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

Abstract

ObjectivesThis 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.DesignCross-sectional study design.SettingEthiopia.ParticipantsA total of 2924 reproductive-age women who had given birth in the 5 years preceding the survey.Outcome measureDelayed initiation of ANC visits.ResultsThe 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.ConclusionsSignificant 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.

Factors Associated with Late Antenatal Initiation among Women in Malawi

“…A similar observation was made in an earlier study in Malawi [61]. This is unexpected and contrary to findings from other studies [27,38,42,48,49,51,62] as urban women are expected to initiate ANC earlier than their rural counterparts. This stems from increased availability and accessibility of healthcare services and conducive characteristics of urban dwellers.…”

“…Older women tend to be more likely to initiate ANC late as compared with younger women. The importance of the participants' age was also underscored in other studies [24,25,38,42,48,49]. One plausible explanation is that young women may be better educated than older women, and, as such, they may have acquired more knowledge on the need to initiate ANC within the first semester.…”

“…Other studies conducted in Malawi have reported regional differences in the utilization of maternal health services. In addition, studies conducted in Burkina Faso [50], Ethiopia [11,42], Ghana [22], Nigeria [27,51] and Sierra Leone [52] have reported regional differences in the initiation of ANC. Two factors could be responsible for the observed regional differences in the late initiation of ANC.…”