Paper Title
Application Of Parametric Survival Analysis To Timing Of First Antenatal Care Visit In Three African Countries

Introduction: Access to Antenatal Care (ANC) right from conception remains the surest way to ensure good pregnancy outcomes. While the usage is low in Africa, information on the rate of uptake of ANC is scarce in te continent. The current study assessed the timing of uptake of ANC among pregnant women and identified its prognostic factors in three African countries. Methods: We used the most recent Demographic and Health Surveys in Botswana, Nigeria and South Africa. They all present cross-sectional and nationally representative. The outcome variable is timing of first ANC visit. Those lost to follow up or those who were currently pregnant and have not accessed ANC were censored. Basic descriptive statistics and survival analysis techniques involving four models were used to analyse the data. Data was weighted while survey design and sampling errors were adjusted for in all analyses. Statistical significance was determined at p-value = 0.05. Results: Almost half of the respondents were aged 25-34 years. About 65.5% had accessed ANC and mostly (58%) in second trimester. The rate of attendance was highest in South Africa and least in Nigeria. Among the three countries, the average pregnancy age at first ANC visit was 4 months with median survival time of 6 months. The overall incidence rate of accessing ANC is 110 per 1000 person year. Women with higher education had higher adjusted hazard of accessing ANC than her uneducated counterpart (aHR=2.89, 95% CI: 2.68-3.11). Older women with higher education and from households in richer wealth quintile are more likely to start ANC earlier. Other significant determinants of timing of first ANC visit are tribe, place and zone of residence accessibility of health facilities and number of previous pregnancies. Conclusion: The ANC use in the countries remained low at 62% and first visits are also delayed. Women age, education, place and zone of residence, wealth quintile, distance to health facility and woman's decision-making autonomy influenced timing of ANC use. For Africa to achieve timely and adequate use of ANC women should be empowered in terms of education, autonomy and earnings while health facilities are provided close enough to all African households. Keywords: Antenatal Care, Timing Of Antenatal Care Visit, Distance From Health Facility, Education, Africa, Women Autonomy