Determinants of optimal number of ANC visits among women of reproductive age in Uganda using modified poisson GLM regression analysis

Antenatal care (ANC) is a critical maternal health intervention that contributes to the prevention of maternal and neonatal morbidity and mortality through early detection and management of pregnancy-related complications. Although Uganda has achieved high coverage of at least one ANC visit, continuity of care remains suboptimal, with many women not completing the recommended number of ANC visits. This study examined the determinants of optimal ANC utilization among women in Uganda using nationally representative data from the 2024 Uganda Malaria Indicator Survey (MIS). A cross-sectional secondary analysis was conducted using data from the 2024 Uganda MIS. The study included 3,477 women aged 15–49 years who had a live birth within the five years preceding the survey. Optimal ANC utilization was defined as attendance of at least four ANC visits during pregnancy. Descriptive statistics were used to summarize participant characteristics, while Multiple Correspondence Analysis (MCA) explored underlying patterns among categorical determinants. Associations between explanatory variables and optimal ANC utilization were assessed using survey-weighted modified Poisson regression with robust variance estimation. Crude and adjusted prevalence ratios (PRs) with 95% confidence intervals (CIs) were reported. Logistic regression was performed as a sensitivity analysis. Overall, 77.7% ( n = 2,702) of women reported attending four or more ANC visits during their most recent pregnancy, while 22.3% ( n = 775) attended fewer than four visits. MCA revealed a clear socioeconomic gradient, with optimal ANC attendance clustering among women with higher educational attainment, greater wealth, urban residence, and higher media exposure. In the adjusted modified Poisson model, educational attainment and region of residence were the only factors independently associated with optimal ANC utilization. Women with secondary education (APR = 1.12, 95% CI: 1.03–1.21) and higher education (APR = 1.15, 95% CI: 1.03–1.29) were significantly more likely to complete at least four ANC visits compared with women with no formal education. Regional disparities were also observed, with women residing in Northern Uganda (APR = 1.20, 95% CI: 1.11–1.30) and West Nile (APR = 1.26, 95% CI: 1.17–1.36) demonstrating higher prevalence of optimal ANC utilization compared with women in the Buganda region. More than three-quarters of Ugandan women achieved the minimum recommended four ANC visits during pregnancy; however, important disparities remain. Educational attainment and region of residence were the principal determinants of optimal ANC utilization at the population level. Efforts to improve maternal healthcare utilization should prioritize female education and strengthen region-specific maternal health strategies.