Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model

Abstract

Background Timely initiating antenatal care (ANC) is crucial in the countries that have high maternal morbidity and mortality. However, in developing countries including Ethiopia, pregnant mother’s time to initiate antenatal care was not well-studied. Therefore, this study aimed to assess time to first ANC and its predictors among pregnant women in Ethiopia. Methods A community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data. A two-stage stratified cluster sampling was employed. The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit. Cox-gamma shared frailty model was applied to determine predictors. Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size. Model adequacy was assessed by using the Cox-Snell residual plot. Statistical significance was considered at p value <0.05. For data management and analysis Stata 14 was used. Results The median time to first ANC was 5 months with IQR (3,-). The independent predictors of time to first ANC visit were primary education [AHR: 1.24 (95%CI, 1.13–1.35)], secondary education [AHR: 1.28(95% CI, 1.11–1.47)], higher education [AHR: 1.43 (1.19–1.72)] as compared to women with no formal education. Having media exposure [AHR: 1.13 (95% CI, 1.03–1.24)], early initiation of ANC increases by 25% [AHR: 1.25 (95% CI, 1.12–1.40)] in poorer, 32% [AHR: 1.32 (95% CI, 1.17–1.49)] in middle, 37% [AHR: 1.37 (95% CI, 1.20–1.56)] in richer and 41% [AHR: 1.41 (95%CI, 1.1.19–1.67)] in richest households as compared to poorest household wealth index. Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit. Conclusions The current study revealed that women’s time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO). The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility. It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women. Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases.

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

“…This later initiation of ANC among rural women could be due to better access to health facilities in urban areas than in rural areas. In addition, Media exposure was positively and significantly related with time to the first ANC visit, and this is consistent with previous studies [ 4 , 11 ]. The presence of media access indirectly indicates the relatively wealthy household, urban residency, better education level, and easy access to healthcare services.…”

“…As it is indicated in Table 5 , the acceleration indicates rural women have prolonged time-to-start first ANC visits than urban women. Similar studies also publicize comparable findings [ 4 , 10 ]. This later initiation of ANC among rural women could be due to better access to health facilities in urban areas than in rural areas.…”

“…The presence of media access indirectly indicates the relatively wealthy household, urban residency, better education level, and easy access to healthcare services. The sums of these factors also empower women to have the autonomy to engage in healthcare services that improve the health of the women and unborn baby including timely commencement of ANC [ 4 ]. Moreover, the study also revealed that women from the richest and middle wealth index households were started first ANC earlier than women from poor households.…”

“…The global maternal mortality ratio (MMR), or the number of maternal deaths per 100,000 live births, was estimated to be 216, with nearly all (95%) occurring in developing nations [ 4 ]. Ethiopia has one of the world’s highest maternal mortality rates, with 412 per 100,000 live births in 2016 [ 5 ].…”

“…Maternal morbidity and mortality were high in developing nations, especially in Sub-Saharan Africa. Most women, on the other hand, started their first ANC in the third or fourth trimester of their pregnancy [ 4 , 6 ]. According to research conducted in Uganda and Kenya, the first ANC visit took an average of 7 and 5 months, respectively [ 7 , 8 ].…”