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A proximate determinant of an outcome (or event) is a variable (or factor) that produces a direct effect on that outcome. It can act as an intermediary variable through which other variables (or factors) which have indirect effects on the same outcome variable operate to exhibit their effects. Socioeconomic, demographic and cultural factors (also called background or underlying factors) are known to have indirect effects on whether or not a pregnant woman would choose to deliver her baby in a healthcare facility. The background or underlying factors of the women can also determine if they will attend or not attend antenatal clinic during pregnancy. However, antenatal clinic attendance also has direct effect on a woman’s use of healthcare facility to deliver her baby.   In this study we examined whether or not antenatal clinic attendance is a major proximate determinant of use of healthcare facility for delivery by Nigerian women. The study used quantitative data from the 2008 Nigeria Demographic and Health Surveys (NDHS). Mothers were asked to indicate where they delivered their last babies (i.e., in Healthcare Facility or outside the healthcare facility) and also the number of antenatal visits they attended during the pregnancy. A mother that had four or more visits during the pregnancy was considered to have had adequate number of visits and those who did not attend at all or attended for less than four times were considered not to have had adequate attendance. Information was also collected on the socio-economic and demographic characteristics of the women. Information was also collected on the socio-economic and demographic characteristics of the women.   The data analyzed consisted of 17,635 women aged 15-49 years who had a live birth within the five years preceding the survey STATA 12 computer software was used to carry out data analyses. Data analyses were at univariate, bivariate and multivariate levels. Due to the dichotomous nature of the outcome variable (i.e., whether a child was delivered in a healthcare facility or not; coded as (1, 0)), the multivariate analyses technique used is Binary Logistic Regression, and Likelihood Ratio (LR) statistical test of significance was applied.   Results from bivariate analysis indicated that the background (underlying) factors of the women (i.e., age, children ever born, region of residence, educational level, wealth index status, and religion) all have significant association with the number of antenatal visits made by mothers during their last pregnancy (P < 0.001). Similarly, antenatal clinic attendance has significant relationship with delivery in healthcare facility (P < 0.001).   The binary logistic regression which includes all the six background variables and antennal clinic attendance (i.e., the proximate determinant) indicated a highly significant contribution to the model chi-square statistic. Women who had adequate number of antenatal clinic visits were about four times more likely to deliver their babies in healthcare facility than were those mothers who did not (OR = 4.4, P < 0.001). The likelihood Ratio (LR) test to determine the extent to which antenatal clinic attendance helped to explain the effect of the background variables on delivery in healthcare facilities also gave a highly significant result (chi-square = 891 on 1 degree of freedom, P < 0.001). This means that antenatal clinic attendance is an important proximate determinant through which socioeconomic, demographic and cultural factors influence Nigerian women delivery in healthcare facilities.  We conclude therefore that policies and programs targeted at encouraging Nigerian pregnant women to attend adequately antenatal clinics will also increase the prevalence of their delivery in healthcare facilities, thereby reducing the risk of maternal and infant mortality.   KEYWORDS: Underlying Factors, Antenatal Clinic Attendance, Proximate Determinants, Healthcare Facility Delivery, Nigeria

IS ANTENATAL CLINIC ATTENDANCE A PROXIMATE DETERMINANT OF USE OF MODERN HEALTHCARE FACILITY FOR DELIVERY BY NIGERIAN WOMEN?