Risk Factors Associated With Frequency of Antenatal Visits, Number of Items of Antenatal Care Contents Received and Timing of First Antenatal Care Visits in Ethiopia: Multilevel Mixed-Effects Analysis
Authors: Woldeamanuel Berhanu , Belachew Tadesse 
Published: December 2020

Abstract
Background: An improved quality Antenatal care (ANC) from skilled providers is essential to pregnant women so that ensure the key health circumstances for mother and child during pregnancy. Thus, this study attempted to assess which risk factors are significantly associated with the timing of antenatal care, the number of antenatal care visits, and the number of items of antenatal care contents received from skilled providers in the recent pregnancy among mothers in Ethiopia. Methods: Data was extracted from the 2016 Ethiopian Demographic and Health Survey. A total of 4,685 mothers was included in the analysis. Multilevel mixed-effects logistic regression analysis and multilevel mixed Negative binomial models were fitted to find the factors associated with antenatal care utilization. A 95% Confidence Interval of Odds ratio/Incidence rate ratio excluding one was reported as significant association with timely initiation of the ANC, numbers of ANC visits, numbers of items of antenatal care contents received and predictor variables.Results: About 20% of the mothers initiated ANC within the first trimester, 36.3% visits at least four ANCs, 3.6% have visited at least eight ANCs, and only 53% received at least four items of antenatal care contents. Rural residence (IRR = 0.81; 95%CI: 0.80-0.89), wanted no more children (IRR = 0.83; 95%CI: 0.75-0.91), mother without decision making power (IRR = 0.90; 95%CI: 0.83-0.98) associated with reduced frequency of ANC visits, while being rural residents (IRR = 0.82; 95%CI: 0.75-0.90), wanted no more children (IRR = 0.87; 95%CI: 0.79-0.96), husband alone decision maker of mothers health care (IRR = 0.88; 95%CI: 0.81-0.96) associated with reduced items of ANC content received. Further, birth order six or more (IRR = 0.74; 95%CI: 0.56-0.96), rural residence (IRR = 0.0.41; 95%CI: 0.34-0.51), wanted no more children (IRR = 0.61; 95%CI: 0.48-0.77) associated with delayed antenatal care utilization. Moreover, higher household wealth status, primary or secondary or higher education of mothers and partner, listening to the radio and watching television at least once a week, and a short distance to health facility were positively significantly associated with the frequency of antenatal care visits, numbers of items of ANC contents received and early initiation of ANC visit for the recent pregnancy during the last five years before the survey. Conclusions: Rural residence, poorest household wealth status, no education level of mothers or partners, unexposed to mass media, unwanted pregnancy, mothers without decision making power, and big distance to the nearest health facility, have a significant impact in delaying the timing of ANC visits, reducing the number of ANC visits and items of ANC received in Ethiopia. We ought to timely initiate an ANC visit for a frequent antenatal care visit during pregnancy. Educating girls and encouraging mothers to use modern contraceptives in order to prevent unwanted pregnancies are vital ingredients that should be included in all policies aiming to reduce maternal and neonatal deaths through improved quality of antenatal care utilization.