Factors associated with antenatal care attendance in the first trimester of pregnancy in Rulindo district, Rwanda

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Timely initiation of antenatal care (ANC) is a critical component of maternal health, as it enables early detection and management of pregnancy-related complications, provision of preventive interventions, and promotion of healthy behaviors. The World Health Organization recommends that pregnant women initiate ANC within the first trimester (before 12 weeks of gestation). Despite improvements in maternal health services in Rwanda, evidence indicates that a significant proportion of women still delay the initiation of ANC, particularly in rural districts. However, there is limited district-level evidence regarding factors influencing early ANC attendance in Rulindo District. This study aimed to assess the prevalence of first-trimester ANC attendance and identify associated factors among pregnant women in Rulindo District, Rwanda. An institution-based cross-sectional study was conducted among 384 pregnant women attending ANC services. A systematic sampling technique was used to recruit participants. Data were collected using a pretested structured questionnaire and analyzed using SPSS version 21.0 Both bivariate and multivariate logistic regression analyses were performed to identify factors associated with early ANC attendance, with statistical significance set at p < 0.05. A total of 384 pregnant women participated in the study. The majority were aged 25–34 years (44.0%), married (83.3%), and had primary education (53.6%), with most engaged in farming (54.7%) and living in low-income households. Obstetric characteristics showed that most women were multigravida (55.7%) and had 1–3 children (56.3%), with 64.6% reporting planned pregnancies. Although 66.1% of respondents attended antenatal care (ANC) in the first trimester, a considerable proportion (33.9%) initiated ANC late. Bivariate analysis showed that education level (p = 0.002), transport cost (p = 0.015), pregnancy planning (p = 0.001), gravidity (p = 0.002), and parity (p = 0.001) were significantly associated with early ANC at-tendance. Multivariate analysis revealed that only planned pregnancy remained a strong predictor of early ANC initiation (AOR = 3.719; 95% CI: 1.610–8.586; p = 0.002), while other socio-demographic and obstetric factors were not statistically significant.