Count regression models analysis of factors affecting antenatal care utilization in Ethiopia: original article

Background: Antenatal care (ANC) reduces maternal and newborn mortalities and makes it easier to find infections early and prevent them from progressing. This study aimed to identify factors affecting ANC utilization in Ethiopia via the count regression model. Methods: The data for the study was drawn from the 2019 Ethiopian Mini Demographic and Health Survey dataset. Count regression models, such as Poisson, Negative Binomial (NB), Zero-Inflated Poisson (ZIP), and Zero-Inflated Negative Binomial (ZINB) models, were used to determine the factors influencing ANC utilization. Results: A total of 3962 women were included in the study. Only about 42% of women used the WHO-recommended number of ANC of a minimum of four visits. The ZIP model was outperforming to fit the data as compared to other count regression models. Rural residence (IRR=0.8832, 95% CI: 0.8264–0.9440), being resident of the Somalia region (IRR=0.4762, 95% CI: 0.3919–0.5785), SNNPR (IRR=0.8716, 95% CI: 0.7913–0.9600), and Gambela Region (IRR=0.7830, 95% CI: 0.7063–0.8680), being Muslim (IRR=0.9384, 95% CI: 0.8876–0.9921) decrease the ANC utilization. Contrarily, Addis Ababa residence (IRR=1.1171, 95% CI: 1.0181–1.2259), primary education (IRR=1.1278, 95% CI: 1.0728–1.1855), secondary and higher education (IRR=1.2357, 95% CI: 1.1550–1.3220), middle wealth index (IRR=1.0855, 95% CI: 1.0095–1.1671) and rich wealth index (IRR=1.0941, 95% CI: 1.0152–1.1790) increase the ANC utilization. Conclusion: The ZIP model best fitted the data compared to others. The study revealed that being poor, rural resident, uneducated, Somalia region resident, SNNPR resident, Gambela region resident, and Muslim were factors associated with lower ANC utilization. Thus, health education is needed to be given for mothers with no education. In addition, building a strong awareness-creation program regarding ANC is required for rural residents so as to improve the level of ANC utilization in Ethiopia.