Prevalence and associated factors of delayed first antenatal care booking among reproductive age women in Ethiopia; a multilevel analysis of EDHS 2016 data

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Abstract
Early or timely initiation of antenatal care and regular visits based on the schedule have a tremendous effect on both maternal and fetal health. Despite the paramount benefits of early initiation of ANC within the first 12 weeks of pregnancy, women still do not have adequate and equal access to high-quality early antenatal care. To determine the prevalence and factors associated with delayed first ANC booking in Ethiopia. A secondary data analysis was conducted using the 2016 Ethiopian demographic and health survey data. All reproductive age women who gave birth in the five years preceding the survey and who had ANC visit for their last child were included in this study. The total weighted sample size analyzed was 4,741. Due to the hierarchical nature of the EDHS data, Multi-level logistic regression model was used to identify the individual and community level factors associated with delayed first ANC booking. In this study, the prevalence of delayed first ANC booking was 67.31% [95% CI: 65.96% to 68.63%]. Women with secondary and higher education [Adjusted Odd Ratio (AOR) = 0.78; 95%CI: 0.61, 0.99] and [AOR = 0.61; 95%CI: 0.44, 0.83] respectively had lower odds of delayed first ANC booking. But woman who were multiparous and grand multiparous [AOR = 1.21; 95%CI: 1.01, 1.45] and [AOR = 1.50; 95%CI: 1.16, 1.93] respectively, women with the last pregnancy wanted no more [AOR = 1.52; 95%CI: 1.10, 2.09], a woman who was living in the rural area [AOR = 1.66; 95%CI: 1.25, 2.21], and a woman who was living in large central regions and small peripheral regions [AOR = 2.76; 95%CI: 2.20, 3.47] and [AOR = 2.70; 95%CI: 2.12, 3.45] respectively had higher odds of delayed first ANC booking. Despite the documented benefits of early antenatal care initiation, late ANC booking is still predominant in Ethiopia as highlighted by this study. Maternal education, parity, wanted the last child, residence and region were significantly associated with delayed first ANC booking. Therefore, taking special attention for these high-risk groups could decrease delayed first ANC booking and this intern decreases maternal and fetal health problems by identifying and intervene early.

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