Spatial distribution and associated factors of antenatal care utilization in Ethiopia in 2019: Spatial and multilevel analysis

Abstract Background: Antenatal care utilization key to reduces pregnant women death and preparing women for birth. In Ethiopian antenatal care utilization was still not meet health sector transformation plan. There was also regional variation of antenatal care services in the country. Therefore, current study was aimed to explore spatial distribution and associated factors of antenatal care utilization in Ethiopia based on the nationally representative EMDHS data.Methods: Secondary data analysis was done on 2019 Ethiopian mini demographic and health survey (EMDHS) data. ArcGIS 10.7 statistical software were used for spatial analysis. Bernoulli model was fitted by applying Kulldorff methods using the StatsCan 9.6.1 software to analyze the purely spatial clusters of ANC utilization. For associated factor mixed effect multilevel logistic regression was fitted. Inter class correlation (ICC), Median odds ratio (MOR), proportional change variance (PVC) and Deviance used for model comparison and fitness. Adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to declare significant factors of antenatal care utilization.Results: The prevalence of antenatal care utilization in Ethiopia was 75% [95 CI: 73%, 76%] in this study. The spatial distribution of antenatal car utilization was non-random across the country with Global Moran’s Index value of 0.032, and significant P-value(p<0.05). For associated factor secondary and higher education were 4.2 and 6 time greater than that of no formal education women with AOR of 4.2(1.99-8.66) and 6 (1.62-22) respectively. The odds of richest households were 4.2 times AOR (1.08-2.3) and the odds of married, windowed, and divorced women were 6, 8 and 4.4 time more that of single women respectively in utilizing ANC. The odd of women utilizing ANC was 4.2 times AOR (6.25-10.62). Conclusion: The spatial distribution of ANC utilization in Ethiopia is non-random. Maternal education, marital status, wealth index, place of delivery, pregnancy status region and community women education were significant predicter of antenatal care utilization in Ethiopia. Government and non-governmental organization should scale up maternal health services to low-rate area(hotspot) and poorest women.