Abstract: Background: Adolescent pregnancy imposes a disproportionate burden on maternal and child health (MCH) outcomes globally, with over 21 million adolescent girls giving birth annually in developing regions. In Rwanda, only 45% of pregnant adolescent girls complete the recommended four antenatal care (ANC) visits, compared to 70% of adult women. Despite national efforts to expand MCH services, the factors limiting accessibility and utilization of MCH nutrition services specifically among pregnant adolescents at facility level in Kigali remain inadequately characterized. This study aimed to determine the prevalence and determinants of MCH nutrition service utilization among pregnant adolescent girls attending Remera Health Centre, Gasabo District, Kigali.
Methods: A cross-sectional mixed-methods study was conducted. The total population of 80 pregnant adolescents aged 10–19 years attending Remera Health Centre during the study period was enrolled via census sampling. Data were collected using structured questionnaires and in-depth interviews with health facility leaders. Descriptive statistics, chi-square/Fisher’s exact tests, and multivariable binary logistic regression identified independent predictors of ANC attendance. Qualitative data were analyzed thematically.
Results: Among 80 pregnant adolescent girls, 82.5% (n=66) reported attending ANC visits at Remera Health Centre; 27.5% always attended and 5.0% rarely attended. Of 21 candidate sociodemographic, geographic, sociocultural, and knowledge/attitude/practice (KAP) variables tested, only two were significantly associated with ANC attendance at the bivariate level: understanding the benefits of ANC check-ups (χ²=6.78, p=0.034) and awareness of community child health services (χ²=8.71, p=0.013). Neither association reflected a simple knowledge gradient; in both cases, attendance was similarly high among adolescents who answered “yes” (85.9% and 87.7%) or “no” (81.8% and 81.2%), but markedly lower among the small subgroup who answered “I don’t know” (40.0% and 42.9%). In a multivariable logistic regression model recoding each variable as certain (yes/no) versus uncertain (“don’t know”), uncertainty about ANC check-up benefits (aOR=0.08, 95% CI 0.01–0.54, p=0.010) and uncertainty about community child health services (aOR=0.09, 95% CI 0.02–0.47, p=0.004) were independently associated with markedly lower odds of ANC attendance (Nagelkerke R²=0.25). Comprehensive prenatal nutrition counselling was received by 63.8% and adequate breastfeeding support by 60.0% of participants. Stigma related to adolescent pregnancy was reported by 70.0% of participants, and qualitative interviews with facility leaders identified stigma, transportation costs, nutritional knowledge gaps, and inadequate adolescent-specific programming as barriers, providing contextual insight that complements the quantitative results.
Conclusion: Among pregnant adolescents attending Remera Health Centre, ANC attendance was high overall and was not significantly explained by the sociodemographic, geographic, or sociocultural factors commonly reported elsewhere in the sub-Saharan African literature, likely reflecting this facility’s urban location and the relative homogeneity of a single-site census sample. The clearest signal to emerge was that adolescents who responded with uncertainty rather than a confident “yes” or “no” to basic MCH knowledge questions had substantially lower odds of ANC attendance, suggesting that indecision or disengagement from health information may be a more useful marker of risk than knowledge level itself. Given the small sample and limited number of non-attendance events, these findings should be treated as exploratory and hypothesis-generating. Qualitative interviews nonetheless point to stigma, transportation costs, and gaps in adolescent-specific counselling as persistent, modifiable barriers worth addressing through targeted, adolescent-friendly service delivery, even where they did not reach statistical significance in this sample.
Keywords: adolescent pregnancy; antenatal care; maternal and child health nutrition; health literacy; knowledge uncertainty; stigma; Rwanda; Kigali; mixed methods.
Title: Factors influencing accessibility and utilization of maternal child health nutrition services among pregnant teenager girls visiting Remera Health Centre, Kicukiro District
Author: Larissa Mukire, Emile Sebera, Donatien Mbonyintwari, Emile Twagirumukiza, Jean Damascene Dusabimana, Maurice Silari
International Journal of Healthcare Sciences
ISSN 2348-5728 (Online)
Vol. 14, Issue 1, April 2026 - September 2026
Page No: 286-299
Research Publish Journals
Website: www.researchpublish.com
Published Date: 24-June-2026
