Geospatial variation and determinants of incomplete antenatal care follow-up in ethiopia: a spatial and geographically weighted regression analysis.

BACKGROUND: Incomplete antenatal care (ANC) follow-up remains a significant public health issue, especially in low- and middle-income countries, where it poses serious risks to both maternal and fetal health. Although ANC plays a critical role in improving maternal and child health outcomes, data on regional disparities and high rates of incomplete ANC follow-up in Ethiopia are limited. Understanding the local factors contributing to these geographic variations is essential for targeted public health interventions. This study aimed to assess the spatial variation and determinants of incomplete ANC follow-up in Ethiopia. METHODS: This study utilized data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS), employing a stratified, two-stage cluster sampling design. A total of 3,926 women gave their consent and were included in the study. Spatial analysis, including hotspot analysis, interpolation, and spatial statistics (SaTScan), was conducted using ArcGIS 10.8, SaTScan 9.6, and STATA 17. Additionally, spatial regression analyses, including ordinary least squares regression and geographically weighted regression (GWR), were performed to identify hotspot areas and geographical predictor variables. RESULTS: The study found that 56.75% (95% CI: 54.32%, 59.14%) of pregnant women had incomplete ANC follow-up. Spatial autocorrelation analysis revealed a Global Moran's I value of 0.660 (p < 0.001), indicating significant spatial clustering of incomplete ANC follow-up across Ethiopia. Hotspot areas were identified in the Southern, Somali, Gambela, Afar, and Oromia regions. GWR analysis indicated that being from rural areas, in the poorest wealth index, and lacking formal education were significant positive determinants of spatial variation in incomplete ANC follow-up. CONCLUSION: This study revealed that over half of pregnant women in Ethiopia had incomplete ANC follow-up, with significant spatial clustering observed across the country. The GWR analysis also indicated that rural residence, low household wealth, and lack of formal education were spatially varying determinants associated with incomplete ANC follow-up. These findings suggest that targeted interventions in the identified hotspot areas and addressing the spatially varying determinants may help improve ANC follow-up.