Dataset Information

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:

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.

SUBMITTER: Aragaw FM

PROVIDER: S-EPMC10450135 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

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.

Aragaw Fantu Mamo FM Alem Adugnaw Zeleke AZ Asratie Melaku Hunie MH Chilot Dagmawi D Belay Daniel Gashaneh DG

BMJ open 20230824 8

<h4>Objectives</h4>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.<h4>Design</h4>Cross-sectional study design.<h4>Setting</h4>Ethiopia.<h4>Participants</h4>A total of 2924 reproductive-age women who had given birth in the 5 years preceding the survey.<h4>Outcome measure</h4>Delayed initiation of ANC visits.<h4>Results</h4>The magnitude of delayed initiat ...[more]

PMID: 37620267

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Project description:BackgroundEarly initiation of the first antenatal care visit provides a critical opportunity for health promotion, disease prevention, and curative care for women and their unborn fetuses. However, in developing countries, including Ethiopia, it is underutilized and most of the pregnant women didn't attend antenatal care visits during the first trimester (early). Therefore, the objective of this study was to estimate the prevalence of early initiation of antenatal care visits and its determinants among reproductive-age women in Ethiopia.MethodsA secondary data analysis was done based on the 2019 intermediate Ethiopian demographic health survey. The data were weighted by sampling weight for probability sampling and non-response to restore the representativeness of the data and have valid statistical estimates. Then, a total weighted sample of 2,935 women aged 15-49 years who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. A multilevel mixed-effects logistic regression model was fitted to examine the determinants of early initiation of first antenatal care visits. Finally, statistical significance was declared at a p-value < 0.05.ResultsIn this study, the overall magnitude of early initiation of the first antenatal care visit was 37.4% (95%CI: 34.6-40.2%). Women who attend higher education (AOR = 2.26: 95%CI; 1.36-3.77), medium wealth status (AOR = 1.80: 95%CI; 1.17-2.76), richer wealth status (AOR = 1.86: 95%CI; 1.21, 2.85), richest wealth status (AOR = 2.34: 95%CI; 1.43-3.83), living in Harari region (AOR = 2.24: 95%CI; 1.16-4.30), and living at Dire-Dawa city (AOR = 2.24: 95%CI; 1.16-4.30) were higher odds of early initiation of first ANC visits. However, women who were rural resident (AOR = 0.70: 95%CI; 0.59-0.93), household headed by male (AOR = 0.87: 95%CI; 0.72, 0.97), having ≥ 5 family size (AOR = 0.71: 95%CI; 0.55-0.93), and living in SNNPRs (AOR = 0.44: 95%CI; 0.23-0.84) were lower odds of early initiation of first ANC visits.ConclusionThe prevalence of early initiation of first antenatal care remains low in Ethiopia. Women's education, residence, wealth status, household head, having ≥ 5 family sizes, and region were determinants of early initiation of first antenatal care visits. Improving female education and women's empowerment through economic transitions with special attention given to rural and SNNPR regional state residents could maximize the early initiation of first antenatal care visits. Furthermore, to increase early antenatal care uptake, these determinants should be considered when designing new policies or updating policies and strategies on antenatal care uptake to help increase early attendance, which can help in the reduction of maternal and neonatal mortality and to achieve sustainable development goals 3 by 2030.

Project description:BackgroundDespite 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.ObjectiveTo determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia.MethodThe 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.ResultsThe 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.ConclusionA 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.

Project description:BackgroundDespite the World Health Organization's firm recommendation to start breastfeeding during the first hour after delivery, nearly 54% of children in low- and middle-income countries are unable to initiate breastfeeding within the recommended time frame. Understanding the initiation of breastfeeding is essential for optimal child health and maternal well-being.MethodsThis study was conducted using the recent Ethiopian Demographic and Health Survey (EDHS) data (2019) on a weighted sample of 1982 Ethiopian mothers of children aged under 24 months. The data extraction was conducted between August 1 and 30, 2023. Delayed' initiation of breastfeeding is defined as failure to initiate breastfeeding within one hour after birth. STATA version 17 was used for non-spatial analysis. ArcGIS Pro and Sat Scan version 9.6 were used to map the visual presentation of delayed breastfeeding initiation. Global Moran's I was computed to determine whether delayed breastfeeding initiation is randomly distributed, clustered, or dispersed. Getis-Ord Gi* Spatial Statistics was done to identify significant spatial clusters of cold and hot spot areas. Multilevel mixed-effect logistic regression analysis was computed to identify determinants of delayed breastfeeding initiation.ResultsThe prevalence of delayed breastfeeding initiation is 26.4% (95% CI 24.4, 28.3). Significant clustering of delayed initiation of breastfeeding practice was found in the Somali region. Less clustering was identified in Northern Amhara, Addis Ababa and Dire Dawa. Being a young mother (15-24 years) (AOR 1.66; 95% CI 1.06, 2.62), no antenatal care (AOR 1.45; 95% CI 1.04, 2.02), cesarean section (AOR 4.79; 95% CI 3.19, 7.21) and home birth (AOR 1.53; 95% CI 1.14, 2.06) were found to be determinants of delayed initiation of breastfeeding.ConclusionsIn Ethiopia, delayed breastfeeding initiation is distributed non-randomly. Significant hotspot areas were identified in the eastern part of Ethiopia. Thus, deploying additional resources in high hotspot regions is recommended. Programs should focus on promoting health facility birth and increasing antenatal care visits. Further emphasis should be considered on supporting young mothers and those giving birth via cesarean section to improve timely breastfeeding initiation.

Project description:BACKGROUND:Early or timely initiation of antenatal care and regular visits based on the schedule have a tremendous effect on both maternal and fetal health. Despite the paramount benefits of early initiation of ANC within the first 12 weeks of pregnancy, women still do not have adequate and equal access to high-quality early antenatal care. OBJECTIVE:To determine the prevalence and factors associated with delayed first ANC booking in Ethiopia. METHOD:A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had ANC visit for their last child were included in this study. The total weighted sample size analyzed was 4,741. Due to the hierarchical nature of the EDHS data, Multi-level logistic regression model was used to identify the individual and community level factors associated with delayed first ANC booking. RESULT:In this study, the prevalence of delayed first ANC booking was 67.31% [95% CI: 65.96% to 68.63%]. Women with secondary and higher education [Adjusted Odd Ratio (AOR) = 0.78; 95%CI: 0.61, 0.99] and [AOR = 0.61; 95%CI: 0.44, 0.83] respectively had lower odds of delayed first ANC booking. But woman who were multiparous and grand multiparous [AOR = 1.21; 95%CI: 1.01, 1.45] and [AOR = 1.50; 95%CI: 1.16, 1.93] respectively, women with the last pregnancy wanted no more [AOR = 1.52; 95%CI: 1.10, 2.09], a woman who was living in the rural area [AOR = 1.66; 95%CI: 1.25, 2.21], and a woman who was living in large central regions and small peripheral regions [AOR = 2.76; 95%CI: 2.20, 3.47] and [AOR = 2.70; 95%CI: 2.12, 3.45] respectively had higher odds of delayed first ANC booking. CONCLUSION:Despite the documented benefits of early antenatal care initiation, late ANC booking is still predominant in Ethiopia as highlighted by this study. Maternal education, parity, wanted the last child, residence and region were significantly associated with delayed first ANC booking. Therefore, taking special attention for these high-risk groups could decrease delayed first ANC booking and this intern decreases maternal and fetal health problems by identifying and intervene early.

Project description:BackgroundCaesarian section is a vital emergency obstetric intervention for saving the lives of mothers and newborns. However, factors which are responsible for caesarian section (CS) were not well established in the country level data. Therefore, this study aimed to assess the prevalence and associated factors of caesarian section in Ethiopia.MethodsData from the Ethiopian Mini Demographic and Health survey 2019 were used to identify factors associated with the caesarian section in Ethiopia. We applied multi-level logistic regression and a p-value of <0.25 to include variables before modeling and a p-value<0.05 with 95% confidence interval (CI) for final results.ResultThe prevalence of caesarian section in Ethiopia was 5.44% (95% CI; 0.048-0.06) in2019. Women in age group of 30-39 and 40-49 years had a higher odd of caesarian section (AOR = 2.14, 95%CI = 1.55-2.94) and (AOR = 2, 95%CI = 1.20-3.97) respectively compared to women in age group of 15-29 years. Women with secondary and higher educational level had higher odds of caesarian section (AOR = 2.15, 95%CI = 1.38-3.34) and (AOR = 2.8, 95%CI = 1.73-4.53) compared to those in no education category. Compared to Orthodox, Muslims and Protestant religions had lower odds of caesarian section with AOR of 0.50 (0.34-0.73) and 0.53 (0.34-0.85). Having <2 births was also associated with the low caesarian section 0.61(0.52-1.22). Using modern contraceptive methods, having ANC visits of 1-3, 4th, 5 plus, and urban residence were associated with higher odds of caesarian section as 1.4 (1.05-1.80]), 2.2 (1.51-3.12), 1.7 (1.12-2.46), and 2.4 (1.65-3.44) 1.6(1.04-2.57) respectively.ConclusionAlthough evidence indicates that the caesarian deliveries increased both in developed and underdeveloped countries, the current magnitude of this service was very low in Ethiopia which might indicate missing opportunities that might costing lives of mothers and newborns. Women's age, religion, educational status, parity, contraceptive method, and ANC visit were individual level factors influenced caesarian section. whereas, region and place of residence were community level factors affected caesarian section in the country. Depending on these factors, the country needs policy decisions for further national level interventions.

Project description:BackgroundThe loss of vaccination cards is a momentous public health challenge in the prevention of vaccine-preventable diseases in most developing countries. There is a paucity of studies on the magnitude of vaccination card losses and associated factors in Ethiopia. Therefore, the aim of the current study was to assess the level of vaccination card loss and associated factors in Ethiopia.MethodsData were extracted from the 2019 Ethiopia Mini Demographic and Health Survey, a nationally representative household survey of women aged 15-49 years with children aged 0-35 months. Data from a total of 3208 mother-child pairs was extracted for the study. A multilevel logistic regression model with random effect analysis techniques was used to identify individual and regional-level determinants of vaccination card loss. We checked the model's fitness by using Akaike Information Criteria and Bayesian Information Criteria. Odds ratios with a 95% Confidence intervals were used to declare statistical significance.ResultsA total of 3208 mother-child pairs from nine regions and two city administrations were included in the analysis. The result revealed that 1933 (60.26%) mother-child pairs did not have vaccination cards during home visits. illiterate mother 2.239 (95% CI: 1.297, 3.864), lowest wealth index category 2.089 (95% CI: 1.432, 3.048), ANC non-user 2.047 (95% CI: 1.605, 2.609), children living with their caretaker 6.749 (95% CI: 1.425, 13.654), having no access to television 1.384 (95% CI: 1.150, 1.664), longer birth interval 1.325 (95% CI: 1.027,1.710), giving birth at home and private health facilities 1.985 (95% CI: 1.579, 2.497), 1.696 (1.086, 2.648), contraceptive non-users 1.295 (95% CI: (1.042,1.609) and children aged 12-23 months and 24-35 months 1.577 (95% CI: 1.252, 1.985) and 2.282 (1.803, 2.889) were associated with vaccination card loss.ConclusionsOverall vaccination card loss among mothers of 0-35-month-old children is considerably high. To enhance maternal awareness regarding the significance of vaccination cards, promote antenatal care and public health facility delivery, and future researchers have to explore how to enhance vaccination card retention in Ethiopia.

Project description:BackgroundThe distribution of under-five mortality (U5M) worldwide is uneven and the burden is higher in Sub-Saharan African countries, which account for more than 53% of the global under-five mortality. In Ethiopia, though U5M decreased substantially between 1990 and 2019, it remains excessively high and unevenly distributed. Therefore, this study aimed to assess geographic variation and factors associated with under-five mortality (U5M) in Ethiopia.MethodsWe sourced data from the most recent nationally representative 2019 Ethiopian Mini-Demographic and Health Survey for this study. A sample size of 5,695 total births was considered. Descriptive, analytical analysis and spatial analysis were conducted using STATA version 16. Both multilevel and spatial analyses were employed to ascertain the factors associated with U5M in Ethiopia.ResultsThe U5M was 5.9% with a 95% CI 5.4% to 6.6%. Based on the multivariable multilevel logistic regression model results, the following characteristics were associated with under-five mortality: family size (AOR = 0.92, 95% CI: 0.84,0.99), number of under-five children in the family (AOR = 0.17, 95% CI: 0.14, 0.21), multiple birth (AOR = 14.4, 95% CI: 8.5, 24.3), children who were breastfed for less than 6 months (AOR = 5.04, 95% CI: 3.81, 6.67), people whose main roof is palm (AOR = 0.57, 95% CI: 0.34, 0.96), under-five children who are the sixth or more child to be born (AOR = 2.46, 95% CI: 1.49, 4.06), institutional delivery (AOR = 0.57, 95% CI: 0.41, 0.81), resident of Somali and Afar region (AOR = 3.46, 95% CI: 1.58, 7.55) and (AOR = 2.54, 95% CI: 1.10, 5.85), respectively. Spatial analysis revealed that hot spot areas of under-five mortality were located in the Dire Dawa and Somali regions.ConclusionUnder-five mortality in Ethiopia is high and unacceptable when compared to the 2030 sustainable development target, which aims for 25 per 1000 live births. Breastfeeding for less than 6 months, twin births, institutional delivery and high-risk areas of under-five mortality (Somali and Dire Dawa) are modifiable risk factors. Therefore, maternal and community education on the advantages of breastfeeding and institutional delivery is highly recommended. Women who deliver twins should be given special attention. An effective strategy should be designed for intervention in under-five mortality hot spot areas such as Somali and Dire Dawa.

Project description:BackgroundQuality Antenatal Care (ANC) is considered if pregnant women have access to essential services that align with the best evidence-based practice. Although several studies have been conducted on ANC uptake in Ethiopia, they have focused on the timing and number of visits and the level of complete uptake of care contents according to the WHO recommendation remains scarce. Hence, this study aimed to assess the magnitude of missing care content during ANC visits, its spatial variations, and individual- and community-level determinants in Ethiopia.MethodsThe study was conducted using the 2016 Ethiopian Demographic and Health Survey and included a total weighted sample of 4,771 women who gave birth within five years before the survey. Spatial analysis was carried out using Arc-GIS version 10.7 and SaTScan version 9.6 statistical software. Spatial autocorrelation (Moran's I) was checked to determine the non-randomness of the spatial variation in the missing contents of care. Multilevel multivariable logistic regression analysis was performed using STATA version 16. The adjusted odds ratio (aOR) with its corresponding 95% CI was used as a measure of association.ResultsThe prevalence of missing full contents of ANC in Ethiopia was 88.2% (95% CI: 87.2, 89.0), with significant spatial variations observed across regions. Missing essential contents of care was higher among women who live in rural areas (aOR = 1.68, 95% CI: 1.47, 2.71), not completed formal education (aOR = 1.94, 95% CI:1.24, 3.02), late initiation of ANC (aOR = 3.05, 95% CI:1.59, 6.54), attended only one ANC (aOR = 4.13, 95% CI: 1.95, 8.74), and not having a mobile phone (aOR = 1.44, 95% CI: 1.07, 1.95).ConclusionThe level of missing care content during prenatal visits was high in Ethiopia, with significant spatial variation across regions. Health systems and policymakers should promote early initiation and encourage multiple visits to provide optimal care to pregnant women. In addition, it is vital to focus on enhancing education and healthcare infrastructure in rural parts of the country.

Project description:BackgroundAntenatal care uptake is among the key indicators for monitoring the progress of maternal outcomes. Early initiation of antenatal care facilitates the timely management and treatment of pregnancy complications to reduce maternal deaths. In Ethiopia, antenatal care utilization is generally low, and delayed initiation of care is very common. We aimed to systematically identify and synthesize available evidence on delayed initiation of antenatal care and the associated factors in Ethiopia.MethodsStudies published in English from 1 January 2002 to 30 April 2017 were systematically searched from PubMed, Medline, EMBASE, CINAHL and other relevant sources. Two authors independently reviewed the identified studies against the eligibility criteria. The included studies were critically appraised using the Joanna Briggs-MAStARI instrument for observational studies. Meta-analysis was conducted in RevMan v5.3 for Windows using a Mantel-Haenszel random effects model. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using the I2 statistics. Pooled estimate of the proportion of the outcome variable was calculated. Pooled Odd Ratios with 95% CI were calculated to measure the effect sizes.ResultThe pooled magnitude of delayed antenatal care in Ethiopia was 64% (95% CI: 57%, 70%). Maternal age (OR = 0.70; 95% CI: 0.53, 0.93), place of residence (OR = 0.29, 95% CI: 0.16, 0.50), maternal education (OR = 0.49; 95% CI: 0.38, 0.63), husband's education (OR = 0.44; 95% CI: 0.23, 0.85), maternal occupation (OR = 0.75; 95% CI: 0.61, 0.93), monthly income (OR = 2.06; 95% CI: 1.23, 3.45), pregnancy intention (OR = 0.49; 95% CI: 0.40, 0.60), parity (OR = 0.46; 95% CI: 0.36, 0.58), knowledge of antenatal care (OR = 0.40; 95% CI: 0.32, 0.51), women's autonomy (OR = 0.38; 95% CI: 0.15, 0.94), partner involvement (OR = 0.24; 95% CI: 0.07, 0.75), pregnancy complications (OR = 0.23; 95% CI: 0.06, 0.95), and means of identifying pregnancy (OR = 0.50; 95% CI: 0.36, 0.69) were significantly associated with delayed antenatal care.ConclusionImproving female education and women's empowerment through economic reforms, strengthening family planning programs to reduce unintended pregnancy and promoting partner involvement in pregnancy care could reduce the very high magnitude of delayed antenatal care in Ethiopia.Trial registrationCRD42017064585 .

Dataset Information

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

Design

Setting

Participants

Outcome measure

Results

Conclusions

Publications

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.

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