Time to first antenatal care visit among pregnant women in Ethiopia: secondary analysis of EDHS 2016; application of AFT shared frailty models

Abstract

Background The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia. Methods This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model. Results The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit. Conclusion The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women’s development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.

Inequality in time to first antenatal care visits and its predictors among pregnant women in India: an evidence from national family health survey

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Predictors for the duration of breastfeeding among ethiopia women of childbearing age with babies; application of accelerate failure time and parametric shared frailty models

“…The parametric baseline distributions namely Gamma frailty distribution, log-normal, and Inverse Gaussian distributions were fitted and compared by considering the regions of the women as frailty terms. The effect of random component (frailty) was significant for Weibull gamma shared frailty because of its smallest AIC and BIC values [ 20 ]. The final Weibull gamma shared frailty model is indicated in Table 6 .…”

Apply Parametric Shared Frailty Models to Colorectal Cancer Patients

“…f(Ui) In this paper, we supposed that the random effect (shared frailty) had inverse Gaussian and gamma distribution with variance θ and unit mean, as described in the density functions bellow. [10] Gamma distribution…”

“…are and survival function of ∈ ij espectively, and β refers to the covariate coefficient's vector associated with the covariates vector z ij measured in the j th event of i th subject. [10]…”