MULTILEVEL COUNT REGRESSION ANALYSIS OF FACTORS AFFECTINGANTENATAL CARE VISITS IN NIGERIA

Authors

  • Musa Ganaka Kubi
    Abubakar Tafawa Balewa University, Bauchi, Nigeria
  • Tobias Chukwudi Ossai
    Nasarawa State University, Keffi , Nigeria
  • E. O Ben
    Abubakar Tafawa Balewa University, Bauchi, Nigeria
  • Rilwan Bala Muhammad
    Federal U niversity of Health Science Azare, Nigeria
  • Y. B. Usman
    Federal Polytechnic Idah, Nigeria

Keywords:

Antenatal care visit , Zero-inflated negative binomial , Multilevel count data modeling

Abstract

Adequate antenatal care (ANC) is essential for maternal and neonatal health, yet utilization in Nigeria remains suboptimal. This study aimed to determine the factors influencing number of ANC visits using multilevel count data regression model. Data from 12,719 women in the 2024 Nigerian Demographic and Health Survey data were analyzed. A multilevel Zero Inflated Negative Binomial (ZINB) model was selected over competing count models based on its superior ability to handle the data's over dispersion, substantial zero inflation (28 %) and clustered structure. Both count (frequency) and zero-inflation (non-visit) components were estimated.In the count component, higher maternal age (25–39: AIRR =1.053; 40-49: AIRR =1.073), maternal secondary (AIRR =1.069) and higher education (AIRR =1.113), husband’s secondary (AIRR =1.077) and higher education (AIRR =1.113), wealthier households (middle: AIRR =1.054; rich: AIRR =1.116), media exposure (AIRR =1.054), employment (AIRR = 1.035), insurance (AIRR =1.080), shorter distance to health facilities (AIRR =1.040), and prior pregnancy termination (AIRR =1.036) were associated with increased ANC visits. In the zero-inflation component, maternal and husband education (AORs =0.530–0.205), wealth (AOR middle =0.731; rich =0.355), employment (AOR =0.641) and shorter facility distance (AOR =0.763) reduced the likelihood of non-attendance, whereas higher parity (2-4: AOR =1.408; ≥5: AOR =1.614) and husband-dominated decision-making (AOR =1.297) increased it. ANC utilization is shaped by demographic, socioeconomic, educational, and access-related factors, with pronounced regional and parity disparities. Targeted interventions are needed to improve equitable ANC coverage.

Author Biographies

Musa Ganaka Kubi

Department of Public Health

Tobias Chukwudi Ossai

Department of Statistics and Data Analytics

E. O Ben

Department of Statistics

Rilwan Bala Muhammad

Department of Epidemiology and Biostatistics

Y. B. Usman

Department of Mathematics and Statistics

Dimensions

Ahmed, T. and Mallick, S. K. (2019). Analyzing antenatal care visit data in Bangladesh using zero-modified count regression models. Journal of Health Research, 33(5), 412–425.

Beckman, A., Chaix, B., Hjerpe, P., Johnell, K., Larsen, K., Merlo, J., Ohlsson, H. and Råstam, L. (2006). A brief conceptual tutorial of multilevel analysis in social epidemiology: Using measures of clustering in multilevel logistic regression to investigate contextual phenomena. Journal of Epidemiology and Community Health, 60(4), 290–297. https://doi.org/10.1136/jech.2004.029454

Bekalo, D. B. and Kebede, D. T. (2021). Zero-inflated models for count data: An application to number of antenatal care service visits. Annals of Data Science, 8(4), 683–708.

Bhowmik, J., Biswas, R. K. and Woldu, M. (2020). Determinants of antenatal care visits among pregnant women in Bangladesh: An advanced count regression modeling. PLOS ONE, 15(11), e0243165.

Bolker, B. M., Brooks, M. E., Clark, C. J., Geange, S. W., Poulsen, J. R., Stevens, M. H. H. and White, J. S. S. (2009). Generalized linear mixed models: A practical guide for ecology and evolution. Trends in Ecology & Evolution, 24(3), 127–135. https://doi.org/10.1016/j.tree.2008.10.008

Brooks, M. E., Kristensen, K., van Benthem, K. J., Magnusson, A., Berg, C. W., Nielsen, A., Skaug, H. J., Mächler, M. and Bolker, B. M. (2017). glmmTMB balances speed and flexibility among packages for zero-inflated generalized linear mixed modeling. The R Journal, 9(2), 378–400. https://doi.org/10.32614/RJ-2017-066

Cameron, A. C. and Trivedi, P. K. (1998). Regression Analysis of Count Data. Cambridge University Press. https://doi.org/10.1017/CBO9780511814365

Consul, P. C. and Jain, G. C. (1973). A generalization of the Poisson distribution. Technometrics, 15(4), 791–799. https://doi.org/10.1080/00401706.1973.10489112

Gebeyehu, N. A., Arage, G. and Degu, A. (2022). Antenatal care visits and associated factors in Sub-Saharan Africa: A multilevel negative binomial regression analysis. BMC Pregnancy and Childbirth, 22(1), 1–12.

Hilbe, J. M. (2011). Negative Binomial Regression (2nd ed.). Cambridge University Press. https://doi.org/10.1017/CBO9780511973420

Hox, J. J., Moerbeek, M. and Van de Schoot, R. (2017). Multilevel Analysis: Techniques and Applications (3rd ed.). Routledge. https://doi.org/10.4324/9781315650982

Kreft, I. G. and de Leeuw, J. (1998). Introducing Multilevel Modeling. Sage Publications. https://doi.org/10.4135/9781849209366

Lambert, D. (1992). Zero-inflated Poisson regression, with an application to defects in manufacturing. Technometrics, 34(1), 1–14. https://doi.org/10.2307/1269547

Mullahy, J. (1986). Specification and testing of some modified count data models. Journal of Econometrics, 33(3), 341–365. https://doi.org/10.1016/0304-4076(86)90002-3

Negash, W., Tefera, L. and Abate, M. (2025). Antenatal care visits and associated factors in Senegal: A multilevel Poisson regression analysis of the 2023 DHS. Maternal and Child Health Journal, 29(1), 150–162.

Payne, E. H., Gebregziabher, M., Hardin, J. W., Ramakrishnan, V. and Egede, L. E. (2018). An empirical approach to determine a threshold for assessing overdispersion in Poisson and negative binomial models for count data. Communications in Statistics - Simulation and Computation, 47(6), 1722–1738. https://doi.org/10.1080/03610918.2017.1323223

Sekata, F. (2015). Antenatal care visits and associated factors in rural Ethiopia: Application of zero-inflated and hurdle regression models. Master's thesis, University of Oslo.

Suleman, M., Yaya, S. and Zegeye, B. (2023). Factors associated with the desired number of antenatal care service visits in Ethiopia: A multilevel count regression analysis. BMJ Open, 13(2), e067891.

Woldeyohannes, D., Asnake, M. and Teklu, A. (2023). Determinants of antenatal care utilization in Ethiopia: A count regression approach. Ethiopian Journal of Health Sciences, 33(1), 1–12.

World Health Organization (2016). WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience. WHO Press.

Yadav, A. K., Nag, S., Jena, P. K. and Paltasingh, T. (2021). Micro-level determinants of antenatal care utilization in India: A count data modeling approach. Children and Youth Services Review, 120, 105780.

Yusuf, O. B. and Ugalahi, T. O. (2015). Comparison of Poisson, negative binomial, and generalized Poisson regression models in predicting antenatal care visits in Nigeria. Journal of Biometrics & Biostatistics, 6(6), 1–7.

Yusuf, O. B., Afolabi, R. F. and Agbaje, A. S. (2018). Comparing the performance of zero-inflated and hurdle models for antenatal care utilization in Nigeria. BMC Medical Research Methodology, 18(1), 1–12.

Zemene, M. and Birhanu, A. (2022). Factors affecting antenatal care utilization in Ethiopia: A count regression model analysis of the 2019 EMDHS. Journal of Pregnancy, 1–10.

Published

03-07-2026

How to Cite

MULTILEVEL COUNT REGRESSION ANALYSIS OF FACTORS AFFECTINGANTENATAL CARE VISITS IN NIGERIA. (2026). FULafia Journal of Science and Technology , 10(2), 174-183. https://doi.org/10.62050/fjst2026.v10n2.731

How to Cite

MULTILEVEL COUNT REGRESSION ANALYSIS OF FACTORS AFFECTINGANTENATAL CARE VISITS IN NIGERIA. (2026). FULafia Journal of Science and Technology , 10(2), 174-183. https://doi.org/10.62050/fjst2026.v10n2.731

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