Geographical variation in hotspots of antenatal care service utilization in Ethiopia: Geographic weighted regression and Multilevel analysis

Background: Antenatal care refers to care given to pregnant women during pregnancy by skilled health professionals. Due to low coverage of antenatal care, women in many developing countries, including Ethiopia, are at risk for pregnancy-related complications. This research aims to explore geographical variation in hotspots of antenatal care service utilization in Ethiopia using data from the 2019 Ethiopian Mini Demographic Health Survey. Method: This study was conducted based on the 2019 Ethiopian Mini Demographic Health Survey (EMDHS) data. A total of 3,927 women were included in this study. To determine the factors associated with hotspots of antenatal care (ANC) utilization, we employ geographic weighted regression (GWR). Adjusted R ² and AICc was used for model comparison. A multilevel analysis was fitted and variables with a p-value < 0.25 in the bi-variable analysis were considered for the multivariable analysis. The adjusted odd ratio with the 95% confidence interval was reported to declare the statistical significance and strength of association. Result: Prevalence of ANC utilization in Ethiopia was 43% (95% CI: 41.5%, 44.6%). Tigray, SNNPR, Addis Ababa, and Benishangul Gmuz regions were most hotspot areas. Multilevel regression analysis revealed that Age 35-39 years, other religion followers, married women, higher educational status, rural residence, being rich in wealth status, and low community level poverty were associated with antenatal care service utilization. Conclusion and recommendation: In Ethiopia, the prevalence of ANC utilization in was low according to our study and there was a significant spatial variation of antenatal care utilization in Ethiopian regions. To improve ANC coverage, geographically targeted strategies are essential. These should focus on reducing regional disparities, improving women’s education and socioeconomic status, and enhancing accessibility and availability of reproductive health services, especially in rural areas of the country.