BACKGROUND:
This study examines associations between fathers’ antenatal care (ANC) attendance and childcare practices, child HIV testing uptake, and child mortality in Mpumalanga Province, South Africa.

METHODS:
A cross-sectional survey study. Bivariate [odds ratios (OR)] and covariate [adjusted odds ratios (AOR)] logistic models were fitted to assess associations between fathers’ ANC attendance and child health outcomes, and their determinants. Probabilities were predicted from the odds ratios and multiplied by 100 to obtain the absolute percentage-point change in the outcome associated with fathers' ANC attendance. All analyses were conducted in STATA 19.5 at 5% alpha and 95% confidence interval (CI).

RESULTS:
A total of 258 fathers participated in the study, with a mean age of 26 (± 2) years. Half of the fathers [131 (50.78%)] reported attending ANC while their partners were pregnant. Fathers who experienced family violence during childhood were less likely to attend ANC [OR; 0.529 (95%CI: 0.314 - 0.891), p=0.017]. Fathers who attended ANC were more involved in their children' s lives [AOR; 2.028 (95%CI: 1.058 - 3.887), p=0.033], played more and built toys [AOR; 2.612 (95%CI: 1.378 - 4.952), p=0.003] and had warm and intimate time [AOR; 3.784 (95%CI:1. 534 - 9.338), p=0. 004] with their children, compared with fathers who did not attend ANC. Fathers’ ANC attendance was associated with a higher likelihood of eldest child HIV testing [AOR; 2.141 (95%CI: 1.107 – 4.140), p=0.024], corresponding to a 17.1 percentage-point increase in probability (p=0.019) and with reduced child mortality [AOR; 0.395 (95%CI: 0.156 – 0.999), p=0.050], corresponding to a 7.4 percentage points decrease in risk (p=0.043).

CONCLUSIONS:
Fathers’ ANC attendance is beneficially associated with childcare practices, child HIV testing uptake, and reduced child mortality. It is important to continuously support male partner engagement during pregnancy and childhood and break intergenerational cycles of childhood experience of violence.