BACKGROUND:
The interrelationship between HIV, anaemia and obesity constitutes to multifaceted triple burden of disease, particularly in regions with high HIV prevalence 1. In South Africa, women aged 15-49 face triple burden of HIV, anaemia and obesity which intensifies chronic metabolic and reproductive health risks 2, contributing to maternal and foetal outcomes 3,4. Nonethless, little is known about how these diseases influence timing and frequency of ANC visits in developing countries including South Africa 5. Therefore, the aim of this study is to explore the prevalence of triple burden exposures on maternal health-seeking behaviour and its association with timing and frequency of ANC visits among women of reproductive age in South Africa within 5 years preceding survey.

METHODS:
This study was cross-sectional quantitative, used secondary data from South African Demographic and Health Survey, 2016. This study used a weighted sample of 2,299 women aged 15–49 years, who gave birth in last 5 years preceding survey (2011-2015). The main predictor variable was triple burden exposures defined as living with HIV, anaemia and obesity. The outcome variables included timing of 1st pregnancy and number of ANC visits. Descriptive statistics, two-way contingency tables and Poisson regression were employed.

RESULTS:
Out of 2299 women, 799 women were living with HIV, anaemia and obesity and 85.0% of them had less than 8 + visits. Out of 799 women living with HIV, anaemia and obesity, 48.5% initiated ANC visits late. The Poisson regression showed that women living with HIV, anaemia and obesity had 5% higher rate of ANC visits compared to those living with no condition.

CONCLUSIONS:
This study provided significant evidence highlighting that the coexistence of triple burden poses substantial health challenge to optimal health-seeking behaviour among women in South Africa. The findings highlight urgent need for integrated and risk responsive antenatal care strategies