Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model.
<h4>Background</h4>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 a...
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2021-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0246349 |
| _version_ | 1818928666611023872 |
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| author | Reta Dewau Amare Muche Zinabu Fentaw Melaku Yalew Gedamnesh Bitew Erkihun Tadesse Amsalu Mastewal Arefaynie Asnakew Molla Mekonen |
| author_facet | Reta Dewau Amare Muche Zinabu Fentaw Melaku Yalew Gedamnesh Bitew Erkihun Tadesse Amsalu Mastewal Arefaynie Asnakew Molla Mekonen |
| author_sort | Reta Dewau |
| collection | DOAJ |
| description | <h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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. |
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| format | Article |
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| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-20T03:32:32Z |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| series | PLoS ONE |
| spelling | doaj.art-53a9e271462241fe9c28aaf19694d7d72022-12-21T19:54:57ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01162e024634910.1371/journal.pone.0246349Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model.Reta DewauAmare MucheZinabu FentawMelaku YalewGedamnesh BitewErkihun Tadesse AmsaluMastewal ArefaynieAsnakew Molla Mekonen<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.https://doi.org/10.1371/journal.pone.0246349 |
| spellingShingle | Reta Dewau Amare Muche Zinabu Fentaw Melaku Yalew Gedamnesh Bitew Erkihun Tadesse Amsalu Mastewal Arefaynie Asnakew Molla Mekonen Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. PLoS ONE |
| title | Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. |
| title_full | Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. |
| title_fullStr | Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. |
| title_full_unstemmed | Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. |
| title_short | Time to initiation of antenatal care and its predictors among pregnant women in Ethiopia: Cox-gamma shared frailty model. |
| title_sort | time to initiation of antenatal care and its predictors among pregnant women in ethiopia cox gamma shared frailty model |
| url | https://doi.org/10.1371/journal.pone.0246349 |
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