Identifying the Associated Risk Factors of Time to First Antenatal Care Contacts among Pregnant Women in Somalia: A Survival Frailty Approach

Antenatal care (ANC) utilization offers a wide range of interventions, such as education, counseling, screening, treatment, monitoring, and supporting the health of pregnant women, making it a significant opportunity for expectant mothers. This study aims to investigate the time to the first ANC contact among pregnant women and to identify associated factors by employing the Accelerated Failure Time (AFT) model using different frailty distributions.

This study used Somalia's Health and demographic survey data. A sample of 3138 women of reproductive age (15-49 years) were included in the study and accelerated failure time (AFT) models with different frailty distributions were compared using information criteria to select the best model.

Among the women included in this study, only 33.1% of them received their first ANC contacts within the recommended time during their pregnancy. A gamma frailty model with log-logistic as base-line distribution was found to be the best model for the time-to-first ANC utilization for our data. The final model, based on the log-logistic gamma frailty, identified marital status, mother's occupation, wanted pregnancy, region, parity, wealth index, education level of mother, persons deciding on mother health care, and media exposure are significant (p-value <0.05) predictors of time to the first ANC contact in Somalia. The final model evidenced a high degree of heterogeneity at an individual level regarding the time to the first ANC utilization in Somalia.

The median time for the first ANC contact among pregnant women was 6.2 months. To ensure accurate analysis and better policy recommendation, different candidate models were compared, and the univariate gamma frailty model with a log-logistic baseline was found to be the most appropriate approach for analyzing time to the first ANC contact among pregnant women. Maternal and child health policies and initiatives must better focus on women's development and implement interventions aimed at increasing the timely initiation of prenatal care services. More specific policy measures, such as targeted educational campaigns, improved pregnancy services, and efforts to minimize regional disparities, should be prioritized as urgent intervention mechanisms.