Published in PLOS One on 2026-05-15, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Kindu Yinges Wondie, Nuhamin Tesfa Tsega, Tazeb Alemu Anteneh, Alemneh Tadesse Kassie, Berihun Agegn Mengistie, Endalk Birrie Wondifraw, Getie Mihret Aragaw
Source: PLOS One • DOI 10.1371/journal.pone.0348679
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Despite high antenatal care contact coverage in Lesotho, the content and quality of care remains suboptimal. This study assessed the level and determinants of content-qualified antenatal care coverage using the 2023–2024 Lesotho Demographic and Health Survey.
Data were analyzed from 1,112 women aged 15–49 who had a live birth or stillbirth in the 2 years preceding the survey. Content-qualified antenatal care was constructed as a composite score (0–16) incorporating the timing of initiation, number of contacts, attendance of skilled providers, and receipt of 10 key content components. The score was categorized into ordered tertiles (low: 0–12, moderate: 13, high: 14–16). Survey-weighted ordinal logistic regression was used to identify factors associated with receiving higher content-qualified antenatal care.
Overall, 28.1% of women had low, 32.4% moderate, and 39.5% high content-qualified antenatal care scores. Higher coverage was significantly associated with being married or living with a partner (AOR = 1.78, 95% CI: 1.12–2.83), having secondary (AOR = 2.05, 95% CI: 1.34–3.14) and higher education (AOR = 1.90, 95% CI: 1.21–2.98), using the internet at least once per week (AOR = 1.61, 95% CI: 1.08–2.40), wanted pregnancy (AOR = 2.87, 95% CI: 1.65–5.01), a smaller household (AOR = 1.36, 95% CI: 1.05–1.76), and higher community education (AOR = 1.38, 95% CI: 1.09–1.75).
Although antenatal care contact coverage is high in Lesotho, content-qualified coverage remains low and inequitable. Targeted interventions to improve maternal and community education, internet access, and pregnancy planning are essential to close the quality-coverage gap.
Introduction
Sub-Saharan Africa (SSA) has the highest global burden of maternal deaths and stillbirths [1,2]. Lesotho has one of the highest maternal mortality ratios globally, with 478 deaths per 100,000 live births [3] and 39 infant deaths per 1000 [4]. Obstetric hemorrhage, hypertensive disorders, and complications of unsafe abortion are the leading causes [5].
Antenatal care (ANC) is defined as skilled healthcare provided to women during pregnancy [6]. ANC is the cornerstone of pregnancy-related complications detection, treatment, and prevention through counseling and advice, maternal and fetal assessments, vaccination, and micronutrient supplementation [7,8].
Lesotho has made strides to improve quality ANC coverage through reforms, including the 2014 National Health Reform, village health worker expansion, and stronger ANC-HIV integration [3,5]. As a result, the percentage of women attending one and four ANC contacts was 93 and 82 respectively. Despite this remarkable achievement in contact coverage, the expected reductions in maternal and neonatal mortality have not been achieved [4]. This discrepancy highlights the critical quality-contact gap, which can widen due to women starting ANC late, not attending the recommended number of contacts, receiving incomplete care content, scarcity of skilled providers, and inaccessible care because of geographic barriers [9–13]. Measuring the current ANCq coverage is a critical part of monitoring and evaluation of Lesotho’s move towards achieving quality ANC coverage.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Kindu Yinges Wondie, Nuhamin Tesfa Tsega, Tazeb Alemu Anteneh, Alemneh Tadesse Kassie, Berihun Agegn Mengistie, Endalk Birrie Wondifraw, Getie Mihret Aragaw. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Determinants of skilled birth attendant delivery among reproductive age women in Lesotho: A multilevel analysis of demographic and health survey data
- Evidence brief: Effective coverage and associated factors of antenatal care service among women who attended antenatal care at West Gojjam Zone Public Hospitals, Northwest Ethiopia
- Evidence brief: Addressing abortion through individual and community-level determinants: Evidence from Southern Ethiopia
