Zero-Inflated Models for Count Data: An Application to Number of Antenatal Care Service Visits

Abstract The risk of maternal death in developing countries is projected to be one in 61, while for developed countries it is estimated to be one in 2800. Antenatal care is a protective obstetric health care system aimed at improving the outcome of the pregnant fetus by routine pregnancy monitoring. One of the most important functions of antenatal care is to offer health information and services that can significantly improve the health of women and their infants. 6450 pregnant women from Ethiopian Demographic and Health Survey of 2016 were used to analyze the determinants of the barriers in number of antenatal care service visits among pregnant women in Ethiopia. The data were found to have excess zeros (35%); thus several count data models such as Poisson, Negative Binomial, Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle regression models were modeled and fitted. From the exploratory analysis the results showed that among those eligible pregnant women, it was seen that 2240 (34.7%) of them did not visit antenatal care service during their periods of pregnancy months. The visualization of data using scatter plot depicts that all of the variables selected for modeling have an influence on the event of not visiting antenatal care cervices while each of these variables had opposite slope in non-zero number of such events in their respective categories. To select the model which best fits the data, models were compared based on their Akaike information criterion value by using the simulation study. The simulation experiment revealed that models for zero-inflated data such as; Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle were models that fitted the data better than the classical models Poisson and Negative Binomial. Each of these zero-inflated models was compared using Voung test and Hurdle model was better fitted the data which was characterized by excess zeros and high variability in the non-zero outcome than any other zero-inflated models. In this study, maternal education, partner education level, age of mothers, religion of mothers and wealth index are major predictors of antenatal care service utilization. Through simulation experiment, it was found that Zero Inflated Poisson, Zero Inflated Negative Binomial and Hurdle models were better fitted zero-inflated data than Poisson and Negative Binomial. Voung test suggests that Hurdle model was better fitted zero-inflated (ZI) data than any other zero inflated models and therefore, it was selected as the best parsimonious model.