MULTILEVEL COUNT REGRESSION ANALYSIS OF FACTORS AFFECTINGANTENATAL CARE VISITS IN NIGERIA
Keywords:
Antenatal care visit , Zero-inflated negative binomial , Multilevel count data modelingAbstract
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.
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