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Model diagnostics and comparison for time to initiation of first antenatal care visit and predictors among reproductive-age women in Ethiopia.
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Background
Early initiation of antenatal care (ANC) is essential for the early detection of pregnancy-related problems and unfavorable pregnancy outcomes. However, a significant number of mothers do not initiate ANC at the recommended time. Therefore, this study aimed to determine the median time of ANC initiation and its predictors among reproduct...
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Citations
... Women who had wanted their last pregnancy were more likely to have their first ANC visit sooner than those who had an unwanted pregnancy. This finding is supported by previous studies [39,40], This may be the result of the mother's desire to maintain the baby's health during her desired pregnancy. As a result, they are eager to receive the follow-up sooner. ...
Background
The first trimester of pregnancy is critical for fetal development, making early antenatal care visits essential for timely check-ups and managing potential complications. However, delayed antenatal care initiation remains a public health challenge in sub-Saharan Africa, including Kenya. Therefore, this study aimed to assess and provide up-to-date information on time to first antenatal care visit and its predictors among women in Kenya, using data from the most recent 2022 Kenya Demographic and Health Survey (KDHS).
Methods
This community-based cross-sectional study analyzed data from 19,530 birth histories in the 2022 Kenya Demographic and Health Survey (KDHS). The primary outcome was the timing of the first antenatal care (ANC) visit, classified as timely if it occurred in the first trimester. Shared frailty survival models were used to account for the hierarchical data structure and unobserved heterogeneity, with the Weibull gamma model identified as the best fit based on Information Criteria (AIC), and Bayesian Information Criteria (BIC). Variables with p < 0.2 entered multivariable analysis, and results were reported as Adjusted Hazard Ratios (AHR) with 95% Confidence Intervals (CI) using the Weibull gamma model.
Results
The study found that the median time for the first antenatal care (ANC) visit in Kenya was four months. Significant predictors of ANC timing included women’s age (35–49 years: AHR 0.83; 95% CI: 0.72–0.95), education level (higher: AHR 1.45; 95% CI: 1.17–1.78), media exposure (yes: AHR 1.21; 95% CI: 1.05–1.39), parity (four or more children: AHR 0.81; 95% CI: 0.72–0.91), wealth status (richest: AHR 2.00; 95% CI: 1.63–2.43), desire for more children (did not want more: AHR 0.64; 95% CI: 0.54–0.77), residence (rural: AHR 1.22; 95% CI: 1.07–1.39), and religion (Islam: AHR 0.76; 95% CI: 0.64–0.89).
Conclusion
The median time for the first ANC visit exceeds the World Health Organization’s recommendation of initiating care within the first trimester. These findings underscore the need for targeted interventions to promote timely ANC, especially among women with limited media exposure, high parity, lower socioeconomic status, and specific religious followers.
... Although there is extensive evidence of the prevalence and associated factors for ANC booking among reproductive-age women (10,(15)(16)(17)(18)(19)(20)(21)(22) using categorical data analysis, evidence related to time to ANC booking and its predictors among pregnant women using the time-to-event model (10,19,23) in different countries of East Africa is limited. Moreover, there is a paucity of evidence for a time to ANC booking that follows the WHO recommendation using recent Demographic and Health Survey (DHS) data from 2016 to 2023 in East Africa (3). ...
Background: Antenatal care (ANC) is an important component of maternal and child healthcare. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, evidence on whether the WHO recommendations have been followed is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa. Method: This study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan-Meier (K-M) survival estimate. A Weibull gamma shared frailty model was used to determine the predictors of time to the first ANC visit. An adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was reported. Result: The median time to ANC booking among pregnant women in East Africa was 4 ± 2 months. Maternal education at the primary (AHR = 1.01, 95% CI: 1.02-1.25), secondary (AHR = 1.03, 95% CI: 1.02-1.05), and higher level (AHR = 1.40, 95% CI: 1.30-1.50); husband's education level at the primary (AHR = 1.08, 95% CI: 1.06-1.09), secondary (AHR = 1.12, 95% CI: 1.10-1.13), and higher (AHR = 1.08, 95% CI: 1.07-1.10) levels as compared to with no education; a middle-class wealth status (AHR = 1.66, 95% CI: 1.60-1.70), being rich (AHR: 1.60, 95% CI: 1.56-1.73), high community-level maternal literacy (AHR = 1.05, 95% CI: 1.04-1.06), high community-level poverty (AHR = 0.99, 95% CI: 0.98-0.99), previous Cesarean section (CS) (AHR = 1.35, 95% CI: 1.33-1.39), and unwanted pregnancy (AHR = 0.74, 95% CI: 0.72-0.77) were predictors of the time to ANC booking. Conclusion: The median time to ANC booking among pregnant women in East Africa is longer than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, a better household, community-level wealth index, and previous CS increase the likelihood of an early ANC booking. However, unwanted pregnancy lowers the likelihood of an early ANC booking. Therefore, strengthening systematic efforts to improve women's and their husbands' educational status, encouraging women's education in the community, providing economic support for women with low wealth status and poor communities, encouraging wanted pregnancy, and providing accessible counseling services for women with unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.
... Although there is extensive evidence of the prevalence and associated factors for ANC booking among reproductive-age women (10,(15)(16)(17)(18)(19)(20)(21)(22) using categorical data analysis, evidence related to time to ANC booking and its predictors among pregnant women using the time-to-event model (10,19,23) in different countries of East Africa is limited. Moreover, there is a paucity of evidence for a time to ANC booking that follows the WHO recommendation using recent Demographic and Health Survey (DHS) data from 2016 to 2023 in East Africa (3). ...
Background: Antenatal care (ANC) is an important component of maternal and child health care. The World Health Organization (WHO) recommends that pregnant women book their ANC contact at or before 12 weeks of gestational age. However, in East Africa, the evidence following WHO recommendations is limited. Therefore, this study aimed to determine the time to ANC booking and its predictors among pregnant women in East Africa.
Method: This study was conducted among 86,662 pregnant women in East Africa. The time to ANC booking was estimated using the Kaplan-Meier survival estimate (K–M). A Weibull gamma shared frailty model was used to determine predictors of time to the first ANC visit. Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was reported.
Result: The median time to ANC booking among pregnant women in East Africa was 4±2 months. Maternal education primary (AHR= 1.01, 95%CI: 1.02, 1.25), secondary (AHR= 1.03, 95%CI: 1.02, 1.05), and higher (AHR= 1.40, 95%CI: 1.30,1.50), husband's education primary (AHR=1.08, 95% CI: 1.06,1.09), secondary (AHR= 1.12, 95%CI: 1.10,1.13), and higher (AHR= 1.08, 95% CI: 1.07,1.10) as compared to with no education, wealth status middle (AHR= 1.66, 95% CI: 1.60,1.70); richest (AHR: 1.60, 95% CI: 1.56,1.73), high community-level maternal literacy (AHR= 1.05, 95% CI: 1.04, 1.06), high community-level poverty (AHR= 0.99, 95%CI: 0.98, 0.99), previous cesarean section (CS) (AHR= 1.35, 95% CI: 1.33, 1.39), and unwanted pregnancy (AHR= 0.74, 95% CI: 0.72, 0.77) were predictors of the time to ANC booking.
Conclusion: The median time to ANC booking among pregnant women in East Africa is too later than the new WHO recommendation. Maternal and husband education, high community-level maternal literacy, better household, and community-level wealth index, and previous CS increase the early ANC booking. However, unwanted pregnancy lowers the early ANC booking. Therefore, strengthening system efforts to improve maternal and husband's educational status, women's education encouragement in the community, and economic support for low-wealth status women and poor community and encouraging wanted pregnancy and provide accessible counseling services for women facing unwanted pregnancies will help to encourage early ANC booking among pregnant women in East Africa.
... In contrast, factors such as age, marital status, and occupation did not show significant associations with late ANC initiation in this study. This aligns with previous studies, which suggest that socioeconomic factors often outweigh demographic characteristics in determining ANC timing (Geta & Yallew, 2017) (Belay et al., 2023). However, this finding differs from the results of previous studies which identified age and marital status as significant predictors of ANC timing (Debelo & Danusa, 2022) (Puthussery et al., 2022). ...
Aim: Pregnancy complications significantly affect health, making timely antenatal care (ANC) essential for early detection and skilled delivery. Despite WHO guidelines, some pregnant women in Ghana's Offinso North District delay their first ANC visit. This study explored intrapersonal and interpersonal factors contributing to this delay. Methods: Conducted from October 2021 to March 2022, this institutional cross-sectional study collected data from 397 pregnant women through a structured questionnaire. Descriptive and inferential statistical analyses were conducted with SPSS version 20. Results: Approximately 47% of pregnant women booked their antenatal care late. Key personal reasons hindering early ANC initiation included financial constraints, busy schedules, and insufficient knowledge about early ANC. Interpersonal barriers included pregnant women’s difficulty in initiating antenatal care (ANC) on their own, inadequate support from partners and family, and a lack of information about the importance of ANC in the media. Lower educational attainment (AOR = 1.86, 95% CI [1.13, 3.08], p = 0.016), lower income levels (AOR = 2.42, 95% CI [1.00, 5.85], p = 0.049), lack of knowledge about early ANC (AOR = 0.59, 95% CI [0.36, 0.99], p = 0.045) and busy schedules (AOR = 0.09, 95% CI [0.05, 0.17], p < 0.001) were significant predictors of late ANC initiation.
Conclusion: The study identifies a high prevalence of delayed antenatal care (ANC), primarily linked to educational and income levels, with financial constraints, demanding schedules, and insufficient knowledge as major contributing factors.
Recommendations: To improve early antenatal care (ANC) uptake and health outcomes, targeted interventions such as financial support and ongoing health education through outreach are crucial. Future research should evaluate the long-term effects of these interventions and explore additional
support mechanisms.
... The selection of independent variables stems from a comprehensive literature review, highlighting factors associated with the timing of the rst ANC visit. These variables encompass women's age (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49), place of residence (urban/rural), educational level (no education, preschool/early childhood education, primary, secondary, higher, don't know), frequency of reading newspapers or magazines (not at all, less than once a week, at least once a week), frequency of listening to the radio (not at all, less than once a week, at least once a week), frequency of watching television (not at all, less than once a week, at least once a week), frequency of using the internet last month (not at all, less than once a week, at least once a week), current pregnancy wanted (Yes, No), distance to the health facility (big problem, not a big problem), possession of health insurance (Yes, No), current marital status (never in union, married, living with partner, widowed, divorced, no longer living together/separated), husband/partner's education level, wealth index combined (poor, middle, rich) and the working status (Yes, No). ...
... It was also observed that women with primary, secondary, or higher education had shorter timings for their rst ANC visits compared to those with no education. This nding is similar to studies conducted in Uganda, Ghana, Ethiopia, and Nepal, which found that a pregnant woman whose level of education was primary, secondary, and higher had a shorter timing of rst ANC visit compared to those who had no education [12] [6] [23] [24] [7]. The consistency might be explained by the fact that education empowers women with self-awareness and knowledge of the effects of late ANC visits ...
Background
Reducing maternal mortality and improving women's healthcare are crucial objectives of the third Sustainable Development Goal (SDG), which aims to lower the global maternal mortality ratio (MMR) to 70 per 100,000 live births by 2030. The study examined the predictors of Timing of the First ANC Visit among pregnant women.
Methods
This study used TDHS data, the study analyzed descriptive statistics to showcase the distribution of women who booked Antenatal Care (ANC) across different trimesters, followed by a log rank to identify variables to include in the multivariate model. Lastly, the multivariate Cox proportional hazard regression was used to examine factors associated with the timing of the first ANC visits.
Results
The study found that most (66%) of women had initiated their first ANC visits over 3 months while 34% initiated within the recommended 3 months. the timing of the first antenatal care (ANC) visit showed variations based on several factors. the results of the Multivariate Cox-Proportional Hazard Regression analysis model found that Women aged 35–49 took 43.7% longer to initiate ANC than younger women aged 15–24. women with primary (AHR: 1.27, 95% CI: 1.08–1.49, p < 0.003), secondary (AHR: 1.30, 95% CI: 1.07–1.58, p < 0.007), and higher (AHR: 1.80 95% CI: 1.16–2.080 p < 0.008) had shorter timings for their first ANC visits compared to those with no education. For women who did not perceive distance to the health facility as a significant issue, the timing of their first ANC visit was (AHR: 1.111, 95% CI: 0.98–1.25, p < 0.001) shorter than those who considered distance a big problem. Working women also had a shorter (AHR: 1.02, 95% CI: 0.988–1.23, p < 0.08) timing for their first ANC visit than non-working women. Women who listened to the radio at least once a week had a (AHR: 1.13, 95% CI: 0.99–1.28, p < 0.067) higher hazard ratio for the timing of the first ANC visit compared to those who did not listen at all. Similarly, women who watched television less than once a week had (AHR: 1.18, 95% CI: 1.01–1.38, p < 0.028) shorter timing for their first ANC visit than non-watchers.
Conclusion
These findings highlight the influence of age, education, perceived distance, employment status, and media habits on the timing of the first ANC visit. The study recommends that the government and stakeholders should continue to Promote Health Literacy by Educating women about the importance of ANC during pregnancy and Utilizing television and radio as powerful tools for disseminating information about ANC.
This study focuses on the importance of early and regular Antenatal Care (ANC) visits in reducing maternal and child mortality rates in Bangladesh, a country where such health indicators are a concern. The research utilized data from the Bangladesh Demographic and Health Survey (BDHS) conducted in 2017-18 and employed the Cox proportional hazard model to identify factors influencing women's intention of ANC services. The results revealed that 40.4% of women engaged in at least one ANC activity during the first trimester, which, although higher than in other countries, falls below the global average. Notably, women between the aged of 25 and 29 years took 15% less time for their first ANC visit compared to their younger counterparts, suggesting higher awareness and preparedness in this age group. Education, both for women and their partners, had a significant influence on the intention to visit ANC early. Women in the poor wealth quantile exhibited lower odds of seeking timely ANC, whereas those with a planned pregnancy were more likely to do so. Moreover, access to mass media decreased the timing of ANC visits by 26% compared to women who were not exposed. Moreover, living in rural areas was linked to a 17% delay in the timing of the first ANC visit compared to urban areas. These findings underscore the importance of addressing these determinants to improve the timeliness and accessibility of ANC services, thereby enhancing maternal and child health outcomes in Bangladesh.
