Maternal and child health service utilisation in Sub-Saharan Africa: A systematic review

Maternal and child health service utilisation remains critical for reducing mortality in Sub-Saharan Africa, where disparities persist. This study synthesised literature to identify key determinants, evaluate interventions, and examine care continuity. Systematic searching of databases and citation chaining identified 635 records, of which 103 peer-reviewed studies (2010–2024) from Sub-Saharan Africa met the inclusion criteria. Antenatal care coverage (4+ visits) averaged 69% nationally, with urban-rural disparities (85% vs. 54%). Skilled birth attendance averaged 61% (78% urban, 45% rural), while postnatal care was lowest at 45% (56% urban, 34% rural). Full immunisation reached 75%, with minimal urban-rural disparity (76% vs. 73%). Rural populations showed lower utilisation than urban populations, ranging from near parity for immunisation (1.04 times) to a 1.73-fold gap for skilled birth attendance. Household income was the strongest predictor (impact score: 92), followed by maternal education (87), women's autonomy (71), and media exposure (67). Geographic distance was the primary barrier (28%), followed by financial constraints (24%) and cultural barriers (18%). Community Health Worker programmes showed optimal effectiveness (65% effectiveness, 85% sustainability), while financial incentives performed poorly (23% effectiveness, 25% sustainability). Only 19% completed the full continuum of care, with the sharpest loss between skilled delivery and postnatal care, a 33-point drop in the waterfall analysis. Inequities persist in maternal and child health utilisation across Sub-Saharan Africa. Socio-economic factors determine access patterns, while community interventions outperform financial approaches. The postnatal care dropout reflects systematic failure requiring immediate attention. Achieving equity demands approaches addressing structural inequities and sustained community engagement.