Characteristics of the sample
Among the 3694 sampled women, only 33.0% (95% CI 31. 5% 34.5%) completed four or more ANC visits (Table
1). Out of the total women considered for this study 56.5% (95% CI 54.8% 58.1%) had at least one ANC visit. Besides, out of those who had at least one ANC, 37.4% (95% CI 35.3% 39.5%) visited in their first trimester.
Table 1
Distribution of completing four or more antenatal care visits by categories of selected variables among women in Ethiopia, 2014. (N = 3694)
Marital status | Never in union/Formerly in union | 281 (7.61) | 39.86 |
Currently in union | 3413 (92.39) | 32.43 |
Birth Order | 1 | 691 (18.71) | 48.19 |
2 or 3 | 1105 (29.91) | 38.10 |
4 or 5 | 922 (24.96) | 27.01 |
6 + | 976 (26.42) | 22.13 |
Community level Quality of received ANC | Low | 1902 (54.34) | 25.55 |
High | 1598 (45.66) | 45.87 |
Community level literacy | Low | 913 (24.72) | 14.79 |
Medium | 1932 (52.30) | 29.35 |
High | 849 (22.98) | 60.90 |
Wealth index | Poor | 1832 (49.59) | 16.7 |
Medium | 572 (15.48) | 31.99 |
Rich | 1290 (34.92) | 56.59 |
Educational status | No education | 2368 (64.1) | 21.11 |
Primary | 1006(27.23) | 45.63 |
Secondary/higher | 320(8.66) | 81.25 |
Place of residence | Urban | 740 (20.03) | 71.62 |
Rural | 2954 (79.97) | 23.32 |
Region | Tigray | 309 (8.36) | 40.13 |
Afar | 369 (9.99) | 11.92 |
Amhara | 386 (10.45) | 22.28 |
Oromia | 460 (12.45) | 32.17 |
Somali | 347 (9.39) | 5.48 |
B. Gumuz | 306 (8.28) | 27.78 |
SNNP | 512 (13.86) | 31.64 |
Gambela | 302 (8.18) | 33.44 |
Harari | 256 (6.93) | 46.88 |
Addis Ababa | 177 (4.79) | 91.53 |
Dire Dawa | 270 (7.31) | 62.22 |
Age | 15–19 | 190 (5.14) | 24.21 |
20–24 | 696 (18.84) | 35.92 |
25–29 | 1123 (30.40) | 35.26 |
30–34 | 777 (21.03) | 35.91 |
35–39 | 575 (15.57) | 31.48 |
40–44 | 228 (6.17) | 19.30 |
45–49 | 105 (2.84) | 21.9 |
HH Sex | Male | 3147 (85.19) | 31.87 |
Female | 547 (14.81) | 33.0 |
The result also showed that out of samples taken more than three fourths (80.0%) were rural residents. Only 23.3% of the rural residents completed four or more ANC visits, while 71.6% of the urban residents completed the recommended four or more ANC visits.
Based on the community level quality of received ANC, 54.3% women lived in a community with a low level quality of received ANC, while 45.7% lived in a community with high community level quality of received ANC. Besides, 45.9% of women living in a community with high quality of received ANC completed four or more ANC visits, whereas only 25.6% of those in a community with low quality of received ANC completed the four or more ANC visits. With respect to community level literacy, 24.7% of women lived in a community with low community level literacy of women. This figure was 52.3% and 23.0% for women in the community with medium and high community level literacy of women, respectively. Moreover, 60.9% of the women in the community which had a high level literacy of women completed four or more ANC visits, while the figures were 29.4% and 14.8% for women in low and medium community level literacy of women, respectively.
When considered from the point of view of wealth index, almost half (49.6%) of the women who took part in the study were from poor households, While 15.5% and 34.9% were from medium and rich ones, respectively. Among women who were from poor, medium and rich households, 16.7%, 32.0% and 56.6% completed four or more ANC visits, respectively. At individual levels, 18.7% of the women with their last delivery were first birth order pregnancies. This figure was 29.9%, 25.0%, and 26.4% for 2nd or 3rd, 4th or 5th and above 6th birth orders, respectively. The proportion of those who completed four or more ANC visits decreased as the birth order increased. For instance, 48.2% completed four or more ANC visits among first birth order pregnancies of their last delivery.
Determinants of completing the four or more ANC visits
The result of the bi-variable analysis showed that all explanatory variables were associated with completing four or more ANC visits at 25% level of significance. The final adjusted model, including all considered factors fits the data well (Goodness of fit test p-value = 0.3516). This could also be supported by area under Receiver Operating Curve (ROC) with a value of 0.8044.
The result showed that variables such as age and highest level of education of women, region, residence, and wealth index of the household; birth order of the child and community level quality of received ANC services were significant determinants of completing four or more ANC visits at 5% level of significance (Table
2).
Table 2
Bi-variable and multi-variable odds ratios for potential factors of completing four or more ANC visits in Ethiopia, 2014
Marital status | Never in union/Formerly in union | 1 | 1 |
Currently in union | 0.72[0.56, 0.94] | 0.97[0.68, 1.39] |
Birth Order | 1st | 1 | 1 |
2nd or 3rd | 0.66[0.54, 0.81] | 0.79[0.60, 1.05] |
4th or 5th | 0.40[0.31, 0.52] | 0.62[0.44, 0.88] |
6th + | 0.30[0.23, 0.40] | 0.64[0.42, 0.96] |
Community level Quality of received ANC | Low | 1 | 1 |
High | 2.47[1.84, 3.30] | 1.42[1.03, 1.96] |
Community level literacy | Low | 1 | 1 |
Medium | 2.39[1.62, 3.52] | 1.08[0.75, 1.54] |
High | 8.97[5.80, 13.89] | 1.14[0.73, 1.79] |
Wealth index | Poor | 1 | 1 |
Medium | 2.34[1.85, 2.97] | 1.78[1.41, 2.24] |
Rich | 6.50[1.94, 2.55] | 1.84[1.40, 2.40] |
Educational status | No education | 1 | 1 |
Primary | 3.13[2.61, 3.77] | 1.86[1.56, 2.21] |
Secondary/ Higher | 16.19[10.52, 24.92] | 3.67[2.53, 5.31] |
Place of residence | Urban | 1 | 1 |
Rural | 0.12[0.08, 0.18] | 0.35[0.22, 0.53] |
Region | Tigray | 1 | 1 |
Afar | 0.20[0.09, 0.44] | 0.33[0.19, 0.58] |
Amhara | 0.43[0.254, 0.73] | 0.56[0.34, 0.94] |
Oromiya | 0.71[0.41, 1.20] | 0.727[0.44, 1.19] |
Somali | 0.09[0.04, 0.21] | 0.15[0.07, 0.32] |
B. Gumuz | 0.57[0.28, 1.18] | 0.78[0.37, 1.63] |
SNNP | 0.69[0.39, 1.23] | 0.87[0.47, 1.60] |
Gambela | 0.75[0.41, 1.36] | 0.70[0.39, 1.26] |
Harari | 0.1.31[0.66, 2.64] | 0.59[0.34, 1.01] |
Addis Ababa | 16.11[8.37, 31.00] | 2.56[1.32, 4.93] |
Dire Dawa | 2.46[1.25, 4.85] | 1.82[0.94, 3.50] |
Age | 15–19 | 1 | 1 |
20–24 | 1.75[1.21, 2.55] | 1.71[1.12, 2.62] |
25–29 | 1.71[1.16, 2.51] | 2.20[1.36, 3.56] |
30–34 | 1. 75[1.19, 2.59] | 2.67[1.63, 4.40] |
35–39 | 1.44[0.95, 2.17] | 2.35[1.35, 4.07] |
40–44 | 0.75[0.47, 1.19] | 1.52[0.82, 2.78] |
45–49 | 0.87[0.50, 1.55] | 1.864[0.94, 3.70] |
HH Sex | Male | 1 | 1 |
Female | 1.39[1.13, 1.73] | 1.11[0.84, 1.46] |
The odds of completing four or more ANC visits for women aged 20–24, 25–30, 30–34, and 35–39 years were 1.71 [OR 1.71, (95% CI 1.12, 2.62)], 2.20 [OR 2.20, (95% CI 1.36, 3.56)], 2.67 [OR 2.67, (95% CI 1.63, 4.40)], and 2.35 [OR 2.35, (95% CI 1.35, 4.07)], times that for women aged 15–19 years, respectively.
Women with primary, and secondary/higher educational levels were 1.86 [OR 1.86, (95% CI 1.56, 2.21)], and 3.67 [OR 3.67, (95% CI: 2.53, 5.31)] times likely to complete four or more ANC visits as compared to un-educated women, respectively.
The result revealed that rural dweller women were 65% [OR 0.35, (95% CI 0.22, 0.53)] less likely to complete four or more ANC visits as compared to urban ones. On the basis of economic status, women in the medium, and rich households were 78% [OR 1.78, (95% CI 1.41, 2.25)], and 84% [OR 1.84, (95% CI 1.41, 2.40)] more likely to complete four or more ANC visits, respectively as compared to their counter parts.
Fourth/fifth, and sixth/above birth order pregnant women were 38% [OR 0.62, (95% CI 0.44, 0.88)], and 36% [OR 0.64, (95% CI 0.42, 0.96)] less likely to complete four or more ANC visits, respectively as compared to 1st birth order pregnant women.
Women in communities with high quality of received ANC were 42% [OR 1.42, (95% CI 1.03, 1.96)] more likely to complete four or more ANC visits as compared to women in communities with low quality of received ANC.
Women in Somali, Afar, and Amhara Regional States were respectively 85% [OR 0.15, (95% CI 0.07, 0.32)], 67% [OR 0.33, (95% CI 0.19, 0.58)] and 44% [OR 0.56, (95% CI 0.34, 0.94)] less likely, while those in Addis Ababa City Administration were 2.56 [OR 2.56, (95% CI 1.32, 4.93)] times likely to complete four or more ANC visits as compared to women in Tigray Regional State.