Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey
Abstract
:1. Introduction
2. Methods and Materials
2.1. Data Source
2.2. Sample Size Determination and Inclusion Criteria
2.3. Outcome Variable
2.4. Independent Variables
2.5. Individual-Level Factors
2.6. Household-Level Factors
2.7. Statistical Analyses
2.7.1. Multi-Level Analysis
2.7.2. Spatial Analysis
Spatial Autocorrelation
Hot Spot Analysis (Getis-OrdGi* Statistic)
Spatial Interpolation or Prediction
Spatial Scan Statistical Analysis
3. Results
3.1. Sociodemographic Characteristics of Respondents
3.2. Spatial Autocorrelation
3.3. Hot Spot Analysis
3.4. Prediction of an Incomplete ANC Visit
3.5. Spatial SaTScan Analysis of Stillbirth Bernoulli-Based Model
3.6. Multi-Level Fixed Effects (Measures of Associations) Results
3.7. Random Effects (Measures of Variations) Results
4. Discussion
4.1. Strengths and Limitations
4.2. Policy and Public Health Implications
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Ethical Approval
Abbreviations
References
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Variable (20,003) | Weighted Frequency | Weighted Percentage | Number of ANC Visits | p-Value (χ2) | |
---|---|---|---|---|---|
Individual Level Factors | Complete | Incomplete | |||
Maternal current age | p < 0.001 | ||||
15–24 | 4793 | 23.96 | 12.59 | 87.41 | |
25–34 | 9665 | 48.32 | 22.67 | 77.33 | |
35 and above | 5545 | 27.72 | 22.53 | 77.47 | |
Maternal education | p < 0.001 | ||||
No education | 9245 | 46.22 | 4.19 | 95.81 | |
Primary education | 2913 | 14.56 | 19.17 | 80.83 | |
Secondary and above | 7846 | 39.22 | 39.48 | 60.52 | |
Partner’s level of education | p < 0.001 | ||||
No education | 7322 | 36.60 | 4.35 | 95.65 | |
Primary education | 2795 | 13.97 | 17.77 | 82.23 | |
Secondary and above | 9886 | 49.42 | 32.66 | 67.34 | |
Marital status | p < 0.001 | ||||
Currently married | 19,387 | 96.92 | 19.51 | 80.49 | |
Cohabitating | 617 | 3.08 | 42.25 | 57.75 | |
Working status | p < 0.001 | ||||
Not working | 6393 | 31.96 | 10.68 | 89.32 | |
Working | 13,610 | 68.04 | 24.69 | 75.31 | |
Ethnicity | p < 0.001 | ||||
Hausa | 9125 | 45.62 | 4.40 | 95.60 | |
Yoruba | 2428 | 12.14 | 61.55 | 38.45 | |
Igbo | 2424 | 12.12 | 44.77 | 55.23 | |
Others | 6027 | 30.13 | 17.63 | 82.37 | |
Parity | p < 0.001 | ||||
1 | 3123 | 15.61 | 26.36 | 73.64 | |
2 | 3618 | 18.09 | 27.47 | 72.53 | |
3 | 3082 | 15.41 | 25.39 | 74.61 | |
4 and above | 10,180 | 50.89 | 14.18 | 85.82 | |
Distance to health facility | p < 0.001 | ||||
Big problem | 5685 | 28.42 | 15.67 | 84.33 | |
Not a big problem | 14,319 | 71.58 | 22.02 | 77.98 | |
Religion | |||||
Christianity | 7255 | 36.27 | 37.93 | 62.07 | |
Islam | 12,647 | 63.22 | 10.16 | 89.84 | |
Traditionalist and others | 102 | 0.51 | 5.83 | 94.17 | |
Exposure to media | p < 0.001 | ||||
No | 7677 | 38.38 | 5.60 | 94.40 | |
Yes | 12,326 | 61.62 | 29.31 | 70.69 | |
Household-level factors | |||||
Place of residence | p < 0.001 | ||||
Urban | 7737 | 38.68 | 35.97 | 64.03 | |
Rural | 12,266 | 61.32 | 10.27 | 89.73 | |
Wealth index | p < 0.001 | ||||
Poorest | 4464 | 22.32 | 3.95 | 96.05 | |
Poorer | 4451 | 22.25 | 7.34 | 92.66 | |
Middle | 4003 | 20.01 | 16.85 | 83.15 | |
Richer | 3671 | 18.35 | 31.08 | 68.92 | |
Richest | 3414 | 17.07 | 50.54 | 49.46 | |
Region | p < 0.001 | ||||
North Central | 2806 | 14.03 | 14.47 | 85.53 | |
North East | 3581 | 17.90 | 3.78 | 96.22 | |
North West | 7269 | 36.34 | 4.15 | 95.84 | |
South East | 1874 | 9.37 | 38.97 | 61.03 | |
South-South | 1675 | 8.38 | 41.35 | 58.65 | |
South West | 2798 | 13.99 | 63.49 | 36.51 | |
Sex of household head | |||||
Male | 18,595 | 92.96 | 19.40 | 80.60 | |
Female | 1409 | 7.04 | 31.00 | 69.00 | |
Community literacy level | p < 0.001 | ||||
Low | 6705 | 33.52 | 4.51 | 95.49 | |
Medium | 6512 | 32.55 | 13.97 | 86.03 | |
High | 6786 | 33.93 | 41.73 | 58.27 | |
Community socioeconomic status | p < 0.001 | ||||
Low | 11,957 | 59.77 | 8.55 | 91.45 | |
Medium | 861 | 4.30 | 17.10 | 82.90 | |
High | 7186 | 35.92 | 40.00 | 60.00 |
Cluster | Enumeration Area (Cluster) Identified | Coordinate/Radius | Population | Case | RR | LLR | p-Value |
---|---|---|---|---|---|---|---|
1 | 336 | (12.458115 N, 10.398881 E)/690.22 km | 6670 | 5952 | 1.79 | 1307.55 | <0.001 |
2 | 8 | (6.224563 N, 7.971626 E)/16.54 km | 109 | 97 | 1.28 | 11.90 | 0.0062 |
Variable Individual-Level Variables | Model 0 | Model I | Model II | Model III |
---|---|---|---|---|
aOR (95% CI) | aOR (95% CI) | aOR (95% CI) | ||
Maternal current age | ||||
15–24 | 1 | 1 | ||
25–34 | 0.72 *** [0.62–0.83] | 0.82 ** [0.71–0.95] | ||
35 and above | 0.58 *** [0.48–0.69] | 0.69 *** [0.58–0.83] | ||
Maternal education | ||||
No education | 1 | 1 | ||
Primary education | 0.58 *** [0.48–0.70] | 0.73 ** [0.60–0.89] | ||
Secondary and above | 0.44 *** [0.36–0.53] | 0.62 *** [0.51–0.76] | ||
Partner’s level of education | ||||
No education | 1 | 1 | ||
Primary education | 0.91 [0.74–1.12] | 1.04 [0.84–1.29] | ||
Secondary and above | 0.63 *** [0.52–0.76] | 0.76 ** [0.62–0.93] | ||
Marital status | ||||
Currently married | 1 | 1 | ||
Cohabitating | 0.84 [0.67–1.05] | 0.99 [0.79–1.23] | ||
Working status | ||||
Not working | 1 | 1 | ||
Working | 0.75 *** [0.66–0.85] | 0.76 *** [0.67–0.87] | ||
Ethnicity | ||||
Hausa | 1 | 1 | ||
Yoruba | 0.12 *** [0.09–0.15] | 0.59 ** [0.43–0.80] | ||
Igbo | 0.22 *** [0.17–0.29] | 0.56 ** [0.40–0.78] | ||
Others | 0.56 *** [0.45–0.69] | 0.97 [0.76–1.24] | ||
Parity | ||||
1 | 1 | 1 | ||
2 | 1.14 [0.97–1.33] | 1.13 [0.96–1.32] | ||
3 | 1.28 ** [1.08–1.52] | 1.23 * [1.03–1.45] | ||
4 and above | 1.65 *** [1.39–1.95] | 1.50 *** [1.27–1.77] | ||
Distance to health facility | ||||
Big problem | 1 | 1 | ||
Not a big problem | 0.99 [0.87–1.12] | 1.03 [0.91–1.18] | ||
Religion | ||||
Christianity | 1 | 1 | ||
Islam | 1.38 *** [1.17–1.62] | 0.98 [0.83–1.16] | ||
Traditionalist and others | 5.01 *** [2.12–11.81] | 5.79 *** [2.45–13.58] | ||
Exposure to Media | ||||
No | 1 | 1 | ||
Yes | 0.51 *** [0.44–0.59] | 0.65 *** [0.56–0.75] | ||
Household-level factors | ||||
Place of residence | ||||
Urban | 1 | 1 | ||
Rural | 1.36 ** [1.14–1.64] | 1.32 ** [1.10–1.58] | ||
Wealth index | ||||
Poorest | 1 | 1 | ||
Poorer | 0.70 ** [0.56–0.88] | 0.80 * [0.63–1.01] | ||
Middle | 0.51 *** [0.40–0.65] | 0.66 ** [0.52–0.84] | ||
Richer | 0.42 *** [0.33–0.54] | 0.62 *** [0.47–0.80] | ||
Richest | 0.27 *** [0.20–0.35] | 0.45 *** [0.33–0.59] | ||
Region | ||||
North Central | 1 | 1 | ||
North East | 4.03 *** [2.97–5.46] | 3.00 *** [2.21–4.07] | ||
North West | 4.17 *** [3.15–5.52] | 3.02 *** [2.19–4.18] | ||
South East | 0.37 *** [0.29–0.49] | 0.60 ** [0.42–0.84] | ||
South-South | 0.45 *** [0.35–0.59] | 0.47 *** [0.36–0.61] | ||
South West | 0.13 *** [0.10–0.16] | 0.19 *** [0.14–0.26] | ||
Sex of household head | ||||
Male | 1 | 1 | ||
Female | 0.95 [0.82–1.11] | 1.00 [0.86–1.17] | ||
Community literacy level | ||||
Low | 1 | 1 | ||
Medium | 0.71 * [0.55–0.93] | 0.92 [0.70–1.19] | ||
High | 0.46 *** [0.34–0.62] | 0.72 * [0.53–0.98] | ||
Community socioeconomic status | ||||
Low | 1 | 1 | ||
Medium | 1.06 [0.69–1.64] | 1.04 [0.68–1.58] | ||
High | 1.11 [0.89–1.38] | 1.08 [0.87–1.34] | ||
Random effects results | ||||
PSU Variance (95% CI) | 5.33 [4.73–6.02] | 1.32 [1.13–1.54] | 1.17 [1.00–1.37] | 1.05 [0.90–1.24] |
ICC | 0.62 | 0.29 | 0.26 | 0.24 |
LR Test | χ2 = 4953.88, p < 0.001 | χ2 = 840.39, p < 0.001 | χ2 = 769.82, p < 0.001 | χ2 = 636.64, p < 0.001 |
Wald χ2 | Reference | 1420.84 *** | 1601.48 *** | 1818.00 *** |
Model fitness | ||||
Log-likelihood | −7161.20 | −6617.80 | −6499.20 | −6379.96 |
AIC | 14,326.39 | 13,275.60 | 13,032.40 | 12,829.91 |
BIC | 14,342.18 | 13,433.51 | 13,166.63 | 13,106.26 |
Number of clusters | 1387 | 1387 | 1387 | 1387 |
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Bolarinwa, O.A.; Sakyi, B.; Ahinkorah, B.O.; Ajayi, K.V.; Seidu, A.-A.; Hagan, J.E., Jr.; Tessema, Z.T. Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey. Healthcare 2021, 9, 1389. https://doi.org/10.3390/healthcare9101389
Bolarinwa OA, Sakyi B, Ahinkorah BO, Ajayi KV, Seidu A-A, Hagan JE Jr., Tessema ZT. Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey. Healthcare. 2021; 9(10):1389. https://doi.org/10.3390/healthcare9101389
Chicago/Turabian StyleBolarinwa, Obasanjo Afolabi, Barbara Sakyi, Bright Opoku Ahinkorah, Kobi V. Ajayi, Abdul-Aziz Seidu, John Elvis Hagan, Jr., and Zemenu Tadesse Tessema. 2021. "Spatial Patterns and Multilevel Analysis of Factors Associated with Antenatal Care Visits in Nigeria: Insight from the 2018 Nigeria Demographic Health Survey" Healthcare 9, no. 10: 1389. https://doi.org/10.3390/healthcare9101389