Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

Befekadu Tesfaye Oyato; Husen Zakir Abasimel; Derara Girma Tufa; Hana Israel Gesisa; Tewodros Getachew Tsegaye; Mukemil Awol

doi:10.1136/bmjopen-2023-075965

Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: a multilevel mixed-effects acceleration failure time model

BMJ Open. 2024 Apr 19;14(4):e075965. doi: 10.1136/bmjopen-2023-075965.

Authors

Befekadu Tesfaye Oyato¹, Husen Zakir Abasimel², Derara Girma Tufa³, Hana Israel Gesisa⁴, Tewodros Getachew Tsegaye⁵, Mukemil Awol¹

Affiliations

¹ Midwifery, Salale University, Fitche, Oromia, Ethiopia.
² Midwifery, Salale University, Fitche, Oromia, Ethiopia husniselam@gmail.com.
³ Public Health, Salale University, Fitche, Oromia, Ethiopia.
⁴ Midwifery, Jimma University, Jimma, Oromia, Ethiopia.
⁵ Midwifery, Hawassa University, Hawassa, Sidama, Ethiopia.

Abstract

Objective: To assess the time to initiation of antenatal care (ANC) and its predictors among pregnant women in Ethiopia.

Design: Retrospective follow-up study using secondary data from the 2019 Ethiopian Mini-Demographic and Health Survey.

Setting and participants: 2933 women aged 15-49 years who had ANC visits during their current or most recent pregnancy within the 5 years prior to the survey were included in this study. Women who attended prenatal appointments but whose gestational age was unknown at the first prenatal visit were excluded from the study.

Outcome measures: Participants were interviewed about the gestational age in months at which they made the first ANC visit. Multivariable mixed-effects survival regression was fitted to identify factors associated with the time to initiation of ANC.

Results: In this study, the estimated mean survival time of pregnant women to initiate the first ANC visit in Ethiopia was found to be 6.8 months (95% CI: 6.68, 6.95). Women whose last birth was a caesarean section (adjusted acceleration factor (AAF)=0.75; 95% CI: 0.61, 0.93) and women with higher education (AAF)=0.69; 95% CI: 0.50, 0.95) had a shorter time to initiate ANC early in the first trimester of pregnancy. However, being grand multiparous (AAF=1.31; 95% CI: 1.05, 1.63), being previously in a union (AAF=1.47; 95% CI: 1.07, 2.00), having a home birth (AAF=1.35; 95% CI: 1.13, 1.61) and living in a rural area (AAF=1.25; 95% CI: 1.03, 1.52) were the impediments to early ANC initiation.

Conclusion: Women in this study area sought their initial ANC far later than what the WHO recommended. Therefore, healthcare providers should collaborate with community health workers to provide home-based care in order to encourage prompt ANC among hard-to-reach populations, such as rural residents and those giving birth at home.

Keywords: OBSTETRICS; PUBLIC HEALTH; Pregnant Women; Prenatal diagnosis; STATISTICS & RESEARCH METHODS.

MeSH terms

Cesarean Section
Ethiopia / epidemiology
Female
Follow-Up Studies
Humans
Parity
Patient Acceptance of Health Care
Pregnancy
Pregnant Women*
Prenatal Care*
Retrospective Studies