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Individual, Household, and Contextual Factors Influencing the Timing of the First Antenatal Care Attendance in Northwest Ethiopia: A Two-Level Binary Logistic Regression Analysis

Authors Emiru AA, Alene GD, Debelew GT

Received 22 February 2020

Accepted for publication 9 June 2020

Published 18 June 2020 Volume 2020:12 Pages 463—471


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Elie Al-Chaer

Amanu Aragaw Emiru,1 Getu Degu Alene,2 Gurmesa Tura Debelew3

1Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia; 2Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Bahir Dar University, Bahir, Ethiopia; 3Department of Population and Family Health, Faculty of Public Health, Institute of Health, Jimma University, Jimma, Ethiopia

Correspondence: Amanu Aragaw Emiru
Department of Reproductive Health and Population Studies, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box: 79, Bahir Dar, Ethiopia
Tel +251 918780295

Background: Early antenatal visit is critical for the health and well-being of mothers and babies. However, various individual, family level, and contextual factors influence the timely initiation of antenatal care.
Objective: The aim of this study was to examine individual, household, and community-level factors associated with the timing of first ANC visit among mothers who gave birth in the last twelve months before the survey.
Methods: A community-based cross-sectional study was conducted in June 2018. A multistage cluster sampling technique was applied, and a sample of 898 women was considered. Data were collected using a questionnaire and checklist. The analysis was made using SPSS. A multilevel logistic regression with random effects at the kebele level was developed to assess the predictors of late initiation of antenatal care. Odds ratio with 95% confidence intervals was used to measure association while the intra-class correlation coefficient and the median odds ratio were used to measure variations.
Results: Overall, 78.4% (95% CI: 75.6, 80.9) of women started their first ANC in 4 months of gestation or later and significant heterogeneity was observed between clusters. At level 1, women with intended pregnancy (aOR=0.31; 95% CI: 0.12, 0.79), and being knowledgeable about the timing (aOR=0.43; 95% CI: 0.25, 0.75) and pregnancy-related complications (aOR=0.16; 95% CI: 0.10, 0.26) were less likely to delay their first ANC visit. Conversely, the odds of late ANC visit was higher among women with no formal education (aOR=4.08, 95% CI: 2.20, 7.55). Distance to the health facility (aOR=1.04; 95% CI, 1.01– 1.08) was the only level-2 significant predictor.
Conclusion: The study revealed that late ANC initiation was rampant. Several factors operating at different levels were associated with late ANC visits; yet, the role of individual-level factors was relatively stronger. Hence, awareness creation is essential to the underprivileged community using the available communication networks.

Keywords: antenatal care, timing, delay, late, multilevel

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