Spatial distribution, and predictors of late initiation of first antenatal care visit in Ethiopia: Spatial and multilevel analysis.

BACKGROUND: Despite the proven benefit of early initiation of first antenatal care visits as a means to achieve good maternal and neonatal health outcomes through early detection and prevention of risks during pregnancy, shreds of evidence showed that most of the women in Ethiopia start their ANC visits lately. OBJECTIVE: To determine the spatial distribution and predictors of late initiation of first antenatal care visits among reproductive-age women in Ethiopia. METHOD: The 2019 Ethiopian Mini Demographic and Health Survey (EMDHS) data were used. A total weighted sample of 2,935 reproductive-age women who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. To check the nature of the distribution of late initiation of ANC visits, the global Moran's I statistics were applied. Gettis-OrdGi statistics and spatial interpolation using the Ordinary Kriging method were done to identify the spatial locations and to predict unknown locations of late initiation of first ANC visits, respectively. For the predictors, a multilevel mixed-effect logistic regression model was applied. Finally, statistical significance was declared at a p-value < 0.05. RESULTS: The prevalence of late initiation of first ANC visits in Ethiopia was 62.6%. The spatial analysis showed that the late initiation of first ANC visits significantly varied across regions of Ethiopia. The spatial interpolation predicted the highest rates of late initiation of first ANC visits in the eastern SNNPRs, southern and western Oromia, and some parts of the Somalia region. Being rural residents, attending higher education, having medium wealth status, richer wealth status, richest wealth status, having ≥ 5 family size, a household headed by male, living in SNNPRs, and Oromia regions were significant predictors of late initiation of first ANC visits. CONCLUSION: A clustered pattern of areas with high rates of late initiation of the first ANC visit was detected in Ethiopia. Public health intervention targeting the identified hotspot areas, and women's empowerment would decrease the late start of the first ANC visit. Furthermore, the identified predictors should be underscored when designing new policies and strategies.

Determinants of early initiation of first antenatal care visit in Ethiopia based on the 2019 Ethiopia mini-demographic and health survey: A multilevel analysis.

BACKGROUND: Early initiation of the first antenatal care visit provides a critical opportunity for health promotion, disease prevention, and curative care for women and their unborn fetuses. However, in developing countries, including Ethiopia, it is underutilized and most of the pregnant women didn't attend antenatal care visits during the first trimester (early). Therefore, the objective of this study was to estimate the prevalence of early initiation of antenatal care visits and its determinants among reproductive-age women in Ethiopia. METHODS: A secondary data analysis was done based on the 2019 intermediate Ethiopian demographic health survey. The data were weighted by sampling weight for probability sampling and non-response to restore the representativeness of the data and have valid statistical estimates. Then, a total weighted sample of 2,935 women aged 15-49 years who gave birth in the five years preceding the survey and who had antenatal care visits for their last child was included. A multilevel mixed-effects logistic regression model was fitted to examine the determinants of early initiation of first antenatal care visits. Finally, statistical significance was declared at a p-value < 0.05. RESULTS: In this study, the overall magnitude of early initiation of the first antenatal care visit was 37.4% (95%CI: 34.6-40.2%). Women who attend higher education (AOR = 2.26: 95%CI; 1.36-3.77), medium wealth status (AOR = 1.80: 95%CI; 1.17-2.76), richer wealth status (AOR = 1.86: 95%CI; 1.21, 2.85), richest wealth status (AOR = 2.34: 95%CI; 1.43-3.83), living in Harari region (AOR = 2.24: 95%CI; 1.16-4.30), and living at Dire-Dawa city (AOR = 2.24: 95%CI; 1.16-4.30) were higher odds of early initiation of first ANC visits. However, women who were rural resident (AOR = 0.70: 95%CI; 0.59-0.93), household headed by male (AOR = 0.87: 95%CI; 0.72, 0.97), having ≥ 5 family size (AOR = 0.71: 95%CI; 0.55-0.93), and living in SNNPRs (AOR = 0.44: 95%CI; 0.23-0.84) were lower odds of early initiation of first ANC visits. CONCLUSION: The prevalence of early initiation of first antenatal care remains low in Ethiopia. Women's education, residence, wealth status, household head, having ≥ 5 family sizes, and region were determinants of early initiation of first antenatal care visits. Improving female education and women's empowerment through economic transitions with special attention given to rural and SNNPR regional state residents could maximize the early initiation of first antenatal care visits. Furthermore, to increase early antenatal care uptake, these determinants should be considered when designing new policies or updating policies and strategies on antenatal care uptake to help increase early attendance, which can help in the reduction of maternal and neonatal mortality and to achieve sustainable development goals 3 by 2030.

Factors Associated with Coronavirus Disease 2019 Prevention Practices in Three Zones of Southwest Ethiopia: Community-Based Cross-Sectional Study.

BACKGROUND: The cases of coronavirus disease 2019 (COVID-19) and related deaths are increasing exponentially in Ethiopia. Prevention is currently available effective management, and its implementation has not been assessed adequately. This study aimed to identify the factors associated with COVID-19 prevention practices in three zones of southwest Ethiopia. METHODS: A community-based cross-sectional study was conducted in the Bench Sheko, Kafa, and West Omo zones. A multistage sampling technique was employed to select 845 study participants. The data collection tool was adapted from the WHO resources and related literature. Independent factors were identified using binary logistic regression and a p-value less than 0.05 was used to declare the level of statistical significance. RESULTS: In this study, 803 participants participated. About two-thirds (64.7%) of the respondents had a history of going to crowded places, while only 30.3% of the participants had a history of wearing a mask when leaving home. Two-thirds of the respondents had a history of maintaining their distance at 2 meters (64.4%) and washing their hands with soap and water or using alcohol-based hand sanitizers (64.8%). Generally, less than two-thirds (59.4%) of study participants had a good prevention practices of COVID-19. Urban residence (AOR [adjusted odds ratio] =2.34; 95% CI=1.39, 3.94), highest family size (AOR=2.95; 95% CI=1.56, 5.57), good knowledge (AOR=1.74; 95% CI=1.10, 2.77), positive attitude (AOR=1.86; 95% CI=1.27, 2.73), intention to seek care (AOR=1.73; 95% CI=1.13, 2.63), and perceived mortality (AOR=2.20; 95% CI=1.50, 3.08) were positively associated with good prevention practices. CONCLUSION: The proportion of individuals who had good COVID-19 prevention practices was inadequate. For such highly infectious diseases, prevention should be the priority intervention, and improving its implementation needs further effort. Community-based interventions such as risk communication and mass education should center on scaling up community knowledge and practice by prioritizing vulnerable groups such as rural residents.