Prevalence and factors associated with antenatal care services utilisation among urban refugees in Kampala, Uganda

Introduction: Regular antenatal care (ANC) is critical for positive maternal health outcomes. Despite the global emphasis on ANC utilization, sub-Saharan Africa, particularly Uganda, faces challenges with low timely ANC coverage. We investigated the prevalence and factors associated with ANC utilization among urban refugees in Kampala, Uganda. Methods: We employed a cross-sectional convergent parallel mixed-methods technique to collect data among urban refugee women aged 15-49 years in Kampala, Uganda. Data were collected from 153 survey participants using structured questionnaires. We also conducted ten key informant interviews using key informant interview guides. Quantitative data were analysed using descriptive statistics and modified Poisson regression to identify the factors associated with maximised ANC utilization. Qualitative data were analysed thematically. Results: The prevalence of ANC utilization (≥4 visits) among urban refugees was 73.2%. Factors independently associated with this level of utilization included having transport ease (aPR = 0.77; 95%CI: 0.61 – 0.99), having at least a primary education (aPR = 1.95; 95% CI: 1.33 – 2.87), being employed (aPR = 1.40; 95% CI: 1.21 – 1.62), receiving social support (aPR = 1.31; 95% CI: 1.11 – 1.56), and recognizing or being aware of pregnancy danger signs (aPR = 1.90; 95% CI: 1.41 – 2.47). The qualitative data elucidated a complex interplay of barriers impeding ANC access. Insufficient social support networks, inadequate antenatal knowledge linked to lower educational attainment, and insufficient transportation due to economic hardships arising from unemployment collectively constitute significant challenges for urban refugee women seeking antenatal care. Conclusions: This study emphasises the multifaceted importance of transportation, education, employment, social support, and awareness of pregnancy danger signs in promoting maximised ANC utilization among urban refugee women in Kampala. Achieving maximised ANC uptake requires a comprehensive, integrated approach. Such an approach should include targeted transport barrier mitigation interventions, health education initiatives, strengthening community-based social support structures, and creating sustainable economic opportunities. Addressing these interconnected factors is essential to improving maternal health outcomes within this vulnerable population and advancing progress toward global maternal health goals.