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Cited by 49Global Maternal and Child HealthMaternal and Neonatal HealthcareReproductive Health and Contraception

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Modelling the number of antenatal care visits in Bangladesh to determine the risk factors for reduced antenatal care attendance

Open access
Bhowmik, Kakoli Rani, Das, Sumonkanti, Islam, Md. Atiqul·2020·PLOS ONE
DOI 10.1371/journal.pone.0228215PMC PMC6980537
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Abstract

The existence of excess zeros in the distribution of antenatal care (ANC) visits in Bangladesh raises the research question of whether there are two separate generating processes in taking ANC and the frequency of ANC. Thus the main objective of this study is to identify a proper count regression model for the number of ANC visits by pregnant women in Bangladesh covering the issues of overdispersion, zero-inflation, and intra-cluster correlation with an additional objective of determining risk factors for ANC use and its frequency. The data have been extracted from the nationally representative 2014 Bangladesh Demographic and Health Survey, where 22% of the total 4493 women did not take any ANC during pregnancy. Since these zero ANC visits can be either structural or sampling zeros, two-part zero-inflated and hurdle regression models are investigated along with the standard one-part count regression models. Correlation among response values has been accounted for by incorporating cluster-specific random effects in the models. The hurdle negative binomial regression model with cluster-specific random intercepts in both the zero and the count part is found to be the best model according to various diagnostic tools including likelihood ratio and uniformity tests. The results show that women who have poor education, live in poor households, have less access to mass media, or belong to the Sylhet and Chittagong regions are less likely to use ANC and also have fewer ANC visits. Additionally, women who live in rural areas, depend on family members' decisions to take health care, and have unintended pregnancies had fewer ANC visits. The findings recommend taking both cluster-specific random effects and overdispersion and zero-inflation into account in modelling the ANC data of Bangladesh. Moreover, safe motherhood programmes still need to pay particular attention to disadvantaged and vulnerable subgroups of women.

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  • The current study observed high ANC attendance rates among Rohingya when compared to Bangladesh more generally and other South Asian countries where most women receive no more than three ANC visits.

    “This is similar to the current study, which observed high ANC attendance rates among Rohingya when compared to Bangladesh more generally and other South Asian countries where most women receive no more than three ANC visits [14, 22, 46, 54].”

    From Predictors of antenatal care utilization among the Rohingya population in the refugee camps of Cox's Bazar, Bangladesh (2025) · cites this paper as [54]

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Metadata

Authors
Bhowmik, K. R., Das, S., & Islam, M. A.
Affiliations
  • Leiden University Medical Center (NL)
  • Shahjalal University of Science and Technology (BD)
Corresponding author
Islam, Md. Atiqul
ORCID
Venue
PLOS ONE
Publisher
Public Library of Science (PLoS)
Published
2020-01-24
Volume
15
Issue
1
Pages
e0228215
ISSN
1932-6203 (ISSN-L)
DOI
10.1371/journal.pone.0228215
PMC
PMC6980537
OpenAlex
W3001093896
Cited by
49
References
0
Citations by year
2026: 6 · 2025: 6 · 2024: 8 · 2023: 10 · 2022: 11 · 2021: 8
FWCI
6.97
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS ONE (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research Publications (Maastricht University) (publishedVersion, cc-by)
  • Research Online (University of Wollongong) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Figshare (submittedVersion, cc-by)
  • Figshare (submittedVersion)
  • Research Publications (Maastricht University) (submittedVersion, other-oa)
  • Greater South Information System
Funders
  • Universiteit Leiden
  • Leids Universitair Medisch Centrum
  • Erasmus Universitair Medisch Centrum Rotterdam
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
Keywords
antenatal care attendance, antenatal care visits, zero-inflated count data, overdispersion, intra-cluster correlation, maternal education, household poverty, mass media access, urban-rural differences, spousal decision-making, unintended pregnancy, Bangladesh
MeSH terms
Adult, Bangladesh, Delivery of Health Care, Female, Health Facilities, Health Surveys, Humans, Pregnancy, Prenatal Care, Regression Analysis, Risk Factors, Social Class, Models, Statistical

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