Spatial distribution and associated factors of dropout from health facility delivery after antenatal booking in Ethiopia: a multi-level analysis.
Nowadays, retaining women in the continuum of care throughout the lifecycle: adolescence, pregnancy, childbirth, postpartum, and childhood in reproductive health is one of the recent global concerns. Most of the previous studies focused on individual-level factors and used classical logistic regression. Furthermore, it doesn't take into account its distribution. Therefore, this study aimed to assess spatial distribution, and associated factors of dropout from health facility delivery after antenatal booking among postpartum women in Ethiopia.
Cross-sectional study by secondary analysis of the Ethiopian Mini Demographic and Health Survey (EMDHS) 2019 dataset was conducted among postpartum women. A total of 2882 women who gave birth 5 years prior to the survey were included. Sampling weight was applied and the analysis was done using STATA version 16. Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used to map the cluster and attribute of dropout from health facility delivery and Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.5 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval was used to show the strength and direction of the association respectively.
Dropout from health facility delivery after ANC (Antenatal Care) booking in Ethiopia was 35.42%, 95% CI (33.70, 37.19), and it spatially clustered (Moran's index = 0.51, P value < 0.001). From individual-level variables: women who were primary educated [AOR = 0.70, 95% CI (0.49, 0.98)], secondary educated [AOR = 0.38, 95% CI (0.19, 0.73)], lived in the middle [AOR = 0.54, 95% CI (0.29, 0.98)], richer wealth [AOR = 0.37, 95% CI (0.18, 0.78)], richest wealth [AOR = 0.21, 95% CI (0.06, 0.74)], being counseled about pregnancy and childbirth complications [AOR = 0.52, 95% CI (0.34, 0.80)] and women who had four and above ANC visit [AOR = 0.52, 95% CI (0.38, 0.71)] were negatively associated with dropout. Whereas, second birth order [AOR = 2.62, 95% CI (1.40, 4.89)], 3-4th birth order [AOR = 4.92, 95% CI (2.82, 8.60)], above 4th birth order [AOR = 4.77, 95% CI (2.16, 10.53))] were positively associated with dropout. From community-level variables: mothers who lived in Afar [AOR = 2.61, 95% CI (1.08, 6.32)] and Oromia [AOR = 2.63, 95% CI (1.15, 6.02)] were positively associated with dropout from health facility delivery after ANC booking.
Dropout from health facility delivery after ANC booking was high as the government's effort and its spatial distribution in Ethiopia was clustered. Increased educational status of the mother, having four or more ANC visits, counseled about pregnancy and childbirth complications, and higher household wealth were negatively associated and higher birth order, and living in Oromia and Afar region were positively associated with dropout in Ethiopia. Strengthening women's education, encouraging women to complete ANC visits, being counseled them on pregnancy and childbirth complications, and improving family wealth status will be the recalled intervention areas of the government.
Yalew M
，Molla A
，Bogale GG
，Birhane T
，Arefaynie M
，Damtie Y
，Kefale B
，Adane B
... -
《BMC Womens Health》
Spatiotemporal distribution and determinants of delayed first antenatal care visit among reproductive age women in Ethiopia: a spatial and multilevel analysis.
Antenatal care (ANC) is one of the four pillars of the initiative for safe motherhood. ANC helps to improve the health of pregnant women and reduce the risk of adverse pregnancy outcome. First ANC is used to know the health status of the mothers and the fetus, to estimate the gestational age and expected date of delivery. Our research aims to investigate the Spatio-temporal distribution of delayed first ANC visit and its predictors using multilevel binary logistic regression analysis.
A total of 10,184 women (2061 in 2005, 3366 in 2011, and 4757 in 2016) were included for this study. The data were cleaned and weighted using STATA version 14. A multilevel binary logistic regression model was fitted to identify significant predictors of delayed first ANC visit. ArcGIS software was used to explore the spatial distribution of delayed first ANC visits and a Bernoulli model was fitted using SaTScan software to identify significant clusters of delayed first ANC visits.
Overall, 77.69, 73.95, and 67.61% of women had delayed their first ANC visit in 2005, 2011, and 2016 EDHSs respectively. Women education [AOR = 0.71; 95%CI; 0.60, 0.84], unwanted pregnancy [AOR = 1.41;95%CI; 1.04, 1.89], and rural residence [AOR = 1.68;95%CI; 1.19, 2.38] have significantly associated with delayed first ANC visit. The spatial analysis revealed that delayed first ANC visit varies in each EDHS period. The SaTScan analysis result of EDHS 2005 data identified 122 primary clusters located between the border of Oromia and Eastern SNNPR regions (RR = 1.30, LLR = 32.31, P-value< 0.001), whereas in 2011 EDHS, 145 primary clusters were identified in entire Tigray, B/Gumuz, Amhara western part of Afar and northwest Oromia regions (RR = 1.30, LLR = 40.79, P-value< 0.001). Besides in 2016 EDHS,198 primary clusters were located in the entire SNNPR, Gambella, Northen B/Gumuz, and western Oromia regions. (RR = 1.35, LLR = 83.21, P-value< 0.001).
In Ethiopia delayed first ANC visit was significantly varied across the country over time Women's education, wanted the last child, and residence were significantly associated with delayed first ANC booking. The effect of each predictor was found to be different across regions of Ethiopia. Therefore, a targeted intervention program is required in highly affected areas of Ethiopia.
Belay DG
，Aragaw FM
，Anley DT
，Tegegne YS
，Gelaye KA
，Tessema ZT
... -
《BMC PUBLIC HEALTH》
ResearchGate
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