Spatial Variation of incomplete antenatal care utilization and its associated factors among pregnant women in Ethiopia: Geographic Weighted Regression

Background Incomplete antenatal care (ANC) utilization refers to a situation where a pregnant woman does not attend the minimum number of recommended ANC visits during her pregnancy. It remained a critical public health issue in Ethiopia, particularly in rural and marginalized communities, contributing to high maternal and neonatal mortality rates. Despite government efforts to improve maternal healthcare, regional variations persist, highlighting the need for targeted and context-specific interventions. Thus, this study aims to assess the spatial variation in incomplete ANC utilization and its associated factors among pregnant women in Ethiopia. Methods A cross-sectional study was conducted using the 2019 Ethiopian mini demographic and health survey data. Two stage cluster sampling technique was utilized. The study analyzed a nationally representative weighted sample of 2,913 women. STATA, ArcGIS, MGWR, and Satscan softwares were used for analysis. Spatial regression analyses, including exploratory regression, GWR and OLS analysis, were performed. The models were compared using AICc and adjusted R². Spatial predictors were considered statistically significant if p-value ≤ 0.05 and the corresponding local coefficients were visualized through mapping. Result The study found that spatial variation of incomplete ANC utilization was non-random and exhibited significant hot spot in central and eastern part of Somali, central and eastern Afar, border of south east Amhara, southern and eastern part of SNNPR, entire Gambela and tip of western and southern Oromia. The sums of 113 significant clusters were found using spatial scan analysis. Maternal age, wealth index, birth order, timing of the first antenatal check, and residence are significant predictors of spatial variation of incomplete ANC utilization. Conclusion and Recommendation: Significant variation in incomplete ANC utilization was found in this study across regions of Ethiopia. This study shows that addressing incomplete ANC utilization in rural residence is of utmost importance. Therefore, priority should be given accordingly.