Contextual Disparity on Trend and Determinants of Optimal Antenatal Care (ANC4+) Use for Women in Eastern Tigray, Ethiopia: Evidence from KA-HDSS Database

Kebede Embaye Gezae,1 Kidanemariam Alem Berhie,1 Assefa Ayalew Gebresilassie,2 Mache Tsadik2 1Department of Biostatistics, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia; 2Department of Reproductive Health, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Tigray, EthiopiaCorrespondence: Kebede Embaye Gezae, Email aredom14@gmail.comBackground: Though optimal antenatal care (ANC4+) use is absolutely critical, only 43% of women had ANC4+ in Ethiopia and nearly 64% in Tigray in 2019. Furthermore, only 20% of women had their first ANC visit during their first trimester in 2016. However, there is no literature on area based disparity of ANC4+ use in Tigray. Therefore, this study is aimed to generate evidence for ANC4+ use using the Kilite-Awlaelo Health and Demographic Surveillance System (KA-HDSS) database.Methods: A population-based longitudinal study was employed on 5,414 women from 12 kebelles included in the KA-HDSS site of Tigray. A pregnancy database was used as a source of data. A Line graph was used to depict the trend of ANC4+ use. A stratified robust Poisson model was fitted to estimate the incidence rate ratio (IRR) for women from rural and urban areas separately.Results: The ANC4+ coverage was 36.3% (95% CI=35.0– 37.6%) – 34.2% in rural versus 52.8% urban areas, with an increasing linear trend. Single marital status (IRR=1.29; 95% CI=1.17– 1.42); able to read and write (IRR=1.15; 95% CI=1.01– 1.32); primary education (IRR=1.22; 95% CI=1.11– 1.34); ANC follow-up (2015– 2018) (IRR=1.42; 95% CI=1.23– 1.64); previous pregnancy exposure (IRR=2.20; 95% CI=1.98– 2.45); and having 6+ children (IRR=1.11; 95% CI=1.01– 1.21) determined ANC4+ use for rural women. Marital status (Divorced/widowed/separated) (IRR=0.79; 95% CI=0.66– 0.95); primary education (IRR=1.44; 95% CI=1.16– 1.79); ANC follow-up (2015– 2018) (IRR=2.00; 95% CI=1.59– 2.50); previous pregnancy exposure (IRR=1.54; 95% CI=1.31– 1.80); and ...