Published in PLOS One on 2026-04-21, 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: Bekalu Endalew, Tsehay Awoke Kassa, Muluye Gebrie Mengie, Dejen Tsegaye Alem, Yihalem Abebe Belay, Agegnehu Bante
Source: PLOS One • DOI 10.1371/journal.pone.0347341
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Effective coverage reflects the performance of a health system by integrating need, service utilization, and quality of care into a single measure. In many developing countries, inadequate effective coverage of antenatal care services along with poor quality maternal health services and low levels of awareness about healthcare has contributed to maternal mortality ratios that are 14 times higher than those in developed countries. Despite this significant disparity, there is limited evidence available regarding the effective coverage of antenatal care in Ethiopia. Therefore, this study aimed to assess the effective coverage of antenatal care and associated factors among women who attended antenatal care at West Gojjam Zone Public Hospitals, northwest Ethiopia.
A facility-based retrospective cross-sectional study design was carried out in West Gojjam public hospitals from June 30 to July 30, 2023. Study participants were selected using a multi-stage simple random sampling technique using patient identification number as a sampling frame. Data were gathered from hospital health information data systems and client charts, entered into Epi data version 4.6, and then exported to SPSS statistical package version 25 for further analysis. Both bi-variable logistic regression and multi-variable logistic regression analyses were carried out. Variables with p-value <0.25 in the bi variable logistic regression were entered into multi-variable logistic regression. Variables having P-values <0.05 in the multi-variable logistic regression were considered as statistically significant predictors of the outcome variable.
The effective coverage of antenatal care service was 25.9% (95% CI: 22.6, 29.4%) in the study area. Age of mothers ranged 25–34 (AOR: 0.32; 95% CI; 0.20–0.50), wanted pregnancy (AOR: 1.65; 95% CI; 1.08–2.55), presence of previous obstetric complication (AOR: 6.27; 95% CI; 3.83–10.28) and presence of previous gynecological complication (AOR: 2.08; 95% CI; 1.66–3.77) were statistically significantly associated variables with effective coverage of antenatal care services.
In this study one out of four mothers received effective coverage of antenatal care in the study area. Age of mothers ranged from 25 to 34, wanted pregnancy, presence of previous obstetric complication and presence of previous gynecological complication were statistical significant predictors of effective coverage of antenatal service. Therefore, boosting effective antenatal care requires targeted interventions based on identified predictors.
Introduction
Maternal mortality remains unacceptably high and continues to be a major global public health concern [1]. The number of women who die each year from complications of pregnancy and childbirth declined from 443,000 in 2000–260,000 in 2023, despite rapid population growth in many high-burden countries. Nevertheless, an estimated 712 women still die each day from pregnancy and childbirth related complications equivalent to one death every two minutes [2]. Ethiopia continues to face a substantial maternal health challenge, with a maternal mortality ratio of 195 deaths per 100,000 live births. This figure remains considerably higher than the Sustainable Development Goal (SDG) target of fewer than 70 deaths per 100,000 live births by 2030, indicating a significant gap that must be addressed [3].
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 research & evidence 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 Bekalu Endalew, Tsehay Awoke Kassa, Muluye Gebrie Mengie, Dejen Tsegaye Alem, Yihalem Abebe Belay, Agegnehu Bante. 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.
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- Evidence brief: Perceptions and experiences of women and providers on barriers and facilitators of quality emergency obstetric and newborn care services in public hospitals of West Shoa Zone, Oromia, Ethiopia: A phenomenological qualitative study
