Spatiotemporal distribution and determinants of delayed first antenatal care visit among reproductive age women in Ethiopia: a spatial and multilevel analysis

Individual and community-level factors associated with women's utilization of postnatal care services in Uganda, 2016: a multilevel and spatial analysis

BACKGROUND

Over time, Uganda has experienced high levels of maternal mortality (435 deaths per 100,000 live births in 2006 to 336 deaths per 100,000 live births in 2016). The persistence of high levels of maternal mortality jeopardizes the achievement of Sustainable Development Goal (SDG) 3.1, which calls for reducing maternal mortality to 70 deaths per 100,000 live births by 2030. Conversely, the utilization of postnatal care (PNC) services in Uganda remained very low and has varied across regions. This study examined the individual and community-level factors influencing women's utilization of postnatal care services in Uganda.

METHODS

Secondary data from the 2016 Uganda Demographic and Health Survey (UDHS) were used in this study. The study population consisted of women aged 15 to 49 who reported giving birth in the five years preceding the 2016 UDHS survey. The factors associated with postnatal care services were identified using multilevel binary logistic regression and spatial analysis.

RESULTS

The result shows that the prevalence of postnatal care service utilization in Uganda was low (58.3%) compared to the World Health Organization (WHO) target of 100%. The univariate analysis shows that 13.7% of women were adolescents, 79% were of higher parity, and 70.4% had primary/no formal education, of which 76.6% resided in rural areas. On the other hand, the multilevel analysis results showed that women aged 20-29 years and 30-39 years were also found to be more likely to use PNC services (AOR = 1.2, 95% CI: 1.01-1.47). Women who received quality ANC (AOR = 2.1, 95% CI: 1.78-2.36) were more likely to use postnatal care services than their counterparts. At the community level, women who lived in media-saturated communities were more likely to use postnatal care services (AOR = 1.3, 95% CI: 1.01-1.65). The spatial analysis found that the Central, Eastern, and Northern regions were the areas of hotspots in the utilization of postnatal care services.

CONCLUSION

This study found that age, parity, level of education, place of residence, employment status, quality of the content of antenatal care, and community media saturation were the predictors of postnatal care service utilization. The spatial analysis showed that the spatial distributions of postnatal care service utilization were significantly varied across Uganda. The government must expand access to various forms of media throughout the country to increase PNC utilization.

Spatial distribution of delayed initiation of antenatal care visits and associated factors among reproductive age women in Ethiopia: spatial and multilevel analysis of 2019 mini-demographic and health survey

OBJECTIVES

This study aimed to assess the spatial distribution, wealth-related inequality and determinants for delayed initiation of antenatal care (ANC) visits among reproductive-age women in Ethiopia.

DESIGN

Cross-sectional study design.

SETTING

Ethiopia.

PARTICIPANTS

A total of 2924 reproductive-age women who had given birth in the 5 years preceding the survey.

OUTCOME MEASURE

Delayed initiation of ANC visits.

RESULTS

The magnitude of delayed initiation of ANC visits among reproductive-age women in Ethiopia was 62.63% (95% CI 60.86%, 64.37%). Women aged 35-49 (AOR=1.42; 95% CI 1.04, 1.94), being protestant religion followers (AOR=1.43; 95% CI 1.06, 1.94), being in higher wealth index (AOR=0.53; 95% CI 0.41, 0.69), living in rural residence (AOR=1.50; 95% CI 1.02, 2.19) and living in the metropolitan region (AOR=0.45; 95% CI 0.26, 0.77) were significantly associated with delayed initiation of ANC visit. Southern Nations Nationalities and Peoples Region (SNNPR), Somalia, Benishangul Gumuz, Southern Addis Ababa and Gambella regions were hot spot regions for delayed initiation of ANC visits. The SaTScan analysis result identified 107 primary clusters of delayed initiation of ANC visits located in regions of SNNPR, Gambella, Southern Addis Ababa, Eastern Oromia and Benishangul Gumuz.

CONCLUSIONS

Significant spatial clustering of delayed initiation of ANC visits was observed in Ethiopia. More than half of women had delayed initiation of ANC visits in Ethiopia. Women's age, religion, wealth index, residence and region were significant predictors of delayed initiation of ANC visits. There is a disproportional pro-poor distribution of delayed initiation of ANC visits in Ethiopia. Therefore, interventions should be designed in the hot spot areas where delayed initiation of ANC visits was high to enhance the timely initiation of ANC visits.

Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis

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 visits 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. 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. 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 prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. 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 the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits.

CONCLUSION

A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

Prevalence and associated factors of delay antenatal care at public health institutions in Gondar city, Northwest Ethiopia, 2021: a cross-sectional study

BACKGROUND

Antenatal care is critical for women's and unborn children's health. In Ethiopia there is still a delay in getting antenatal care visit in the first trimester as recommended by the World Health Organization. Therefore, the purpose of this study was to assess the prevalence of delayed antenatal care visits and associated factors among pregnant women who attend antenatal care at a public health facility in Gondar town, Northwest Ethiopia.

METHODS

An institutional-based cross-sectional study was conducted between August 20 to September 15/2021. A simple random sampling technique was used to select 392 women. Data were collected using a pre-tested structured questionnaire through a face-to-face interview. Epi Info version 7 and SSPS 26.0 were used for data entry and further analysis. Descriptive statistics and multivariable logistic regression analyses were performed. An adjusted odds ratio with 95% confidence interval at p-value < 0.05 was declared that the outcome can be statistically significant.

RESULTS

A total of 392 study participants with a response rate of 98% were participated. The mean age of study participants was 29.1 ± 6.5 (SD) years. In this study, the prevalence of delay antenatal care was 63.8%( 95% CI: 58.9, 68.9). Age (Adjusted odds ratio = 0.51; 95% CI: 0.28, 0.93), types of health facilities (Adjusted odds ratio = 2.02; 95% CI :( 1.12, 3.64), and satisfaction with health service (Adjusted odds ratio = 3.23, 95%CI: (2.02, 5.16) were significantly associated with delay antenatal care.

CONCLUSION

The current study found high prevalence of delay antenatal care. Age between 31 and 34, hospital health facility and satisfaction with health service quality were associated factors for delay antenatal care visit. To begin antenatal care follow-up in the recommended time frame, a collaborative effort between the Minister of Health, health facilities, and relevant stakeholders is needed.

Identifying geographical inequalities of maternal care utilization in Ethiopia: a Spatio-temporal analysis from 2005 to 2019

INTRODUCTION

Inequalities in maternal care utilization pose a significant threat to maternal health programs. This study aimed to describe and explain the spatial variation in maternal care utilization among pregnant women in Ethiopia. Accordingly, this study focuses on identifying hotspots of underutilization and mapping maternal care utilization, as well as identifying predictors of spatial clustering in maternal care utilization.

METHODS

We evaluated three key indicators of maternal care utilization: pregnant women who received no antenatal care (ANC) service from a skilled provider, utilization of four or more ANC visits, and births attended in a health facility, based the Ethiopian National Demographic and Health Survey (EDHS5) to 2019. Spatial autocorrelation analysis was used to measure whether maternal care utilization was dispersed, clustered, or randomly distributed in the study area. Getis-Ord Gi statistics examined how Spatio-temporal variations differed through the study location and ordinary Kriging interpolation predicted maternal care utilization in the unsampled areas. Ordinary least squares (OLS) regression was used to identify predictors of geographic variation, and geographically weighted regression (GWR) examined the spatial variability relationships between maternal care utilization and selected predictors.

RESULT

A total of 26,702 pregnant women were included, maternal care utilization varies geographically across surveys. Overall, statistically significant low maternal care utilization hotspots were identified in the Somali region. Low hotspot areas were also identified in northern Ethiopia, stretching into the Amhara, Afar, and Beneshangul-Gumuz regions; and the southern part of Ethiopia and the Gambella region. Spatial regression analysis revealed that geographical variations in maternal care utilization indicators were commonly explained by the number of under-five children, the wealth index, and media access. In addition, the mother's educational status significantly explained pregnant women, received no ANC service and utilized ANC service four or more times. Whereas, the age of a mother at first birth was a spatial predictor of pregnant who received no ANC service from a skilled provider.

CONCLUSION

In Ethiopia, it is vital to plan to combat maternal care inequalities in a manner suitable for the district-specific variations. Predictors of geographical variation identified during spatial regression analysis can inform efforts to achieve geographical equity in maternal care utilization.

Factors associated with Women’s timing of first antenatal care visit during their last pregnancy: evidence from 2016 Uganda demographic health survey

Background

Utilization of antenatal care services (ANC) during pregnancy has been recognized as a major public health intervention to abate maternal morbidity and mortality. Uganda has experienced high levels of maternal morbidity and mortality over the past two decades. This could be partly attributed to the lower proportion of women who initiated their first antenatal care visit during the first trimester of their gestation period. This study aimed at investigating the factors associated with timing of first ANC visit by women in Uganda.

Method

This study used secondary data from the 2016 Uganda Demographic and Health Survey (UDHS). The study population comprises of women aged 15–49 who reported to have given their last birth during the five years preceding the 2016 UDHS survey. The outcome variable for this study was the timing of first ANC visit. Univariate, bivariate, and multilevel binary logistic regression analysis was used to determine the factors associated with the utilization of timing of first ANC visit.

Results

Findings show that only 30% [95%CI; 0.28–0.31] of women utilized ANC during the first trimester. Women of higher parity (4+) were less likely to utilize ANC in the first trimester compared to the lower parity (1) (AOR, 0.74, CI; 0.60–0.92). Women who reside in communities with good access to health facility were more likely to utilize ANC during the first trimester as compared to women residing in communities inaccessible to health facility (AOR, 1.36, CI; 1.04–1.77). Women who reside in less diverse ethnic communities were less likely to utilize ANC in the first trimester compared to their counterparts (AOR, 0.15, CI; 0.11–0.22).

Conclusion

This study demonstrated that contextual factors are important predictors of utilization of ANC during the first trimester apart from individual, factors. It is thus important for maternal health programme interventions to consider both individual and contextual factors when encouraging women to utilize ANC services during the first trimester.