Determinants of the number of antenatal visits in Uganda using the 2016 Uganda demographic and health survey data: identification. of the best count model, with multilevel adjustment.

Abstract

Background The importance of Antenatal Care (ANC) cannot be overstated as it promotes both the mother's and the fetus's health. However, countries have significant differences in 4th ANC attendance Kenya (47%), Malawi (46%), and Ghana (78%). Uganda’s 4th ANC has progressed from 42% in FY 2019/20 to 48% in FY 2020/21. Estimating regression models without considering clustering can lead to biased estimates, and inaccurate inferences hence less precision. Therefore, the study aimed to identify factors associated with the number of ANC visits in Uganda and determine the best count regression model that considers issues such as overdispersion, zero inflation, and intracluster correlation. Methods A Cross-sectional study using quantitative data collection methods was applied. Data from the Uganda Demographic Health Survey (UDHS),2016 was utilized for this study. Count data regression analysis models using R were fit and intracluster correlation was accounted for by incorporating cluster-specific random effects in the models. The best-fit model was then used in the estimation of coefficients. Results:The median number of ANC attendance was 4. Accounting for both individual and community-level factors reduced the clustering effect (ICC=0.047). The best model was the mixed effects hurdle Poisson model. The number of ANC visits was significantly associated with having health insurance, access to media, maternal age, maternal education, wealth index, region of residence and maternal employment status. Mothers who had health insurance had 13% (ARR= 1.13; CI 1.04-1.24) more ANC visits than those who did not. Women aged 25 to 35 years had 4% (ARR 1.04; CI 1.01-1.07) more ANC visits than women aged 15-24 years. Women from Eastern, Northern and Western Uganda had 8%, 6% and 7% fewer ANC visits, respectively, than women from Central Uganda. Conclusion The study revealed that interventions to promote ANC attendance should focus on improving access to healthcare and addressing factors such as maternal education and employment status through community and individual strategies.