medtigo Journal of Emergency Medicine

| Volume 1, Issue 1

Systematic Literature Review and Meta-Analysis of Timely Initiation of Antenatal Care Among Pregnant Women in Ethiopia: Prevalence and Associated Factors

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Author Affiliations

medtigo J Emerg Med. |
Date - Received: Nov 03, 2024,
Accepted: Nov 06, 2024,
Published: Dec 31, 2024.

https://doi.org/10.63096/medtigo3092116

Abstract

Background: Timely initiation of antenatal care (ANC) is crucial for clinical practices, including routine hypertension screening, fetal heart sound detection, illness identification, eradicating inequalities, providing psychological support, and postpartum family planning. However, the timely start and coverage of prenatal care differ throughout continents, nations, regions, and even within an area. Therefore, this study aims to determine the pooled prevalence of timely initiation of antenatal care and its associated factors.
Methods: The studies were searched in various databases such as PubMed, MEDLINE, ScienceDirect, Embase, Google Scholar, Cochran Library, Africa Journal of Online, and university repository. Found 23 research publications, and data was extracted using Microsoft Excel 365 and analyzed using the STATA 17 version. Heterogeneity (I2) was found, and a random effect model was used to determine the pooled prevalence of timely prenatal care commencing. Related factors were also investigated.
Result: The overall pooled prevalence of timely initiation of antenatal care among the pregnant women in Ethiopia was 37% (95% CI: 33–42), with statistical heterogeneity (I2 = 98.32%, p = 0.00). Good knowledge about antenatal care (OR=2.2, 95% CI: 1.78-2.62), a secondary education or above (OR=2.32, 95% CI: 1.49-3.14), received advice and counseling (OR= 95% CI:1.76-3.23), planned pregnancy (OR=3.8, 95% CI:2.30-5.30), primigravida (OR=2.21, 95% CI:1.73-2.269), urban residence (OR=2.59, 95% CI: 1.56-3.62) and pregnancy recognition urine test (OR=3.17; 95% CI:1.88-4.46) are the associated of timely initiation of antenatal care.
Conclusion: The study indicates that timely antenatal care initiation is low, linked to factors like anticipatory counseling knowledge, education, being a primigravida, urban living, pregnancy detection, planned pregnancy, wealth index, and medical guidance. Regular monitoring and evaluation are needed to reduce complications and improve birth preparedness.

Keywords

Timely initiation, Antenatal care, Pregnant women, Associated factors, Systematic review, Meta-analysis, Prevalence.

Introduction

Antenatal care is care given to pregnant women during the antenatal period that may be essential to their health and the health and wellness of their unborn children.[1] While pregnancy is a normal physiological process, about 5–20 percent of pregnancies end in difficulties that raise the mother’s and/or the fetus’s mortality or morbidity.[2] Previously, focused antenatal care was recommended for four visits, with the first visit starting in the first trimester of the pregnancy.[3] Currently, to lower perinatal mortality and enhance women’s experiences with care, the 2016 World health organization (WHO) suggested new ANC models with a minimum of eight encounters in which the first contact is recommended less than 12 weeks, which is considered timely initiation of antenatal care.[4] The number of ANC visits and coverage increases with timely ANC initiation. This, in turn, helps pregnant women become more aware of the danger signs that arise both during pregnancy and the postpartum period, further contributing to the reduction of mortality and morbidity in both the mother and her unborn child.[5]

ANC is a care given during pregnancy and a pregnancy-related service that offers a foundation for critical health-related tasks like early illness prevention, screening, and diagnosis. It has been proven that ANC can save lives when used in a timely and suitable manner, employing evidence-based approaches.[6] Furthermore, it helps to decrease complications during gestation, labor, delivery, and the postpartum period. ANC aims to identify pregnant women at high risk and provide special care for the mother and baby.[7,8] The quality of ANC care was very important in preventing and reducing the complications occurring among the mother and baby.[9] Besides this quality of antenatal care, coverage lagged in low-income countries when compared to high-income countries. Additionally, the timely initiation of antenatal care was more prevalent in high-income countries than in low-income countries.[10]

The timely initiating rate of the ANC over the world from 1990 to 2013 was 58.6% and accounted for about 84.8 percent of high-income countries and 48.1.0 percent of low-income countries, respectively.[11]  Furthermore, the study reveals that the overall timely ANC initiation rate was 92.5% in the United States of America,[12]  and 11% in Bangladesh.[13] In Sub-Saharan Africa, it was 38 percent, with a range of 14.5 percent in Mozambique to 68.6 percent in Liberia.[14] This variation might be due to the fact that the extent to which the recommended ANC interventions are implemented, need to be introduced, or require higher-quality delivery will differ across countries.[15]

In Ethiopia, the timely initiation of ANC care ranged between 20% and 65.9%.[16,17] Furthermore, according to the final result of the 2019 Ethiopian mini-demographic survey, roughly 28% of pregnant women began prenatal treatment within the first trimester of their pregnancy.[18]  The timing and actual coverage of ANC care varied across the continent and between countries due to several factors, including socio-economic conditions, healthcare infrastructure, cultural norms, and socio-demographic factors.[19-22] Various studies show that knowledge of pregnant women, sociodemographic characteristics (age, residence, education level, occupation, wealth index), obstetrical and medical factors (parity, prior experience, recognition of the pregnancy test, birth experience), and getting advice from a health care provider were all associated with the timely initiation of ANC.[23-28]

The WHO recommendation of ANC within the first 12 weeks helps to timely initiation of ANC was important for good clinical practices, which are defined as routine screening for hypertensive illnesses throughout pregnancy by frequent blood pressure monitoring, fetal heart detection, timely identification of illness, elimination of inequalities, provision of psychological support, postpartum family planning, and birth preparedness counselling.[29-31]

Timely initiation of ANC is an essential component in guaranteeing the best possible health outcomes for both the mother and the newborn.[32] Despite its importance, previous studies reveal variation in the prevalence of timely initiation of ANC and associated factors between regions and within a region.[16,19,26,27,29,33-35] Generally, there is a lack of compressive understanding of the timely initiation of antenatal care and associated factors that may increase the complexity of assessing it. Thus, to close these information gaps and provide a comprehensive description of the prevalence and contributing factors, a systematic review and meta-analysis are necessary. Our study was conducted using preferred reporting items for systematic review and meta-analysis statement (PRISMA) guideline.[36] By conducting an extensive examination of the existing data, this study aims to bridge this information gap and contribute to the existing literature by providing incisive suggestions for researchers, healthcare practitioners, and policymakers to encourage and promote the timely beginning of ANC.

Methodology

Study design and setting: This systematic review and meta-analysis were conducted in Ethiopia to assess the pooled prevalence and factors associated with the timely initiation of ANC among pregnant women. Ethiopia is a country found in East Africa with a total population of more than 120 million and is currently working on decreasing maternal and neonatal mortality by following the recommendations of the WHO. The study was not registered on PROSPERO.

Reporting: This systematic review and meta-analysis followed the PRISMA criteria.[36]

Selection and eligibility criteria
Inclusion criteria: The Population, Intervention, Comparison, and Outcome (PICO) tools were utilized by the authors to establish the inclusion and exclusion criteria for this systematic and meta-analysis. All studies conducted in Ethiopia on the timely initiation of ANC among pregnant women were included in this analysis. Included were studies with relevant data on prevalence, related variables, sample size, and outcome.

Study design: Cross-sectional studies were included.

Language: All research conducted in the English language.

Publication condition and time: published and unpublished studies between 2014 and 2024 were included.

Population: Pregnant women

Outcome variable: Timely initiation of ANC

Exposure: factors associated with the timely initiation of ANC.

Exclusion criteria: We exclude studies that were qualitative, of poor quality, had unintended results, were duplicated, or lacked full length. Furthermore, not included was research on delayed initiation.

Searching strategies: The search for research articles was conducted from January 1 to February 10, 2024, using different databases such as PubMed, MEDLINE, ScienceDirect, Cochrane Library, Embase, Google Scholar, and the African Journal of Online. In the starting point, a compressive search was performed using the title “Timely Initiation of Antenatal Care (ANC) AND Associating Factors among the Pregnant Women Attending Antenatal Care Clinic in Ethiopia” and the keywords “Timely Initiation”, “Early Initiation”, “Antenatal Care (ANC)”, “Pregnant Women”, “Associated Factors”, “Predictors,” “Attending Antenatal Care Clinic”, “Health Care Facilities” and “Ethiopia”). The Boolean operations “OR” and “AND” are used independently or in combination to connect the keyword and concept to establish search terms. Furthermore, Addis Ababa and Jimma University institutional repository searches were performed.

The population, exposure, comparison, and outcome statements were employed in this review. Population: pregnant women attending antenatal care at health facilities in Ethiopia. Exposure: associated factors (variables) such as demographic factors, obstetrical factors, knowledge, and information-related factors. Comparison: the reference group mentioned in every primary study finding. Outcome: timely initiation of ANC among pregnant women.

Data extraction: Data extraction was done by four authors (SHN, GT, DD, and SHT) independently using different databases using a piloted data extraction spread sheet on Microsoft Excel that included contents of data such as author name, year of publication, study area, study design, sample size, prevalence, associated variables, and study population. The relevance of the retrieved papers to the study issue is evaluated by screening them using their titles and abstracts. The studies that met the inclusion requirements were moved to the next step. The discrepancy between reviewers can be resolved through discussion and re-evaluation.

Data quality assessment: We have used the Newcastle Ottawa Scale (NOS) of a cross-sectional study design to assess the quality of the article.[37] The scale has Selection, comparability, and outcome or exposure are the three aspects that each component has, and a maximum score of nine points is possible for each (eight items in total). A score of 0–2 is regarded as low quality, a score of 3–5 as moderate quality, and a score of 6 or more as good or high quality. The quality of the article was evaluated independently by three authors (BM, GW, and MY). SHN and DD worked together to settle any disputes. After the data extraction process, SHN and SHT combined the data and prepared it for statistical analysis.

Characteristics of study: This systematic review and meta-analysis included 21 studies conducted in Ethiopia on a total population of 21758, which ranged from 239 to 6645. The included studies were cross-sectional and were conducted among pregnant women attending antenatal care in public health facilities in Ethiopia on the timely initiation of ANC. The prevalence of timely initiation of ANC ranges from 20% to 65.9% (Table 1).

Authors Year Study Area Prevalence Sample size Study design Quality
Edessa A et al.[20] 2023 Oromia 30.50% 344 CS Good
Lema Abate et al.[38] 2022 EDHS 31% 3065 CS Good
Girmatsion Fisseha et al.[39] 2015 Tigray 32.70% 410 CS Good
Cheru Kore et al.[21] 2021 Addis Ababa 47.60% 334 CS Moderate
Berhanu Teshome et al.[16] 2021 EDHS 20% 6645 CS Good
Alemwork Getninet et al.[22] 2021 Amhara 31.50% 820 CS Good
Tsigereda Abebe et al.[40] 2017 Addis Ababa 26.10% 422 CS Good
Megersa, Getu et al.[41] 2017 Oromia 37% 334 CS Moderate
Samuel Hailu et al.[17] 2022 Oromia 65.90% 401 CS Good
M Dembelu, et al.[18] 2016 SNNPR 39% 255 CS Moderate
Hanna Gulema et al.[23] 2017 Addis Ababa 42% 979 CS Good
Girma Tufa et al.[42] 2020 Oromia 57.80% 377 CS Moderate
Azimeraw Arega et al.[28] 2021 Amhara 44.20% 804 CS Good
Teshome Abuka et al.[24] 2016 SNNPR 35.40% 369 CS Moderate
Dagmawit Tessema et al.[19] 2022 SNNPR 34.30% 348 CS Moderate
Berhanu G. et al.[26] 2019 EDHS 27.50% 386 CS Moderate
Workaferu Fetene et al.[43] 2023 Amhara 40% 748 CS Good
E Ambaye et al.[44] 2022 Amhara 48.60% 592 CS Good
Mekdes Kondale et al.[29] 2016 SNNPR 27.10% 249 CS Moderate
TW Gudayu et al.[45] 2014 Amhara 35.40% 407 CS Good
Toffik Redi et al.[46] 2019 Oromia 41.90% 375 CS Moderate
Kasiye Shiferaw et al.[25] 2021 EDHS 26.80% 2855 CS good
Gebreamlak Gidey et al.[33] 2017 Tigray 41% 239 CS Moderate

Table 1: Characteristics of studies

SNNPR: Southern Nation Nationalities of people region

Measure outcome of Interest: The main outcome of this study was to estimate the overall pooled prevalence of timely initiation of ANC among pregnant women attending antenatal care in Ethiopia. The next outcome was determining the factors associated with timely ANC using an adjusted pooled odds ratio with a 95% confidence level. When it begins before 12 weeks of gestation, it is considered timely to initiate when it starts before 12 weeks of gestational age.

Data analysis: After relevant data has been extracted from studies using Microsoft Excel 2019, the authors synthesize and analyze the data using “statistics” and “data” (STATA) version 17 software. The primary studies were summarized and presented in a frost plot and table. We have computed the standard error of the prevalence of timely initiation of antenatal care for every primary research study. We identify the presence of heterogeneity I2 among the studies, which is interpreted as a percentage of total variation between studies. Heterogeneity can be considered low, moderate, and high if I2 = 25, I2 = 50, and I2 = 75, respectively. The statistical test analysis reveals that there is considerable heterogeneity among the studies (I2 = 98.04%, P = 0.00). A random effect model was used with the Der Simonian-Lair approach to estimate the pooled effect.[47]

Publication bias: Egger’s correlation weight and Begg’s regression intercept test were used to examine publication bias at the 5% significance level.[48] A funnel plot was used to indicate the symmetrical distribution of the studies. Subgroup analysis was carried out based on regions and publication by classifying to decrease the random variation among estimated points of primary studies (Figure 1).

Funnel plot to show distribution of studies publication bias on timely initiation of ANC among pregnant women

Figure 1: Funnel plot to show the distribution of studies publication bias on the timely initiation of ANC among pregnant women,2024

Results

Initially, we obtained 560 entries from the databases of PubMed, MEDLINE, ScienceDirect, Embase, Google Scholar, Cochran Library, and the Africa Journal of Online, together with 5 records from the university repository. 432 records were eliminated due to duplication. 133 records were obtained after the authors assessed the lack of relevant abstracts and titles. 57 of the remaining 133 were removed after their relevance was assessed. After that, the authors analyzed and appraised 76 complete texts to determine the inclusion criteria. In conclusion, these systematic reviews and meta-analyses comprised 23 research papers deemed pertinent (Figure 2).

Flow chart illustrates the selection of research articles using PRISMA checklist

Figure 2: Flow chart illustrates the selection of research articles using PRISMA checklist, 2024

Prevalence of timely initiation of ANC: The overall pooled prevalence of timely initiation of ANC among pregnant women in Ethiopia was 37% (95% CI: 33-42). The statistical heterogeneity observed was I2=98.32%, p=0.00 (Figure 3).

The overall pooled prevalence of timely initiation of ANC among the pregnant women attending antenatal care in Ethiopia in 2024

Figure 3: The overall pooled prevalence of timely initiation of ANC among pregnant women attending antenatal care in Ethiopia in 2024

Factors associated with Timely initiation of ANC: Our study shows that pregnant women who have good knowledge about antenatal care were 2.2 times more likely to timely initiate ANC care than women who have poor knowledge (OR = 2.2, 95% CI: 1.78–2.62) (Figure 4).

Forest plot for the association between knowledge and timely initiation of ANC among pregnant women

Figure 4: Forest plot for the association between knowledge and timely initiation of ANC among pregnant women, 2024

Pregnant women with a secondary education or above were 2.3 times more likely to start ANC on time than those with less education (OR=2.32, 95% CI: 1.49-3.14) (Figure 5).

Frost plot that shows association between secondary education or above and timely initiation ANC among pregnant women

Figure 5: Frost plot that shows an association between secondary education or above and timely initiation ANC among pregnant women, 2024

As illustrated in Figure 6, eight studies revealed a positive correlation between health care providers’ guidance and t,herefore, pregnant women’s timely ANC begins. Women who received advice and counseling from their healthcare provider were 2.5 times more likely to timely commence ANC than their counterparts who did not receive such advice and counseling (OR = 95% CI: 1.76-3.23).

The Frost plot shows the association between counseling received from their healthcare and the timely initiation of ANC among pregnant women in 2024

Figure 6: The Frost plot shows the association between counseling received from their healthcare and the timely initiation of ANC among pregnant women in 2024

According to the five studies analyzed, planned pregnancy has a significant association with the timely initiation of ANC. Therefore, the overall estimate of the pooled prevalence odds ratio shows that pregnant women who had planned their pregnancy were 3.8 times more likely to timely initiate ANC than those who had not planned their pregnancy (OR = 3.8, 95% CI: 2.30–5.30) (Figure 7).

The frost plot of planned pregnancy and timely initiation of ANC among the pregnant women

Figure 7: The frost plot of planned pregnancy and timely initiation of ANC among the pregnant women, 2024

As illustrated in Figure 8, women who confirmed their pregnancy via urine test at health care facilities were 3.17 times more likely to initiate ANC than women who confirmed their pregnancy through a missed period (OR = 3.17; 95% CI: 1.88–4.46).

Frost plot of confirmed their pregnancy via urine test association with timely initiation of ANC among the pregnant women

Figure 8: Frost plot of confirmed pregnancy via urine test association with timely initiation of ANC among pregnant women, 2024

Furthermore, Pregnant women who primigravida where 2.21 times more likely start ANC on time than multipara pregnant women (OR= 2.21, 95% CI:1.73-2.269) (Figure 9).

Frost plot show the associate between primigravida and timely initiation of ANC among the pregnant women

Figure 9: Frost plot shows the association between primigravida and timely initiation of ANC among the pregnant women, 2024

Finally, three studies were pooled and show an association between urban residence and timely initiation among pregnant women. Therefore, pregnant women who reside in urban areas were 2.59 times more likely to initiate ANC timely than those living in rural areas (OR = 2.59, 95%; CI: 1.56-3.62) (Figure 10).

Frost plot of pooled odd ratio show an association between urban residence and timely initiation among pregnant women-2024

Figure 10: Frost plot of pooled odds ratio shows an association between urban residence and timely initiation among pregnant women, 2024

Discussion

This systematic review and meta-analysis examined the pooled prevalence and factors associated with the timely initiation of ANC among pregnant women in Ethiopia. According to this study, the overall pooled prevalence of timely initiation of ANC among pregnant women was 37% (95% CI).[33-42] Although the factors that were associated with the timely initiation of ANC were knowledge of pregnant women on ANC, urban residence, secondary educational level and above, planned pregnancy, primigravida, advice on ANC, and pregnancy recognition with a urine test. The pooled prevalence of this study was consistent with studies in Asela (37%), Wolayita Sodo (39%), Amhara region (40%), Gondar  (35%), Cameroon, demographic health survey conducted in sub-Saharan Africa systematic review in 19 African countries (37%) and south Asia.[41-52] This might be due to data taken from the same study population, and sometimes the study population shares common associated factors. But the prevalence of timely initiation of ANC was lower when compared to the study conducted in Bule Hora, Ethiopia (57%), Fantale Oromia (65.9%), and Addis Ababa (47%).[17,21,42] This is because the previous studies were conducted in urban areas among pregnant mothers. Another possible reason could be the data analysis method used in this study and previous studies.

Furthermore, the prevalence of this study was lower than that of the study in Afghanistan (66.9%), low-middle-income countries (49.9%), Sudi-Arabia (75%), and the United Kingdom (79.2%).[13,52-54] This is because of the social and economic differences, political factors, and lack of living standards in Ethiopia and those countries. Another possible reason might be the need to improve maternal and child healthcare services in those countries through community training. This is supported by research conducted on ANC improvement training in the community.[55]  The prevalence of this meta-analysis was higher than the study conducted in Ambo Oromia (30.5%), the demographic health survey of Ethiopia (20%).[16,44] This might be a difference in the sample size used for the study. The previous study had only a single prevalence, but the pooled prevalence of different studies included people from different regions. It is also lower than the study conducted in Nigeria (24%), Uganda (17%), and Bangladesh (22.2%).[56,57] The variation might be due to differences in access to health care facilities in Ethiopia compared to those in other countries, differences in cultural practices and knowledge of ANC, and differences in the level of application of WHO recommendations.

We have found that the knowledge of pregnant women was a significant factor associated with the timely initiation of antenatal care. This is congruent with studies conducted in Ethiopia, Zambia, and Nigeria.[17,19,23,24,27,28,43,44,49,58,59] Having good knowledge about pregnancy has a positive association with the timely initiation of ANC.[60] This is because having good knowledge makes a mother understand the importance of antenatal care for herself and her unborn baby. When mothers are aware of the potential complications of pregnancy, they are more likely to seek care. Our study agrees with previous studies conducted in Ethiopia, Ghana, Uganda, Cameroon, and a systematic review in Africa.[16,19,26,28,50,51,61-63] This study revealed that pregnant women with secondary education and above were more likely to initiate ANC on time when compared to women who were not educated. Having a formal education helps women make decisions about their health and gives them better access to health care facilities.[14,62] The possible explanation for this is that educated women have a better understanding of the recommendation of timely initiation of antenatal care rather than delaying. Additionally, compared to uneducated women, educated women have better access to reading material and media that provide health-related knowledge to initiate antenatal care on time.

In line with earlier research, systematic review in Africa, Ethiopia , Guinea,  Ghana, our study also showed that women who planned their pregnancies were more likely to start prenatal care on time than those who didn’t.[17,19,27,38,44,49,62,64] This may be because women who have planned their pregnancies may receive assistance from their partners to prepare physically, psychologically, and emotionally. This allows them to make prompt contact with a healthcare practitioner to begin antenatal care. According to our research, women who resided in urban areas were twice as likely to start ANC on time as women who lived in rural areas. This is consistent with studies conducted in Ethiopia, Uganda, Zambia, Benin, and a systematic review in Africa.[44,51,66-68] Maybe because women tend to reside in urban regions closer to healthcare facilities than in rural ones. More women in urban areas than in rural ones have greater access to informative and instructional campaigns.

Different literature conducted elsewhere shows that primipara mothers were more likely to initiate ANC than multipara. This is because primigravida mothers are more likely to experience mild pregnancy disorders, pregnancy signs and symptoms, and complications, which prompts them to seek medical attention as soon as possible to begin prenatal care on time.[44,46,51] Our research also found that women with the highest wealth index were more likely than those with the lowest wealth index to start ANC on time. This is aligned with the research that was done.  This was consistent with a study conducted in Ethiopia, Sub-Saharan Africa, Nigeria, and Pakistan.[14,38,65,66,69-71] This may be because the wealthiest women have better access to health information and education, are able to afford health insurance, and have a choice of healthcare providers and facilities. Furthermore, they can afford to travel to medical facilities, even those that are far away.

Additionally, our study shows that women who confirm their pregnancy by a urine test at a health facility are more likely to start antenatal care on time than women who confirm their pregnancy by signs, symptoms, and a pregnancy test at home. This agrees with results from prior research in Ethiopia, Nigeria, and South Africa.[72,73] This may be because starting antenatal care is made easier when a pregnancy is detected at a health facility, which tends to increase understanding, which could encourage them to prioritize their unborn child’s health as well as their own and seek care as soon as possible. Furthermore, if a pregnancy has been confirmed, there can be a suggestion to begin prenatal care. Finally, the results of our study showed that pregnant women who received guidance and support from their healthcare professionals had a higher likelihood of starting ANC on time than those who did not. This is consistent with research findings from Ethiopia, Madagascar, and Malawi.[38,45,49,65,74,75] This could be because learning more from medical professionals has raised awareness of the significance of prenatal care. Women who seek help from healthcare providers are also better satisfied in terms of health information and problem detection. This is supported by the study conducted on health education on antenatal care.[76]

Limitation: No PROSPERO registration is available for this study. Studies that follow lengthy periods of time are scarce, which could impact data analysis.

Conclusion

The evidence suggests that the timely initiation of antenatal care was relatively low. Timely prenatal care initiation was linked to anticipatory counseling knowledge, a secondary education or higher educational attainment, being a primigravida, living in an urban area, detecting pregnancy through a urine test at a medical facility, planning pregnancy, having a higher wealth index, and receiving guidance and recommendations from medical professionals. Regardless of those factors, regular monitoring and evaluation are needed in addition to health education and applying the new recommendations of the WHO 2016 guidelines practically by administrators, health care providers, policymakers, and other stakeholders.

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Acknowledgments

Not reported

Funding

Not reported

Author Information

Corresponding Author:
Shambel Negese Marami
Department of Midwifery
College of Health Science, Mattu University, Ethiopia
Email: negeseshambel@gmail.com

Co-Authors:
Gemeda Wakgari Kitil, Shimalis Tadese Abebe, Gizu Tola Feyisa, Dagne Deresa Dinagde
Department of Midwifery
College of Health Science, Mattu University, Ethiopia

Authors Contributions

All authors contributed to the conceptualization, investigation, and data curation by acquiring and critically reviewing the selected articles. They were collectively involved in the writing – original draft preparation, and writing – review & editing to refine the manuscript. Additionally, all authors participated in the supervision of the work, ensuring accuracy and completeness. The final manuscript was approved by all named authors for submission to the journal.

Ethical Approval

Consent and ethical approval did not apply to this study. Since it is a meta-analysis and systematic review.

Conflict of Interest Statement

Not reported

Guarantor

None

DOI

https://doi.org/10.63096/medtigo3092116

Cite this Article

Shambel NM, Gemeda WK, Shimalis TA, et al. Systematic Literature Review and Meta-Analysis of Timely Initiation of Antenatal Care Among Pregnant Women in Ethiopia: Prevalence and Associated Factors. medtigo J Emerg Med. 2024;1(1):e3092116. doi:10.63096/medtigo3092116 Crossref

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