.27 vs AOR=2.46 95% CI: 1.37-4.44) respectively. Being covered by health insurance was a protective factor for delaying first antenatal care, where 23% would have delayed first ANC if they were not covered by the health insurance (Table 3).

Table 2. Bivariate analysis for socio-demographic and maternal factors associated with delayed first antenatal care in the rural areas of Rwanda, RDHS 2019-2020.

Characteristics	Weighted N=5060		X2 p-Value
Characteristics	N	%	X2 p-Value
Sex of Household Head			0.07
Male	3935	77.8
Female	1125	22.2
Wealth Index			<0.001*
Poor	2470	48.8
Middle	1126	22.2
Rich	1464	29
Religion			0.164
Catholic	1794	35.4
Protestant	2435	48.1
Adventist	673	13.3
Muslim	60	1.2
Others	98	2.0
Province of residence			0.001*
Kigali	241	4.70
South	1173	23.1
West	1209	24.0
North	898	17.7
East	1539	30.4
Women age category			0.002*
15-24	884	17.4
25-34	2336	46.2
35-49	1840	36.3
Marital status			<0.001*
Never in union	487	9.70
Married/living with a partner	4133	81.6
widowed/divorced/separated	440	8.7
Women's Education			<0.001*
No formal education	615	12.2
Primary	3527	69.7
Secondary or higher	918	18.1
Women Occupation			<0.001*
Unemployed	751	14.8
Agricultural	2366	46.7
Profession/employed	113	2.4
Manual work/services	1830	36.1
Distance to Health Facility			0.004*
Big problem	1347	26.6
Not a big problem	3713	73.4
Covered by health insurance			<0.001*
No	912	18.1
Yes	4148	81.9
Total children ever born			<0.001*
One child	1148	22.7
2-4 children	2752	54.4
Over 4 children	1160	22.9
Knowledge of the ovulatory cycle			0.948
None/Not enough	2159	42.7
Yes/Adequate	2901	57.3

*Stands for Statistical significance, Ref: Reference

Table 3. Multivariate analysis of Factors associated with delayed first antenatal care visits in rural areas of Rwanda, RDHS 2019-2020.

	Full model			Adjusted model
	COR	95% CI	P-Value	AOR	95% CI	P-Value
Characteristics
Sex of the house
Male	Ref
Female	0.98	[0.84-1.13]	0.79	-	-	-
Wealth Index
Poor	1.7	[1.46-1.97]	<0.001	1.47	[1.23-1.76]	<0.001**
Middle	1.29	[1.08-1.55]	0.04	1.15	[0.93-1.49]	0.186
Rich	Ref			Ref
Religion
Catholic	Ref
Protestants	1	[0.80-1.14]	0.92	_	_	_
Adventist	1.18	[0.98-1.43]	0.07	_	_	_
Muslim	1.37	[0.76-2.49]	0.29	_	_	_
Others	1	[0.63-1.58]	0.99	_	_	_
Province
Kigali	Ref			Ref
south	0.45	[032-0.62]	<0.001	0.34	[0.19-0.60]	<0.001
West	0.55	[0.39-0.75]	<0.001	0.41	[0.23-0.73]	0.002
North	0.54	[0.39-0.75]	<0.001	0.43	[0.24-0.76]	0.004
East	0.49	[0.36-0.68]	<0.001	0.38	[0.22-0.67]	0.001
Women age category
15-24	Ref			Ref
25-34	0.82	[0.65-0.97]	0.02	1.20	[1.02-1.51]	0.033*
35-49	1.04	[0.87-1.23]	0.01	1.30	[1.04-1.70]	0.023*
Marital status
Married/Living with a partner	Ref			Ref
Never in Union	1.7	[1.40-2.08]	<0.001	2.20	[1.70-2.62]	<0.001***
Widow/divorced/separated	1.08	[0.86-1.34]	0.48	1	[0.72-1.25]	0.737
Women's education level
No formal education	1.86	[1.47-2.34]	<0.001	1.20	[0.93-1.57]	0.158
Primary	1.5	[1.26-1.77]	<0.001	1.10	[0.95-1.40]	0.145
Secondary/higher education	Ref			Ref
Women's Occupation
Unemployed	3.43	[1.95-6.02]	<0.001	2.10	[1.16-3.95]	0.014*
Agricultural	3.84	[2.22-6.62]	<0.001	2.40	[1.33-4.27]	0.003*
Profession/employed	Ref			Ref
Manuel/work/services	4.15	[2.40-7.18]	<0.001	2.46	[1.37-4.44]	0.003*
Distance to Health Facility
Big problem	1.21	[1.06-1.39]	0.004	1.10	[0.95-1.27]	0.198
Not a big problem	Ref			Ref
Covered by Health Insurance
No	Ref			Ref
Yes	0.6	[0.51-0.70]	<0.001	0.77	[0.60-0.86]	<0.001***
Total Children Ever Born
One child	Ref			Ref
Two- four	1,06	[0.91-1.23]	<0.001	1.30	[1.11-1.59]	0.001**
Over 4	1.75	[1.46-2.09]	<0.001	2.30	[1.79-3.04]	<0.001***
Knowledge about the ovulatory cycle
None/Not enough	1	[0.88-1.13]	0.94	_	_	_
Yes/Adequate	Ref

Statistical significance: *** for (P<0.001), ** for (P=0.001), and * for (P<0.05), Ref: Reference.

5. Discussion

This study aimed to determine predictors associated with the first delayed antenatal care visit in the rural areas of Rwanda, to inform policymakers in creating strategies that promote early and timely ANC visits and improve the high standard of prenatal care. The World Health Organization (WHO) recommends the initiation of antenatal care in the first 12 weeks (3 months) of pregnancy, especially for women residing in low- and middle-income countries

[30]

. An effective attended first antenatal care visit allows the mother to be aware of the basic information about the pregnancy and to be screened for conditions, plus an iron supplement that improves both the health status of the mother and fetus

[31]

. This study exposed that the prevalence of delayed first ANC visit among rural women was 40.2% which is almost similar to the proportion of women with delayed ANC, 41% as revealed by the study done in Rwanda

[32]

, and this proportion is not consistent with what was found in Ethiopia, DRC, Kenya, and Tanzania (68.4%, 64.9%, 69.2% and 53.0%), respectively

[33, 34]

This study showed that the odds of first delayed first ANC in rural areas increase as maternal age increases, which is in line with findings reported in Ethiopia

[34]

. However, it was different from what studies have done in Kenya

[35]

and South Africa

[36]

reported that maternal age below 20 years was found to be associated with late first ANC. Our findings showed that delaying first ANC is associated with increasing maternal age. This may be attributed to older and multiparous women are likely to be complacent and less inclined to prioritize ANC. This may stem from their familiarity with pregnancy and childbirth, leading to a perception that ANC is less essential, particularly when compounded by caregiving responsibilities.

Unemployed women, farmers, and those who work manual labor/services were more likely to delay their first ANC visit, and this is supported by the studies conducted in Tanzania

[9]

and Rwanda

[32]

, which showed that mothers who were not employed were more likely to delay first ANC visit. This may be due to a lack enough economic support that puts them in the position of being more occupied with earning duties and giving less priority to seeking ANC services on time. This study also found that women with a poor wealth index were more likely to experience the delays of first ANC, which is in line with a study conducted in three eastern countries, Kenya, RDC, and Tanzania, which revealed that the odds of late first ANC initiation were significantly higher among women in poor-income households. The possible reason for this could be that Women with a poor wealth index face delayed first antenatal care (ANC) visit due to financial barriers, limited access to health facilities, and competing basic needs

[33]

Contrary to the study conducted in Ethiopia

[37]

, this study also revealed that mothers who have never been in a union were more likely to delay the first antenatal care visit. The plausible reason could be that mothers who had not been in union may feel less confident in seeking ANC due to social stigma, low familial support, and financial constraints. Also, consistent with the other research endeavors done in countries within the Sub-Saharan African region, where Rwanda is located

[6, 38]

, indicated that women who did not have health insurance were more likely to attend lately first antenatal care visit. Our findings showed that being covered with Health insurance is a protective factor for delaying first antenatal care.

From our findings, the odds of delaying first antenatal care increase as the number of children increases. Having two to four children and above was a potential factor in the delay of first ANC; this is similar to what has been found in the studies conducted in Ethiopia

[39]

and Rwanda

[6]

. The thinkable explanation might be that women who live in families with a rise in the number of children are more likely to have financial shortages and get busy taking care of families and accomplishing various household activities than taking care of their health when they are pregnant.

6. Strengths and Limitations of the Study

Despite the strengths of this study, including the use of nationally representative data with a large sample size and high data quality, there are limitations that should be acknowledged. Some crucial variables, such as mothers’ perceptions on antenatal care services and the quality of care, were not captured in the Demographic and Health Survey. In addition, recall bias may have occurred, as women were required to report information related to the pregnancies within 5 years before the survey.

7. Conclusion

This study highlights the urgent need to address the low uptake of initial antenatal care (ANC) services in rural areas of Rwanda. Key predictors of delayed first ANC visit include low household wealth, advanced maternal age, unemployment, and large household size, reflecting underlying social and systemic barriers to maternal healthcare access.

To address these challenges, policymakers and health authorities should implement inclusive, context-specific strategies that prioritize poor and vulnerable populations. Strengthening community health workers' follow-up roles, expanding community-based health education, particularly on family planning, and sustaining interactive outreach programs are critical to promoting early ANC attendance. A coordinated approach involving policymakers, healthcare providers, and community stakeholders is essential to improve timely ANC initiation and maternal health outcomes in rural areas.

Abbreviations

WHO	World Health Organization
ANC	Antenatal Care
MMR	Maternal Mortality Rate
RDHS	Rwanda Demographic Health Survey
AOR	Adjusted Odds Ratio
COR	Crude Odds Ratio
EAs	Enumeration Areas
CI	Confidence Interval

Acknowledgments

The authors are immensely thankful to ICF International for the measure DHS program and for providing consent to use the RDHS dataset for this study.

Author Contributions

Japhet Ishimwe: Conceptualization, Data curation, Formal Analysis, Methodology, Writing – original draft, Writing – review & editing

Odille Niyibizi: Methodology, Writing – review & editing

Aphrodis Tuyishime: Formal Analysis, Methodology, Writing – Original draft, Writing – review & editing

Joseph Imanishimwe: Methodology, Writing - Original draft, Writing – review & editing

John Mugisha: Writing- Original draft, Methodology

Absolomon Gashaija: Formal Analysis, Methodology

Raphael Ndahimana: Conceptualization, Data curation, Formal Analysis, Writing – Original draft

Roger Muragire: Methodology, Writing – review & editing

Marie Colombe Munezero: Conceptualization, Writing -Original draft

Gad Binayisa: Data curation, Formal Analysis, Methodology, Writing – Original draft, Writing – review & editing

Kevin Nwanna Uchechukwu: Supervision, Validation, Writing – review & editing

Funding

There was no funding received for this study.

Data Availability Statement

The dataset utilized for generating the research results is accessible online through the DHS database at https://dhsprogram.com/publications/publication-FR370-DHS-Final-Reports.cfm.

Conflicts of Interest

The authors declare no conflicts of interest.

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Ishimwe, J., Niyibizi, O., Tuyishime, A., Imanishimwe, J., Mugisha, J., et al. (2026). Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. American Journal of Health Research, 14(1), 21-32. https://doi.org/10.11648/j.ajhr.20261401.14

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Ishimwe, J.; Niyibizi, O.; Tuyishime, A.; Imanishimwe, J.; Mugisha, J., et al. Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. Am. J. Health Res. 2026, 14(1), 21-32. doi: 10.11648/j.ajhr.20261401.14

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AMA Style

Ishimwe J, Niyibizi O, Tuyishime A, Imanishimwe J, Mugisha J, et al. Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. Am J Health Res. 2026;14(1):21-32. doi: 10.11648/j.ajhr.20261401.14

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@article{10.11648/j.ajhr.20261401.14,
  author = {Japhet Ishimwe and Odille Niyibizi and Aphrodis Tuyishime and Joseph Imanishimwe and John Mugisha and Absolomon Gashaija and Raphael Ndahimana and Roger Muragire and Marie Colombe Munezero and Gad Binayisa and Kevin Nwanna Uchechukwu},
  title = {Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020},
  journal = {American Journal of Health Research},
  volume = {14},
  number = {1},
  pages = {21-32},
  doi = {10.11648/j.ajhr.20261401.14},
  url = {https://doi.org/10.11648/j.ajhr.20261401.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20261401.14},
  abstract = {Background: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with almost 95% occurring in low and middle-income countries where Rwanda is located. Therefore, this study aimed to determine predictors of delayed first ANC visits in rural areas of Rwanda. Methods: This cross-sectional study utilized the Rwanda Demographic and Health Survey (RDHS) data, enrolling a weighted sample of 5,060 women who had been pregnant within the five years preceding the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits. Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment of variables in a multivariate regression model, factors associated with the delays included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against the delays of ANC. Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of the first antenatal care visit, as the study revealed socio-demographic and maternal factors that significantly influence delays in initiating antenatal care.},
 year = {2026}
}

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TY  - JOUR
T1  - Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020
AU  - Japhet Ishimwe
AU  - Odille Niyibizi
AU  - Aphrodis Tuyishime
AU  - Joseph Imanishimwe
AU  - John Mugisha
AU  - Absolomon Gashaija
AU  - Raphael Ndahimana
AU  - Roger Muragire
AU  - Marie Colombe Munezero
AU  - Gad Binayisa
AU  - Kevin Nwanna Uchechukwu
Y1  - 2026/01/29
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhr.20261401.14
DO  - 10.11648/j.ajhr.20261401.14
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 21
EP  - 32
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20261401.14
AB  - Background: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with almost 95% occurring in low and middle-income countries where Rwanda is located. Therefore, this study aimed to determine predictors of delayed first ANC visits in rural areas of Rwanda. Methods: This cross-sectional study utilized the Rwanda Demographic and Health Survey (RDHS) data, enrolling a weighted sample of 5,060 women who had been pregnant within the five years preceding the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits. Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment of variables in a multivariate regression model, factors associated with the delays included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against the delays of ANC. Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of the first antenatal care visit, as the study revealed socio-demographic and maternal factors that significantly influence delays in initiating antenatal care.
VL  - 14
IS  - 1
ER  -

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Author Information

Japhet Ishimwe

School of Public Health, University of Rwanda, Kigali, Rwanda

Contact Email

http://orcid.org/0009-0009-5213-3925
Odille Niyibizi

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0009-0717-7507
Aphrodis Tuyishime

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0006-0920-3666
Joseph Imanishimwe

School of Public Health, University of Rwanda, Kigali, Rwanda;Human Resources for Health Department, Rwanda Ministry, Kigali, Rwanda

http://orcid.org/0009-0007-8245-4012
John Mugisha

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0004-0610-0165
Absolomon Gashaija

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0005-8081-6687
Raphael Ndahimana

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0004-0066-1826
Roger Muragire

School of Public Health, University of Rwanda, Kigali, Rwanda;School of Health Science, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0007-8747-9729
Marie Colombe Munezero

School of Nursing and Midwifery, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0001-2969-9332
Gad Binayisa

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0009-0003-2207-4086
Kevin Nwanna Uchechukwu

School of Public Health, University of Rwanda, Kigali, Rwanda

http://orcid.org/0000-0003-1488-4532

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APA Style

Ishimwe, J., Niyibizi, O., Tuyishime, A., Imanishimwe, J., Mugisha, J., et al. (2026). Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. American Journal of Health Research, 14(1), 21-32. https://doi.org/10.11648/j.ajhr.20261401.14

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ACS Style

Ishimwe, J.; Niyibizi, O.; Tuyishime, A.; Imanishimwe, J.; Mugisha, J., et al. Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. Am. J. Health Res. 2026, 14(1), 21-32. doi: 10.11648/j.ajhr.20261401.14

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AMA Style

Ishimwe J, Niyibizi O, Tuyishime A, Imanishimwe J, Mugisha J, et al. Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020. Am J Health Res. 2026;14(1):21-32. doi: 10.11648/j.ajhr.20261401.14

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@article{10.11648/j.ajhr.20261401.14,
  author = {Japhet Ishimwe and Odille Niyibizi and Aphrodis Tuyishime and Joseph Imanishimwe and John Mugisha and Absolomon Gashaija and Raphael Ndahimana and Roger Muragire and Marie Colombe Munezero and Gad Binayisa and Kevin Nwanna Uchechukwu},
  title = {Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020},
  journal = {American Journal of Health Research},
  volume = {14},
  number = {1},
  pages = {21-32},
  doi = {10.11648/j.ajhr.20261401.14},
  url = {https://doi.org/10.11648/j.ajhr.20261401.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajhr.20261401.14},
  abstract = {Background: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with almost 95% occurring in low and middle-income countries where Rwanda is located. Therefore, this study aimed to determine predictors of delayed first ANC visits in rural areas of Rwanda. Methods: This cross-sectional study utilized the Rwanda Demographic and Health Survey (RDHS) data, enrolling a weighted sample of 5,060 women who had been pregnant within the five years preceding the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits. Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment of variables in a multivariate regression model, factors associated with the delays included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against the delays of ANC. Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of the first antenatal care visit, as the study revealed socio-demographic and maternal factors that significantly influence delays in initiating antenatal care.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Predictors for Delayed First Antenatal Care Visit in Rural Area of Rwanda: Evidence from Rwanda Demographic Health Survey 2019-2020
AU  - Japhet Ishimwe
AU  - Odille Niyibizi
AU  - Aphrodis Tuyishime
AU  - Joseph Imanishimwe
AU  - John Mugisha
AU  - Absolomon Gashaija
AU  - Raphael Ndahimana
AU  - Roger Muragire
AU  - Marie Colombe Munezero
AU  - Gad Binayisa
AU  - Kevin Nwanna Uchechukwu
Y1  - 2026/01/29
PY  - 2026
N1  - https://doi.org/10.11648/j.ajhr.20261401.14
DO  - 10.11648/j.ajhr.20261401.14
T2  - American Journal of Health Research
JF  - American Journal of Health Research
JO  - American Journal of Health Research
SP  - 21
EP  - 32
PB  - Science Publishing Group
SN  - 2330-8796
UR  - https://doi.org/10.11648/j.ajhr.20261401.14
AB  - Background: Timely commencement of antenatal care (ANC) improves maternal outcomes by reducing complications that often result in death. According to the World Health Organization, 800 women died daily in 2020 from preventable complications related to pregnancy and childbirth, with almost 95% occurring in low and middle-income countries where Rwanda is located. Therefore, this study aimed to determine predictors of delayed first ANC visits in rural areas of Rwanda. Methods: This cross-sectional study utilized the Rwanda Demographic and Health Survey (RDHS) data, enrolling a weighted sample of 5,060 women who had been pregnant within the five years preceding the survey. Logistic regression modeling identified socio-demographic and maternal characteristics associated with delayed first ANC visits. Results: The prevalence of delayed first ANC visits was 40.2%. After adjustment of variables in a multivariate regression model, factors associated with the delays included low wealth index, marital status, maternal age (25-34 and 35-49), having 2-4 or more than 4 children, and occupation. Health insurance coverage was a protective factor against the delays of ANC. Conclusion: The findings highlight the need for interventions at multiple levels to increase timely uptake of the first antenatal care visit, as the study revealed socio-demographic and maternal factors that significantly influence delays in initiating antenatal care.
VL  - 14
IS  - 1
ER  -

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