Characteristics of the sample
Among the 8025 sampled women, only 31 % (95% CI 29.5-33.5) had an optimal ANC visit out of the total women considered for this study. 69% had at least one ANC visit and 37.4% visit in their trimester. The result also showed that out of sample taken 7057(87%) were rural residents. only 26.77 % of rural respondents complete four or more ANC visits, while 62.95% of urban residents completed the recommended four or more ANC visits(Table1).
Spatial Analysis Result
The clustered patterns (on the right sides) show high rates of not to have an optimal ANC utilization occurred over the study area. The outputs have automatically generated keys on the right and left sides of each panel. Given the z score of 26.94 indicated that there is less than 1 % likelihood that this clustered pattern could be the result of random chance. The bright red and blue colors to the end tails indicate an increased significance level. The table shows that the observed value is greater than the expected value and P-value is < 0.05, it is statistically significant and means that there is spatial variability in optimal utilization of ANC among pregnant women in Ethiopia. (Figure2)
Spatial distribution of an optimal ANC visit in Ethiopia
A total of 622 clusters were considered for the spatial analysis of an optimal ANC visit. Each point on the map represents one enumeration area with a proportion of an optimal ANC visit in each cluster. The red color indicates areas with a high proportion of optimal ANC whereas blue color indicates EAs with lower proportion an optimal ANC visit(Figure3).
Incremental spatial autocorrelation for a series of distance presented by line graph with corresponding Z-score was done to determine the average nearest neighbor, minimum, and maximum distance band. Totally 10 distance bands were detected by a beginning distance of 121,803 meters, and first maximum peak (clustering) was observed at 151379.64 meters (Figure 4)
Hot spot Analysis of Optimal ANC visit in Ethiopia
The red color indicates that significant areas to have an optimal ANC visit. This is found in Addis Ababa, Tigray region, Harari and Diredawa whereas, the blue color indicates significant riskier areas that had no Optimal ANV visit observed in the Somalia region, Amhara region, Afar Region, Oromia region and Gomella region.
Interpolation of an ANC visit
When we go from green to red-colored areas the predicted, an optimal ANC visit over the area increases. The red color indicates the predicted not an optimal ANC visit high-risk areas and the green color indicates the predicted high optimal ANC visit areas. The figure Afar Somalis and Gambella are regions which have no Optimal ANC visit (Figure 6).
Spatial SaTScan analysis of an Optimal ANC visit Bernoulli based model
Most likely (primary clusters) and secondary clusters of an optimal ANC visit identified. 111 significant clusters were identified. Of which, 55 of them were most likely (primary) clusters and 56 were secondary clusters.
The primary cluster's spatial window was located in the west Benishangul, which was centered at (8.883803 N, 38.778503 E) / 21.03 km, RR=2.94 and Log-Likelihood ratio (LLR) of 145.88 at p < 0.001. It showed that women within the spatial window had 2.94 times higher an optimal ANC than outside the widow (Table3, Figure7).
Determinants for an optimal ANC visit
In the multivariate analysis, residence, religion, male partner's educational level, distance to the health institution, region, the timing of ANC,community-level literacy and community level service utilization were significantly associated with optimal ANC visit at p-value 0.05.
The odds of optimal ANC utilization is reduced by 41% among rural women (AOR=0.59, 95%CI: 0.45-0.77) as compared to women residing in urban areas. The odds of optimal ANC utilization is reduced by 29% for Protestants (AOR=0.71, 95%CI: 0.55-0.91) and 48% for catholic & traditional (AOR=0.52, 95%CI: 0.33-0.83) as compared to orthodox Christian followers. Women, whose partners attain the secondary level of education, are 1.33 times (AOR=1.33, 95%CI: 1.05-1.67) more likely to have 4 ANC visits as compared to women who have partnered with no formal education. Women who reported that distance to a health institution is not a big problem are 1.21 times (AOR=1.21, 95%CI: 1.04-1.39) more likely to have optimal ANC visits than their counterparts. Women who start ANC after 12 weeks of gestation are less likely times (AOR=0.70, 95%CI: 0.60-0.82) to have adequate ANC visits than those who start before 12 weeks of Gestation. Pregnant women residing in regional states of Ethiopia are less likely to have optimal ANC visits, Tigray (AOR=0.48, 95%CI: 0.28-0.82), Afar (AOR=0.13, 95%CI: 0.07-0.24), Amhara (AOR=0.24, 95%CI: 0.14-0.42), Oromia (AOR=0.25, 95%CI: 0.15-0.43), Somali (AOR=0.08, 95%CI: 0.05-0.15), Benishangul (AOR=0.48, 95%CI: 0.28-0.84), Southern nations nationalities and peoples region (AOR=0.0.48, 95%CI: 0.28-0.83), Gambela (AOR=0.37, 95%CI: 0.21-0.66), Harari (AOR=0.16, 95%CI: 0.09-0.28), Diredawa (AOR=0.52, 95%CI: 0.29-0.93), than women in the capital city, Addis Ababa. Women who live in a community where the distance to the health institution is not a big problem for a higher proportion of the women in the community are 1.28 times (AOR=0.128, 95%CI: 1.04-1.57) more likely to have optimal ANC visits. Women living in a community where ANC utilization is high are 2.67 times (AOR=2.67, 95%CI: 2.21-3.24) more likely to have optimal ANC visits than women residing in a community with a low proportion of ANC utilization (Table 2).