Multilevel Modelling of the Individual and Regional Level Variability in Predictors of Incomplete Antenatal Care Visit among Women of Reproductive Age in Ethiopia: Classical and Bayesian Approaches

Abstract

Background: Antenatal care is an operational public health intervention to minimize maternal and child morbidity and mortality. However, for varied reasons, many women fail to complete the recommended number of visits. The objective of this study was to assess antenatal care utilization and identify the factors associated with the incomplete antenatal care visit among reproductive age women in Ethiopia. Methods: The 2019 Ethiopian Mini Demographic and Health Survey data were used for this study. Multilevel logistic regression analysis and two level binary logistic regression models were utilized. Results: Around 56.8% of women in Ethiopia did not complete the recommended number of antenatal care visits. Women from rural areas were about 1.622 times more likely to have incomplete antenatal care compared to women from urban areas. Women who had no pregnancy complication signs were about 2.967 times more likely to have incomplete antenatal care compared to women who had pregnancy complication signs. Women who had a slight problem and a big problem with the distance from a health center were about 1.776 and 2.973 times more likely, respectively, to have incomplete antenatal care compared to women whose distance from a health center was not a problem. Furthermore, women who had ever terminated pregnancy were about 10.6% less likely to have incomplete antenatal care compared to women who had never terminated pregnancy. Conclusions: The design and strengthening of existing interventions (e.g., small clinics) should consider identified factors aimed at facilitating antenatal care visits to promote maternal and child health related outcomes. Issues related to urban–rural disparities and noted hotspot areas for incomplete antenatal care visits should be given special attention.

Antenatal Care Dropout and Associated Factors in Ethiopia: A Systematic Review and Meta-Analysis

“…The included studies publication year ranged from 2020 to 2022. The two from Amhara [12, 13], one from Tigray [10] and one from Oromia [15] regions and three of them were nationwide studies[5, 11, 14] based on Ethiopian demographic and health survey data. All studies were cross-sectional studies and have a low risk of bias (Table 1).…”

“…To examine the association between place of residence and antenatal care dropout two studies were used [11, 14]. In this study pregnant women from rural areas were about 1.6 times more likely to have ANC dropout compared to women from urban areas counterparts (AOR= 1.59, 95% CI= 1.31, 1.87) (Fig.…”

“…In this meta-analysis , women who travel more than 1h to reach the health institution was 2.55 times more likely to have antenatal care dropout than their counterparts to [AOR = 2.55, 95% CI: 1.79, 3.31] (Fig 6). The pooled effect of place of residence on antenatal care dropout was assessed by using two studies [11,14]. In this study pregnant women from rural areas were about 1.6 times more likely to have ANC dropout compared to women from urban areas counterparts (AOR= 1.59, 95% CI= 1.31, 1.87) (Fig.…”

“…7). Additionally, two studies [11,12] were used to assess the pooled odd ratio for the association between pregnancy complication signs and antenatal care dropout. Accordingly, pregnant women who had no pregnancy complication signs were 2.88 times more likely to dropout from ANC compared to the counterparts (AOR=2.88, 95% CI= 2.41, 3.66) (Fig 8).…”

“…In Ethiopia different studies conducted on the prevalence of ANC dropout and lies between 33.39% [10] to 56.49% [11]. Different factors affect the dropout of ANC services utilization were Being far distance, Not developing a pregnancy danger sign, Not satisfied in ANC service, Having no formal education, employment status, marital status, Didn't informed about institutional delivery, place of residence, age group, current pregnancy planned/supported, presence of professional advice during ANC visit [5,6,[10][11][12][13][14][15].…”