Factors Influencing Timing of First Antenatal Care Visit Among Bangladeshi Women: Application of Accelerated Failure...

The timing of receiving the first antenatal care (ANC) service is of substantial importance in the early recognition and management of any probable difficulties during pregnancy and after delivery. Most studies analyzed ANC determinants using binary outcomes rather than time-to-event approaches. This study aims to determine the potential determinants of the timing of the first ANC visit for Bangladeshi women aged 15 to 49 through a time-to-event model. The study chose the accelerated failure time (AFT) models over proportional hazard models to adjust the predictor of timing to first ANC and estimate the expected survival time directly. The AFT model allows for the estimation of the expected survival time for an event of interest and describes the acceleration factor (AF) of the event occurrence due to various time-variant covariates.

The study utilized the nationally representative Bangladesh Demographic and Health Survey (BDHS 2022) data and employed different AFT models, viz., Exponential, Weibull, Log-logistic, and Lognormal. The Weibull AFT model was the best-fitted model among other models considered.

The findings indicate significant disparities in the timing of the first ANC visit based on socio-economic and demographic factors. Rural women were found to take 7% (AF = 1.07, 95% CI: 1.03-1.12) longer periods of receiving their first ANC service than urban women. The expected survival time for higher educated mothers was 22% (AF = 0.78, 95% CI: 0.72-0.84) shorter of receiving the first ANC service than illiterate mothers. Moreover, other factors such as media access, women's empowerment, mother's age at index child birth were also significantly impacted the timing of the first ANC visit.

This study offers a comprehensive understanding of the timing dynamics of the first ANC visit through AFT models and contributes valuable insights for policymakers and healthcare providers aiming to improve maternal health outcomes.