Spatial distribution and determinants of an optimal ANC visit among pregnant women in Ethiopia: further analysis of 2016 Ethiopia demographic health survey

Abstract

Background: Antenatal care (ANC) is essential to improve maternal and newborn health and wellbeing. Antenatal care coverage is improving in Africa since over two-thirds of pregnant women have at least one ANC contact. However, to realize the complete life-saving potential that ANC guarantees for mothers and babies, at least four visits providing essential evidence-based interventions are required.. Therefore, this study was conducted to identify determinants of an optimal ANC visit and its spatial distribution in Ethiopia. Methods: This study is a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS). A total of 8025 women who had a live birth in the five years preceding the survey were included in this study. STATA 14 software and ArcGIS10.7 software were used for analysis. The generalized estimating equation (GEE) model was fitted to identify factors associated with an optimal ANC visit. Crude and Adjusted odds ratio with a 95% CI computed to assess the strength of association between explanatory and outcome variables.Results: This study revealed that rural residence (AOR = 0.59, 95%CI: 0.45-0.77),male partners educational status [secondary school (AOR = 1.33, 95%CI: 1.05-1.67)], distance to the health institutions [not a big problem (AOR = 1.21, 95%CI: 1.04-1.39)], community-level literacy (AOR = 1.07, 95%CI: 1.03-1.12), and community level service utilization (AOR = 2.67,95%CI:2.21-3.24) were significantly associated with optimal ANC visits. From the spatial analysis result, an Optimal ANC visit was observed in Addis Ababa, Tigray, Harari, and Dire Dawa regions whereas areas with no optimal ANC visit were Afar, Amhara, Oromia Benishangul, SNNP, and Somalia regions. Conclusion: Living in peripheral regions of the country and in rural areas, lower educational status of male partners and distance to health institutions were prohibiting factors for an adequate number of visits. In this study, community-level literacy and community level service utilizations were were also affect womens' ANC utilization which implies community-level interventions should be considered for improving antenatal care utilization and better health outcomes. The government should give special attention to the regions like Afar, Amhara, Oromia, Benishangul, SNNP, and Somalia which had low optimal ANC visits.

The Usage of Antenatal Care Visit and Its Determinant Factors Using 2016 EDHS Data: Application of Count Regression Models

“…The finding showed that in the current study pregnant women in the middle, richer, and richest households were more likely to have frequent ANC visits compare to those in the poorest household. This result is similar to the studies conducted in other countries including Ethiopia [9,13,25,28,31]. This is maybe because of the easy to afford the transportation and health service fee the pregnant mothers who got the service they want, and most of the time mothers from the above-mentioned wealth quintile having access to get an education and different mass media system.…”

“…Maternal educational status had a significant effect on the number of antenatal care visits in developing countries. This result is supported by most of the studies related to ANC service conducted somewhere [2,9,11,13,21,25,28]. This could be because educated mothers were more concerned with the outcome of their pregnancy and pregnancy complications, and they were close to seeking health care services.…”

Association of Higher Educational Attainment on Antenatal Care Utilization Among Pregnant Women in East Africa Using Demographic and Health Surveys (DHS) from 2010 to 2018: A Multilevel Analysis

“…There is strong evidence suggesting that religion, level of education, occupation, distance from the health facility, residence, country, mass media, maternal age, and wealth index were associated with ANC utilization. [7][8][9][10][11][12][13][14] From the previous, many sociocultural factors were associated with late ANC booking. 15,16 Among the factors likely to be critical in health promotional activities and health services uptake is educational attainment.…”

How applicable is geospatial analysis in maternal and neonatal health in sub-Saharan Africa? A systematic review

“…For instance, in Ethiopia, a relatively higher utilization was found in Addis Ababa [ 31 - 37 ], Dire Dawa [ 31 , 34 - 37 ], Tigray [ 31 , 33 - 39 ], and Harari [ 31 , 33 , 35 , 36 ]. A relatively low utilization was found in regions of Somali [ 31 , 33 , 34 , 36 , 37 , 39 ], Afar [ 31 , 33 - 35 , 37 ], Oromia [ 32 , 33 , 35 , 36 , 39 ], most of Amhara [ 33 - 35 , 37 , 40 ], Gambela [ 32 , 33 , 37 , 39 ], Benishangul Gumuz [ 34 , 35 ], and parts of Southern Nations Nationalities and Peoples Region [ 32 , 34 - 36 , 39 , 40 ]. Similarly, a significant north-south divide in the likelihood of maternal health care utilization was reported in Nigeria.…”

“…Inequality in maternal health care utilization was also identified at a national level. For instance, in Ethiopia, a relatively higher utilization was found in Addis Ababa [31][32][33][34][35][36][37], Dire Dawa [31,[34][35][36][37], Tigray [31,[33][34][35][36][37][38][39], and Harari [31,33,35,36]. A relatively low utilization was found in regions of Somali [31,33,34,36,37,39], Afar [31,[33][34][35]37], Oromia [32,33,35,36,39], most of Amhara [33][34][35]37,40], Gambela [32,33,37,39], Benishangul Gumuz…”