From a total of 7913 pregnant women; 2545(35.4%) of the pregnant women have not visited ANC and only 2.9% visited eight and more than eight times. Besides, the variance of the number ANC visit (5.614) is larger than its mean (2.53) representing over-dispersion. Moreover, the data has excess zeros (35.4%) and the Zero Inflated Poisson model would be appropriate to predict the number of ANC visits (Table 1).
Table 1: The number of mothers that experienced ANC visits
Number of visits
|
Count
|
Percent
|
|
0
|
2545
|
35.4
|
1
|
342
|
4.8
|
2
|
563
|
7.8
|
3
|
1187
|
16.5
|
4
|
1136
|
15.8
|
5
|
621
|
8.6
|
6
|
402
|
5.6
|
7
|
187
|
2.6
|
8+
|
108
|
2.9
|
Total
|
7193
|
100.0
|
|
Mean
|
2.53
|
|
|
Variance
|
5.614
|
|
Socio-Demographic Characteristics
The majority of the study respondents were from rural residences (79%) and 21% of the respondents in urban residences. Most of the respondents were a housewife (70%) and 30% of the respondents were employed. About 60.6% of mothers no attended primary school and only 12.4% of mothers attended secondary and above education. The greater part, (69.4%) of the respondents had no pregnancy complications and 64.4% had not got access to mass media. About 91.5 percent of women were married, 3.2 percent of women were never married, while t 5.3% were divorced and widowed. The majority, 79.8% of pregnancy was planned and 91.1% pregnancy was not terminated. The greater part, (69.4%) of the respondents had no pregnancy complications and 64.4% had not got access to mass media. Regarding husbands' education, 31.7% of husbands' had no formal education while 30% of husbands attend primary education. The more (50.70%) of women from low economic status, only 14.3% were from the medium. Regarding the mother's age, the majorities of mothers were under the age group of 30 years plus, then followed 25-29 years (Table 2).
Table 2: Characteristics of respondents in the study of determinant of Antenatal Care Visits among Pregnant Women in Ethiopia
Categories
|
Frequency (n)
|
Percentage (%)
|
Residence
|
|
|
Urban
|
1512
|
21
|
Rural
|
5681
|
79
|
Occupation of mothers
|
|
|
Housewife
|
5033
|
70
|
Others
|
2160
|
30
|
Planned pregnancy
|
|
|
No
|
1452
|
20.2
|
Yes
|
5741
|
79.8
|
Terminated pregnancy
|
|
|
No
|
6556
|
91.1
|
Yes
|
637
|
8.9
|
Wealth index
|
|
|
Low
|
3607
|
50.7
|
Medium
|
1028
|
14.3
|
Rich
|
2558
|
35.6
|
Marital status
|
|
|
Never married
|
230
|
3.2
|
Married
|
6579
|
91.5
|
Divorced/widowed
|
384
|
5.3
|
Age of women in a year
|
|
|
15-24
|
1852
|
25.7
|
25-29
|
2015
|
28.1
|
30 and above
|
3326
|
46.2
|
Husband education
|
|
|
No education
|
3719
|
51.7
|
Primary
|
2160
|
30.0
|
Secondary and above
|
1314
|
18.3
|
Woman's education
|
|
|
No education
|
4359
|
60.6
|
Primary
|
1942
|
27
|
Secondary and above
|
892
|
12.4
|
Access to mass media
|
|
|
No
|
4646
|
64.6
|
Yes
|
2547
|
35.4
|
Pregnancy complications
|
|
|
No
|
5015
|
69.7
|
Yes
|
2178
|
30.3
|
Husbands occupation
|
|
|
Not working
|
1285
|
17.9
|
Working
|
5908
|
82.1
|
Factors associated with ANC visit in Ethiopia
Table 3 presents summaries from the Zero-inflated Poisson model result of both the negative binomial and logit components. The Poisson component shows that the Incidence rate of ANC visits (IRR). The finding of this study revealed that woman and husbands' levels of education have a significant factor in the number of ANC visits. The incidence rate of non-zero ANC visit for women's with primary education was 1.06 (IRR =1.06; 95%CI: 1.02, 1.10) times higher compared to their uneducated counterparts. The incidence rate of non-zero ANC visit for women's with secondary and above education was 1.11 (IRR =1.11; 95% CI: 1.05, 1.18) times higher compared to their uneducated counterparts. Likewise, the incidence rate of non-zero ANC visit for husbands with primary education was 1.05 (IRR =1.05; 95% CI: 1.01, 1.10) times higher compared to their uneducated counterparts. Similarly, the incidence rate of non-zero ANC visit for husbands with secondary and above education was 1.09 (IRR =1.09; 95%CI: 1.03, 1.14) times higher compared to their uneducated counterparts. The incidence rate of non-zero ANC visits of the rural woman was decreased by 12% (IRR =0.88; 95%CI: 1.85, 1.92) compared to their woman who was living in urban area.
The study also indicated that the husband's wealth index and marital status were a significant factor in the number of ANC visits. The incidence rate of non-zero ANC visits for rich wealth index would be 1.08 (IRR =1.08; 95% CI: 1.03, 1.13) times higher compared to their poor wealth index. The incidence rate of non-zero ANC visits for married women would be 1.19 (IRR =1.19; 95% CI: 1.09, 1.30) times higher compared to their never-married women.
Moreover, the incidence rate of non-zero ANC visits for women who had seen signs of pregnancy complications was 1.20 (IRR =1.20; 95% CI: 1.17, 1.24) times higher compared to their women who had no sign’s pregnancy complication. The incidence rate of ANC visit for women being the use of mass media was 1.09 (IRR =1.09; 95% CI: 1.05, 1.13) times higher compared to their not to use of mass media. The incidence rate of non-zero ANC visit for mothers age 25-29 was 1.06(IRR =1.06; 95% CI: 1.02, 1.10) times higher compared to whose age is 15-24. The incidence rate of non-zero-ANC visits for mothers age 30 and above was 1.07 (IRR =1.07; 95% CI: 1.02, 1.11) times higher compared to whose age is 15-24 (Table 3).
Table 3: Zero-inflated Poisson regression model result (IRR and AOR)
|
Poisson part
|
Bernoulli part
|
Parameter
|
IRR(95% CI of IRR)
|
p-value
|
AOR(95%CI of AOR)
|
p-value
|
Intercept
|
3.051( 2.777,3.352)*
|
0.0001
|
0.542(0.399, 0.738)*
|
0.0001
|
Residence
|
|
|
|
|
Urban
|
1
|
|
1
|
|
Rural
|
0.884(0.846, 0.924)*
|
0.0001
|
2.254(1.780, 2.855)*
|
0.0001
|
Access to mass media
|
|
|
|
|
No
|
1
|
|
1
|
|
Yes
|
1.086(1.045, 1.128)*
|
0.0001
|
0.612(0.525,0.713)*
|
0.0001
|
Planned pregnancy
|
|
|
|
|
No
|
1
|
|
1
|
|
Yes
|
1.028( 0.989, 1.069)
|
0.168
|
0.794(0.685, 0.920*
|
0.0020
|
Husbands occupation
|
|
|
|
|
not working
|
1
|
|
1
|
|
Working
|
1.017(0.959, 1.077)
|
0.576
|
0.761(0.655,0.884)*
|
0.003
|
Wealth index
|
|
|
|
|
Low
|
1
|
|
1
|
|
Medium
|
1.039(0.989, 1.093)
|
0.130
|
0.594(0.501, 0.704)*
|
0.0001
|
Rich
|
1.077( 1.029, 1.127)*
|
0.001
|
0.568(0.479, 0.672)*
|
0.0001
|
Women's education
|
|
|
|
|
No education
|
1
|
|
|
|
Primary
|
1.057(1.015, 1.101)*
|
0.008
|
0.454(0.388, 0.531)*
|
0.0001
|
Secondary and above
|
1.112(1.052, 1.176)*
|
0.0002
|
0.389(0.286, 0.530)*
|
0.0004
|
Husband education
|
|
|
|
|
No education
|
1
|
|
1
|
|
Primary
|
1.052(1.010, 1.096)*
|
0.015
|
0.625(0.542, 0.721)*
|
0.0001
|
Secondary and above
|
1.085(1.031, 1.142)*
|
0.002
|
0.666(0.532, 0.836)*
|
0.0001
|
Age of mother (year)
|
|
|
|
|
15-24
|
1
|
|
|
|
25-29
|
1.060(1.016, 1.104)*
|
0.006
|
|
|
30 and above
|
1.067(1.024, 1.111)*
|
0.002
|
|
|
Marital status
|
|
|
|
|
Never married
|
1
|
|
|
|
Married
|
1.187(1.087, 1.296)*
|
0.0001
|
|
|
Divorced/widowed
|
1.083(0.990, 1.184)
|
0.0811
|
|
|
Pregnancy complications
|
|
|
|
|
No
|
1
|
|
|
|
Yes
|
1.203(1.165, 1.242)*
|
0.0001
|
|
|
Occupation of mother
|
|
|
|
|
Housewife
|
1
|
|
|
|
Working
|
0.982(0.950, 1.016)
|
0.294
|
|
|
Terminated pregnancy
|
|
|
|
|
No
|
1
|
|
|
|
Yes
|
1.039(0.986,1.094)
|
0.151
|
|
|
Note: 1 = reference category of the categorical variable.
* Significant at 5% level of significance
The Bernoulli or logit part used to show the likelihood of ANC visit (AOR) on the household level. The odd of the number of ANC visit becomes zero with husbands who have worked was decreased by 24% (AOR = 0.76; 95%CI: 0.66, 0.88) as compared to fathers without work. The estimated odds that the number of ANC visit becomes zero with woman's who have primary education we were 0.45 times (AOR =0.45; 95%CI: 0.39, 0.53) less than non-educated woman's. The estimated odds that the number of ANC visit becomes zero with women who have secondary and above education was 0.39 times(AOR = 0.39; 95%CI: 0.29, 0.53) less than the non-educated women. The estimated odds that the number of ANC visit becomes zero with husbands who have primary education was decreased by 37 percent (AOR = 0.63; 95%CI: 0.54, 0.72) as compared to non-educated husbands. The estimated odds that the number of ANC visit becomes zero with husbands who have secondary and above education are decreased by 33 percent(AOR = 0.67; 95% CI: 0.53, 0.84) as compared to non-educated husbands. The estimated odds that the number of ANC visit becomes zero for use of mass media was 0.61 times (AOR = 0.61; 95%CI: 0.53, 0.71) lower compared to those not to use of mass media. The estimated odds that the number of ANC visits becomes zero for women who had wanted pregnancy was 0.79 times (AOR = 0.79; 95%CI: 0.69, 0.92) lower than as compared to unwanted pregnancy.
The estimated odds that the number of ANC visits becomes zero for the rural woman were 2.25 times (AOR = 2.25; 95%CI: 1.78, 2.86) higher than the urban woman. The estimated odds that the number of ANC visits becomes zero for medium wealth index would be 0.59 times (AOR = 0.59; 95%CI: 0.50, 0.70) lower than the poor wealth index. Similarly, the estimated odds that the number of ANC visits becomes zero for rich wealth index would be 0.57 times (AOR = 0.57; 95%CI: 0.48, 0.67) lower than the poor wealth index (Table 3).