Abstract:
Abstract
Antenatal care is the systemic supervision of women during pregnancy to monitor the
progress of fetal growth and to ascertain the well-being of the mother and fetus. Starting as early
as possible within 12
th
weeks, all pregnant women should have minimum of four ANC visits.
However, the existing evidence from Ethiopia indicate that majority of pregnant mothers did not
start their first visit as recommended. The aim of this study was to assess the timing of first ANC
visit and identify its determinants among pregnant women in Ethiopia.
The 2016 EDHS data were used for this analysis. The study considered all women age 15-49, who
had a live birth in the 5 years before the survey from nine regional states and two city
administrations. The gestational age at time of first ANC visit for the last pregnancy was taken as
the survival time. Descriptive statistics and parametric shared frailty models were employed to
identify determinant factors for time to first ANC visit. The accelerated factor (ϕ) were reported to
show association of factors with time to first ANC visit where accelerated factor (ϕ) >1 indicates
prolonged time-to-first ANC visit, and accelerated factor (ϕ) <1 indicates shorter survival time to
first ANC visit.
From a total women (N= 7559) only 20.4% started first ANC on recommended time within 12
weeks. The median survival time of first ANC visit in Ethiopia was 18 weeks (4.5 months). The
clustering effect was significant for all baseline parametric shared frailty models. A log logistic
gamma shared frailty model was preferred over other models based on smallest AIC. Mother‟s
rural residence (ϕ = 1.29, 95% CI: 1.19, 1.40), birth order of 2-3, 4-5 and 6+ (ϕ =1.06, 1.08, and
1.21, respectively), long distance to health facility (ϕ = 1.08, 95% CI: 1.04, 1.12), has ϕ >1
acceleration factors, while women‟s primary, secondary and above educational level (ϕ= 0.91 and
0.87 respectively), wealth index middle, rich (ϕ= 0.87 and 0.86 respectively), women‟s had media
access (ϕ = 0.92) and women‟s involved on health care decision have ϕ <1 acceleration factor.
The finding of this study suggest that spouse‟s high level of education, having media access,
urban resident, lower birth order and increasing wealth index of the family shorten time-to-first
ANC visit, while residing in rural areas, higher birth order and long distance to health facility
prolong time to first ANC visit. The log logistic gamma shared frailty model fits the dataset.
Therefore, provide information, education and communication to create community awareness
about importance of early ANC visit through health extension workers and concerned bodies.
th
Keywords: Antenatal Care, timing to first ANC visit, acceleration factor, Determinants, shared frailty.