Spatial distribution, and multilevel analysis of the predictors of late initiation of first antenatal care visit among reproductive-age women in Ethiopia: Using the recent 2019 Ethiopia Mini Demographic and Health Survey

Abstract

Background: Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visit lately. Objective: To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia. Method: The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used for this study. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran’s I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. Intraclass correlation coefficient (ICC), median odds ratio (MOR), and proportional change in variance (PCV) statistics were computed to determine variations of late initiation of first the ANC visit across clusters. The Akaike’s Information Criteria (AIC) was used to compare the best-fitted model and a model with the smallest AIC value was selected. For the predictors, a multilevel mixed effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05. Results: The overall prevalence of late initiation of first ANC visits in Ethiopia was 62.6% ranging from 32.2% in Dire Dawa to 71.2% in SNNPRs. The spatial analysis showed that the late initiation of first ANC visits was significantly varied across the country. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of southern, western, and northern parts of the Somalia region. Being rural resident (AOR = 1.51: 95%CI; 1.05 – 5.63), attend higher education (AOR = 0.62: 95%CI; 0.26 – 0.94), medium wealth status (AOR = 0.42: 95%CI; 0.15 – 0.83), richer wealth status (AOR = 0.31: 95%CI; 0.15 – 0.62), richest wealth status (AOR = 0.25: 95%CI; 0.13 – 0.50), having ≥ 5 family size (AOR =1.46: 95%CI; 1.13 – 2.28), household headed by male (AOR = 1.86: 95%CI; 1.21 - 2.85), living in SNNPRs (AOR = 3.13: 95%CI; 1.12 – 8.77), and Oromia region (AOR = 2.98: 95%CI; 1.26 – 7.08) were significant predictors of late initiation of first ANC visits. Conclusion: The prevalence of late initiation of first antenatal care visits remains high in Ethiopia. Being rural residents, having ≥ 5 family sizes, households headed by a male, and living in SNNPRs and Oromia regions were more likely to initiate their first ANC visits lately whereas attending higher education, and household wealth status was associated with lower odds of late initiation of first ANC visits. Public health intervention targeting rural residents, females, poor household economic class, and women’s empowerment would decrease the late start of the first ANC visit. Furthermore, to maximize early ANC uptake, these factors should underscore when designing new policies and strategies, which can help in the reduction of maternal and neonatal mortality and achieve sustainable development goal (SDG) 3 by 2030.