scholarly journals Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246349
Author(s):  
Reta Dewau ◽  
Amare Muche ◽  
Zinabu Fentaw ◽  
Melaku Yalew ◽  
Gedamnesh Bitew ◽  
...  

Background Timely initiating antenatal care (ANC) is crucial in the countries that have high maternal morbidity and mortality. However, in developing countries including Ethiopia, pregnant mother’s time to initiate antenatal care was not well-studied. Therefore, this study aimed to assess time to first ANC and its predictors among pregnant women in Ethiopia. Methods A community-based cross-sectional study was conducted among 7,543 pregnant women in Ethiopia using the Ethiopian Demographic Health Survey (EDHS), 2016 data. A two-stage stratified cluster sampling was employed. The Kaplan-Meier (KM) method was used to estimate time to first antenatal care visit. Cox-gamma shared frailty model was applied to determine predictors. Adjusted Hazard Ratio (AHR) with 95% confidence interval was reported as the effect size. Model adequacy was assessed by using the Cox-Snell residual plot. Statistical significance was considered at p value <0.05. For data management and analysis Stata 14 was used. Results The median time to first ANC was 5 months with IQR (3,-). The independent predictors of time to first ANC visit were primary education [AHR: 1.24 (95%CI, 1.13–1.35)], secondary education [AHR: 1.28(95% CI, 1.11–1.47)], higher education [AHR: 1.43 (1.19–1.72)] as compared to women with no formal education. Having media exposure [AHR: 1.13 (95% CI, 1.03–1.24)], early initiation of ANC increases by 25% [AHR: 1.25 (95% CI, 1.12–1.40)] in poorer, 32% [AHR: 1.32 (95% CI, 1.17–1.49)] in middle, 37% [AHR: 1.37 (95% CI, 1.20–1.56)] in richer and 41% [AHR: 1.41 (95%CI, 1.1.19–1.67)] in richest households as compared to poorest household wealth index. Living in city administration, media exposure and community women literacy were also enabler factors, while, long distance from health facility and nomadic region residency were hindering factors of early ANC visit. Conclusions The current study revealed that women’s time to first antenatal care visit was by far late in Ethiopia as compared to the world health organization recommendation (WHO). The predictors of time to first ANC visit were education status of women, having media exposure, level of household wealth index, community women literacy ad distance to health facility. It is vital that maternal and child health policies and strategies better to be directed at women development and also designing and applying interventions that intended to increase timely initiation ANC among pregnant-women. Researchers also recommended conducting studies using a stronger design like a cohort to establish temporality and reduce biases.

2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Kenaw Derebe Fentaw ◽  
Setegn Muche Fenta ◽  
Hailegebrael Birhan Biresaw ◽  
Solomon Sisay Mulugeta

Abstract Background The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia. Methods This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model. Results The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit. Conclusion The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women’s development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.


2020 ◽  
Author(s):  
Chilot Desta Agegnehu ◽  
Getayeneh Antehunegn Tesema ◽  
Achamyeleh Birhanu Teshale ◽  
Adugnaw Zeleke Alem ◽  
Yigizie Yeshaw ◽  
...  

Abstract Background Although the World Health Organization recommends for all pregnant women taking iron tablet should be a routine activity, more than 50% of anemia in pregnant women was occurred due to lack of iron supplementation and remains global public health problem and varies with in country. Lack of iron tablet supplementation during pregnancy leads to maternal anemia, which intern increases the risk of maternal death, obstetric complications, preterm birth and low birth weight. Therefore, studying spatial distribution and determinants of iron supplementation use among pregnant women in Ethiopia is vital to design appropriate maternal health services and preventing the determinants earlier. Method: A stratified two-stage cluster sampling technique was used in the Ethiopian Demographic Health Survey in 2016 data. A total of a weighted sample of 7589 pregnant women were included for analysis. Bernoulli model was used to explore the purely spatial clusters of pregnant women using SaTScan version 9.6 and ArcGIS version10.3.A multi-level logistic regression model was used to identify determinant factors of iron supplementation use among pregnant women. Results Spatial distribution of iron supplementation use among pregnant women was non –random in the country with Moran’s index 0.3 (p < 0.001). The primary cluster was in Southwest Somali and Central part of the Oromia region (LLR = 66.69, P < 0.001). ANC visit (AOR = 3.66, 95%CI: 3.21, 417), community education [AOR = 1.31, 95%CI, 1.07, 1.59), media exposure (AOR = 1.33, 95%CI: 1.15, 1.53), distance to health facility (AOR = 1.32, 95%CI: 1.16, 1.50), region and household wealth index were significantly associated with iron supplementation use among pregnant women in Ethiopia. Conclusion Spatial distribution of Iron supplementation use among pregnant women varies across the country. ANC visit, region, household wealth index, media exposure, distance to the health facility, and community education were significant predictors of iron supplementation use among pregnant women. Therefore, it needs great interventions in the hot spot areas and maternal health services should be delivered in all areas of our country.


2020 ◽  
Vol 46 (1) ◽  
Author(s):  
Zemenu Tadesse Tessema ◽  
Getayeneh Antehunegn Tesema

Abstract Background Neonatal mortality remains a serious public health concern in developing countries including Ethiopia. Ethiopia is one of the countries with the highest neonatal mortality in Africa. However, there is limited evidence on the incidence and predictors of neonatal mortality at the national level. Therefore, this study aimed to investigate the incidence of neonatal mortality and its predictors among live births in Ethiopia. Investigating the incidence and predictors of neonatal mortality is essential to design targeted public health interventions to reduce neonatal mortality. Methods A secondary data analysis was conducted based on the 2016 Ethiopian Demographic and Health Survey (EDHS) data. A total weighted sample of 11,022 live births was included in the analysis. The shared frailty model was applied since the EDHS data has hierarchical nature, and neonates are nested within-cluster, and this could violate the independent and equal variance assumption. For checking the proportional hazard assumption, Schoenfeld residual test was applied. Akakie Information Criteria (AIC), Cox-Snell residual test, and deviance were used for checking model adequacy and for model comparison. Gompertz gamma shared frailty model was the best-fitted model for this data since it had the lowest deviance, AIC value, and the Cox-Snell residual graph closet to the bisector. Variables with a p-value of less than 0.2 were considered for the multivariable Gompertz gamma shared frailty model. In the multivariable Gompertez gamma shared frailty model, the Adjusted Hazard Ratio (AHR) with a 95% confidence interval (CI) was reported to identify significant predictors of neonatal mortality. Results Overall, the neonatal mortality rate in Ethiopia was 29.1 (95% CI: 26.1, 32.4) per 1000 live births. In the multivariable Gompertz gamma shared frailty model; male sex (AHR = 1.92, 95% CI: 1.52, 2.43), twin birth (AHR = 5.22, 95% CI: 3.62, 7.53), preceding birth interval less than 18 months (AHR = 2.07, 95% CI: 1.51, 2.85), small size at birth (AHR = 1.64, 95% CI: 1.24, 2.16), large size at birth (AHR = 1.53, 95% CI: 1.16, 2.01) and did not have Antenatal Care (ANC) visit (AHR = 2.10, 95% CI: 1.44, 3.06) were the significant predictors of neonatal mortality. Conclusion Our study found that neonatal mortality remains a public health problem in Ethiopia. Shorter birth interval, small and large size at birth, ANC visits, male sex, and twin births were significant predictors of neonatal mortality. These results suggest that public health programs that increase antenatal care service utilization should be designed to reduce neonatal mortality and special attention should be given for twin births, large and low birth weight babies. Besides, providing family planning services for mothers to increase birth intervals and improving accessibility and utilization of maternal health care services such as ANC is crucial to improve neonatal survival.


2021 ◽  
Vol 79 (1) ◽  
Author(s):  
Ayal Debie ◽  
Getayeneh Antehunegn Tesema

Abstract Background Most maternal and infant deaths occurred within the first month after birth. Nearly half of the maternal deaths and more than a million newborn deaths occurred within the first day of life but these were preventable through early initiation of postnatal care (PNC) services. However, the available evidence on the level of early initiation of PNC service utilization was not adequate to inform policy decisions. Therefore, this study aimed to assess time to early initiation of postnatal care and its predictors using the 2016 Ethiopian Demography and Health Survey (EDHS) datasets. Methods Two-stage stratified cluster sampling technique by separating each region into urban and rural areas. A total weighted sample of 6364 women of the 2016 EDHS datasets who gave birth within 2 years preceding the survey was used. Time to early initiation of the PNC visit was estimated using the Kaplan-Meier (K-M) method. Shared frailty model with baseline distributions (Weibull, Gompertz, exponential, log-logistic, and lognormal) and frailty distributions (gamma and inverse Gaussian) were used by taking enumeration areas/clusters as a random effect for predictors of time to early initiation of PNC visit. The adjusted hazard ratio (AHR) with a 95% confidence interval (CI) and p-value less than 0.05 were used to declare the significant predictor variables for time to early initiation of the PNC service utilization. Results The prevalence of women who utilized PNC services within 42 days was 13.27% (95% CI, 12.46, 14.13). Among these women, only 1.73% of them had got within the first 24 h of birth; 4.66% of them received within 48–72 h and 1.74% of them also had got within 7–14 days. Variables, such as parity (AHR = 1.61, 95% CI: 1.21, 2.15), media exposure (AHR = 1.42, 95% CI: 1.21, 1.68), place of delivery (AHR = 14.36, 95% CI: 11.76, 17.53), caesarean delivery (AHR = 2.17, 95% CI: 1.60, 2.95) and antenatal care visit (AHR = 2.07, 95% CI: 1.63, 2.63) had the higher hazard for PNC services utilization. On the other hand, women who faced with healthcare access problems (AHR = 0.74, 95% CI: 0.60, 0.87) had a lower hazard of PNC service utilization. Conclusion The overall postnatal care service utilization among women in the survey was low, particularly within the first 24 h of delivery. Policy-makers and implementers should promote the utilization of antenatal care and institutional delivery using mass media to increase the continuum of maternity care. The government should also design a new approach to enhance the uptake of postnatal care services for poor households and to scale up the PNC services, including the different possibilities for women who give births at the health facilities and homes. Future researchers had better assess the capacity and accessibility of the local health systems, the level of decentralized decision making, common cultural practices, knowledge, attitude, and perception of mothers towards PNC service utilization.


2021 ◽  
Author(s):  
Mastewal Arefaynie ◽  
Bereket Kefale ◽  
Melaku Yalew ◽  
Bezawit Adane ◽  
Reta Dewau ◽  
...  

Abstract Background The frequency of antenatal care enhances the effectiveness of the program to reduce maternal and child mortality and morbidity. The aim of the study was to determine the number of antenatal care and associated factors in Ethiopia by using 2019 intermediate EDHS. Methods Secondary data analysis was done on 2019 intermediate EDHS. A total of 3,916.6 weighted pregnant women were included in the analysis. Zero-inflated Poisson regression analysis was done by Stata version 14.0. Incident rate ratio and odds ratio with a 95% confidence interval were used to show the strength and direction of the association. Result About one thousand six hundred eighty eight (43.11%) women were attending four and more antenatal care during current pregnancy. Attending primary education (IRR= 1.115, 95% CI: 1.061, 1.172), secondary education (IRR=1.211, 95% CI: 1.131, 1.297) and higher education (IRR=1.274, 95% CI: 1.177, 1.378), reside in poorer household wealth index (IRR= 1.074, 95% CI: 1.01, 1.152), middle household wealth index (IRR= 1.095, 95% CI: 1.018, 1.178), rich household wealth index (IRR=1.129, 95% CI: 1.05, 1.212) and richer household wealth index (IRR=1.186, 95% CI: 1.089, 1.29) increases the number of antenatal care utilization. The frequency of antenatal care was less likely become zero among women attending primary (AOR=0.434, 95% CI: 0.346, 0.545), secondary (AOR=0.113, 95% CI: 0.053, 0.24), higher educational level (AOR=0.052, 95% CI: 0.007, 0.367) in the inflated part. Conclusion The number of antenatal care utilization is low in Ethiopia. Being rural, poorest household index, uneducated and single were factors associated with low number of antenatal care and not attending antenatal care at all. Improving the educational coverage and wealth status of women is important to increase coverage of antenatal care.


2021 ◽  
Vol 12 ◽  
pp. 215013272199689
Author(s):  
Shewangizaw Hailemariam ◽  
Wubetu Agegnehu ◽  
Misganaw Derese

Introduction: Evidences suggest a significant decline in maternal health service uptake following the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia. However, COVID-19 related factors impacting the service uptake are not sufficiently addressed. Hence, the current study was intended to explore COVID-19 related factors influencing antenatal care service uptake in rural Ethiopia. Methods: A community-based qualitative study was conducted from September 25/2020 to November 25/2020 among selected pregnant women residing in rural districts of Bench-Sheko Zone, and healthcare providers working in the local health care facilities. Six focus group discussions and 9 in-depth interviews were made between pregnant women, and health care providers, respectively. Data was collected by health education and behavioral science professionals who also have experience in qualitative data collection procedure. Data were transcribed, translated, and analyzed thematically using Open Code 4.0 software. Result: The study revealed several COVID-19 related factors influencing the uptake of antenatal care service during the pandemic. Health facility related barriers, perceived poor quality of care during the pandemic, government measures against COVID-19, anxiety related to the pandemic, and risk minimization were the identified factors possibly influencing the current antenatal care service uptake among women in rural Bench-Sheko Zone. Conclusion: COVID-19 preventive measures, and health facility related factors and individual factors were responsible for the current decline in antenatal care service uptake. Preserving essential health care service is critical to prevent avoidable losses of maternal and child lives during the pandemic period. Hence, programs and strategies designed to maintain maternal health services particularly, antenatal care service have better take the above determinants into consideration.


2019 ◽  
Vol 14 (5) ◽  
pp. 590-597 ◽  
Author(s):  
Richard Johnston ◽  
Roisin Cahalan ◽  
Laura Bonnett ◽  
Matthew Maguire ◽  
Alan Nevill ◽  
...  

Purpose: To determine the association between training-load (TL) factors, baseline characteristics, and new injury and/or pain (IP) risk in an endurance sporting population (ESP). Methods: Ninety-five ESP participants from running, triathlon, swimming, cycling, and rowing disciplines initially completed a questionnaire capturing baseline characteristics. TL and IP data were submitted weekly over a 52-wk study period. Cumulative TL factors, acute:chronic workload ratios, and exponentially weighted moving averages were calculated. A shared frailty model was used to explore time to new IP and association to TL factors and baseline characteristics. Results: 92.6% of the ESP completed all 52 wk of TL and IP data. The following factors were associated with the lowest risk of a new IP episode: (a) a low to moderate 7-d lag exponentially weighted moving averages (0.8–1.3: hazard ratio [HR] = 1.21; 95% confidence interval [CI], 1.01–1.44; P = .04); (b) a low to moderate 7-d lag weekly TL (1200–1700 AU: HR = 1.38; 95% CI, 1.15–1.65; P < .001); (c) a moderate to high 14-d lag 4-weekly cumulative TL (5200–8000 AU: HR = 0.33; 95% CI, 0.21–0.50; P < .001); and (d) a low number of previous IP episodes in the preceding 12 mo (1 previous IP episode: HR = 1.11; 95% CI, 1.04–1.17; P = .04). Conclusions: To minimize new IP risk, an ESP should avoid high spikes in acute TL while maintaining moderate to high chronic TLs. A history of previous IP should be considered when prescribing TLs. The demonstration of a lag between a TL factor and its impact on new IP risk may have important implications for future ESP TL analysis.


PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257782
Author(s):  
Jesmin Pervin ◽  
Mahima Venkateswaran ◽  
U. Tin Nu ◽  
Monjur Rahman ◽  
Brian F. O’Donnell ◽  
...  

Background Timely utilization of antenatal care and delivery services supports the health of mothers and babies. Few studies exist on the utilization and determinants of timely ANC and use of different types of health facilities at the community level in Bangladesh. This study aims to assess the utilization, timeliness of, and socio-demographic determinants of antenatal and delivery care services in two sub-districts in Bangladesh. Methods This cross-sectional study used data collected through a structured questionnaire in the eRegMat cluster-randomized controlled trial, which enrolled pregnant women between October 2018-June 2020. We undertook univariate and multivariate logistic regression analysis to determine the associations of socio-demographic variables with timely first ANC, four timely ANC visits, and facility delivery. We considered the associations in the multivariate logistic regression as statistically significant if the p-value was found to be <0.05. Results are presented as adjusted odds ratios (AOR) with 95% confidence intervals (CI). Results Data were available on 3293 pregnant women. Attendance at a timely first antenatal care visit was 59%. Uptake of four timely antenatal care visits was 4.2%. About three-fourths of the women delivered in a health facility. Women from all socio-economic groups gradually shifted from using public health facilities to private hospitals as the pregnancy advanced. Timely first antenatal care visit was associated with: women over 30 years of age (AOR: 1.52, 95% CI: 1.05–2.19); nulliparity (AOR: 1.30, 95% CI: 1.04–1.62); husbands with >10 years of education (AOR: 1.40, 95% CI: 1.09–1.81) and being in the highest wealth quintile (AOR: 1.49, 95% CI: 1.18–1.89). Facility deliveries were associated with woman’s age; parity; education; the husband’s education, and wealth index. None of the available socio-demographic factors were associated with four timely antenatal care visits. Conclusions The study observed socio-demographic inequalities associated with increased utilization of timely first antenatal care visit and facility delivery. The pregnant women, irrespective of wealth shifted from public to private facilities for their antenatal care visits and delivery. To increase the health service utilization and promote good health, maternal health care programs should pay particular attention to young, multiparous women, of low socio-economic status, or with poorly educated husbands. Clinical trial registration ISRCTN69491836; https://www.isrctn.com/. Registered on December 06, 2018. Retrospectively registered.


2020 ◽  
Author(s):  
Tsegahun Worku Brhanie ◽  
Walelgn Tefera ◽  
Mamo Dereje

Abstract Background: Adequate and healthy diet during pregnancy is essential for the health of both mother and newborn. Dietary diversity is a proxy indicator of maternal nutrient adequacy. However, little is documented on the prevalence of dietary diversity among pregnant women. This study was aimed to assess the dietary diversity practice and associated factors among pregnant women attending antenatal care in health centers of the coffee keranyo sub city, Addis Ababa, Ethiopia. Methods: Institution based cross-sectional study was conducted on 406 randomly selected pregnant women attending ANC in health centers of the coffee keranyo sub city, Addis Ababa from March 2-April 2/ 2018. Data were collected by using interviewer and 24 H dietary recall method. Data had entered and analyzed using SPSS version 21. Multiple logistic regression was run to assess factors associated with the dependent variable at P<0.05. Results: The mean Dietary Diversity Score of pregnant women was 5. 45+-1. 83. About 60.9% of pregnant women had good dietary diversity practice. Pregnant women who learned collage and above had more dietary diversity practice than the illiterate one [AOR=2.26, 95% CI: (1.066, 4.808)]. Pregnant women with monthly income more than 5,000 ETB had more dietary diversity than income less than 2,000 ETB [AOR=2.33, 95% CI: (1.234, 4.416)]. Pregnant women at second antenatal care visit had more dietary diversity than at the first visit [AOR=2.42, 95% CI: (1.183, 4.952)]. Having nutrition information during pregnancy increases 2 times better dietary diversity practice than none informed ones [AOR=2.10, 95% CI: (1.294, 3.422)].Conclusions: The mean Dietary Diversity Score of pregnant mothers was 5.45. And 60.9% of pregnant women had a good dietary diversity score, whereas 39.1 % of them had a poor diet diversity score. Mothers’ education, monthly income, second and third antenatal care visit and nutrition information had a significantly associated with pregnant mothers’ dietary diversity.


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