Determinants of Time-to-Death of Chronic Lymphocytic Leukemia Patients at Felege Hiwot Referral Hospital, Bahir Dar, Ethiopia.

Background: Leukemia is a group of cancers that usually begin in the bone marrow and results in a large number of abnormal white blood cells. Chronic Lymphocytic Leukemia is the most prevalent leukemia in Western countries, with an estimated incidence rate of less than 1 to 5.5 per 100 000 people, and average age at diagnosis of 64 to 72 years. It is more common in men among Chronic Lymphocytic Leukemia patients in Ethiopia's hospitals at Felege Hiwot Referal Hospital. Methods: A retrospective cohort research design was employed to acquire critical information from patients' medical records in order to achieve the study's purpose. The study comprised the medical records of 312 Chronic Lymphocytic Leukemia who were followed from January 1, 2018 to December 31, 2020. A Cox proportional hazard model was used to determine the risk factors for time to death in Chronic Lymphocytic Leukemia patients. Results: Accordingly the Cox proportional hazard model, age (Hazard Ratio = 11.36; P < .001), sex of male (Hazard Ratio = 1.04; P = .004), married status (Hazard Ratio = 0.03; P = .003), medium stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.29; P = .024), high stages of Chronic Lymphocytic Leukemia (Hazard Ratio = 1.99; P < .001), presence of anemia (Hazard Ratio =0.09; P = .005), platelets (Hazard Ratio = 2.11; P = .007), hemoglobin (Hazard Ratio = 0.02; P < .001), lymphocytes (Hazard Ratio = 0.29; P = .006), red blood cell (Hazard Ratio = 0.02; P < .001), which patients with Chronic Lymphocytic Leukemia had a significant relationship with time to death. Conclusions: Age, sex, Chronic Lymphocytic Leukemia stage, anemia, platelets, hemoglobin, lymphocytes, and red blood cells were all statistically significant determinants in the time to death of Chronic Lymphocytic Leukemia patients, according to the data. As a result, healthcare providers should pay particular attention to and emphasize the identified characteristics, as well as provide frequent counseling on how to enhance the health of Chronic Lymphocytic Leukemia patients.

Determinant factors of leprosy-related disability; comparison of acceleration failure time and parametric shared frailty models.

BACKGROUND: Leprosy is an illness persisting for a long time or constantly recurring brought about by Mycobacterium leprae. The collusion of the causing agent with Schwann cells leads to incapable of being changed loss of fringe nerve tissue; followed by incapacity and that is not restricted to actual powerlessness yet additionally makes a negative picture, prompting segregation and social disgrace against the altered people also, their families. METHODS: The analysis of this study comprises 205 samples of patients at All African TB and Leprosy Rehabilitation and Training Centre from January 2015 up to December 2019 G.C who were taking medication for leprosy and who possess all necessary data. Territorial conditions in the region of the patients were utilized as a clustering impact in all frailty models. Acceleration failure time models and parametric shared frailty models with Weibull and log-strategic patterns were utilized to dissect hazard factors related to disability ensued by leprosy. All fitted models were looked at by utilizing AIC. RESULTS: From that of 205, 69(33.7%) experienced at least one kind of disability grade during treatment taking. In light of AIC, log-logistic-gamma shared frailty model was the final best fitting model and also there was considerable variation among patients. The final model showed the age of patients, symptom duration, treatment category of patients, and sensory loss were found to be the most significant determinants of leprosy disability. CONCLUSION: In this investigation, there is proof of heterogeneity at the group level and disability was related to the age of patients, symptom duration, treatment category of patient, what's more, sensory loss subsequently, uncommon consideration ought to be given to these huge indicators, which eventually diminish the event of disability. To lessen the patient-related postponement, the program should lay more noteworthy accentuation on bringing issues to light in the local area by zeroing in on key messages like indications, inability result of the late discovery, accessibility of free treatment what's more, accessibility of disease care in general wellbeing office.

Determinants of Low Birth Weight Among Newborns at Debre Tabor Referral Hospital, Northwest Ethiopia: A Cross-Sectional Study.

Introduction: Low birth weight is one of the important predictors of perinatal survival, infant morbidity, and mortality, as well as the risk of developmental disabilities and diseases in the future. Objectives: The study aimed to identify the associated factors of low birth weight among newborns at Debre Tabor referral hospital, Northwest Ethiopia. Methods: A hospital-based cross-sectional study was conducted from January 1, 2021 to October 30, 2021 at Debre Tabor Referral Hospital. A total sample of 420 newborn birth records was considered. The binary logistic regression model was used to assess the associated factors of low birth weight. The results are presented as crude odds ratios and adjusted odds ratios (AOR) together with their corresponding 95% confidence intervals. Results: In this study, 422 participants were included. Rural residence (AOR = 2.01; 95%CI 1.10-3.69), married marital status (AOR = 0.82; 95%CI 0.78-0.86), formal education (AOR = 0.79; 95%CI 0.67-0.92), smoking during pregnancy (AOR = 1.19; 95%CI 1.07-1.33), attended antenatal care (ANC) visits (AOR = 0.57; 95%CI 0.35-0.91), diabetes during pregnancy (AOR = 4.34; 95%CI 3.50-5.39), iron supplementation (AOR = 0.23; 95%CI 0.20-0.25), and maternal history of anemia (AOR = 5.87; 95%CI 2.67-12.89) were significantly associated with low birth weight of newborns. Conclusion: This finding showed that residence, marital status, educational status, smoking during pregnancy, ANC visit, diabetes during pregnancy, iron supplementation, and mother's history of anemia were significantly associated with low birth weight. Therefore, policy makers and public health experts/practitioners should plan smoking preventive public health promotion campaigns. Furthermore, it is important that all health professionals properly manage the possible cause of LBW during pregnancy.

Reason and Associated Factors for Nonuse of Contraceptives Among Ethiopian Rural Married Women: A Multilevel Mixed Effect Analysis.

Introduction: Contraception has a clear impact on the health of women and families in developing countries. This study aims to identify multilevel determinants of nonuse of modern contraceptives among Ethiopian rural married women in their productive age group. Method: The study relied on data from the 2016 Ethiopian Demographic and Health Surveys. A multilevel logistic regression model was used for analysis. Result: In rural areas, nonuse of modern contraceptives is surprising high (81.7%), primarily due to fear of side effects (12.89%) and breastfeeding (8.2%). Among women aged 35 to 49 years (adjusted odds ratio [AOR] = 0.66; 95% confidence interval [CI]: 0.540.81), husbands with secondary and above education levels (AOR = 0.83; 95% CI: 0.7-1), those in the high wealth index (AOR = 0.61; 95% CI: 0.51-0.72), and those who have had 1 to 2 children in the past 5 years (AOR = 0.28; 95% CI: 0.24-0.33), there was a lower chance of not using contraception. Muslims are less likely to want to use modern contraceptives (AOR = 1.2; 95% CI: 0.96-1.4). Women living in Afar (AOR = 20.9; 95% CI: 9.6-44.7), Oromia (AOR = 1.5; 95% CI: 1.01-2.3), Somali (AOR = 71.1; 95% CI: 24.1-209.2), Gambela (AOR = 2.3; 95% CI: 1.4-3.9), Harari (AOR = 4.4; 95% CI: 2.24-8.72), and Dire Dawa (AOR = 3.2; 95% CI: 1.5-6.9), regional states, were less likely to want to use modern contraceptives as compared to those in Tigray. Conclusion: Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. In order to maximize the effectiveness of family planning promotion policies, it's important to address the reasons for nonuse of contraceptives identified in each region and contextual differences regarding women of reproductive age.

Prevalence of HIV/AIDS Infection among Sexually Active Women in Ethiopia: Further Analysis of 2016 EDHS.

Background: The issue of HIV/AIDS is prevalent around the world and in Ethiopia as well. The aim of this study was to determine the prevalence and risk factors of HIV/AIDS infection among sexually active women in Ethiopia. Methods: For this study, data were obtained from the Ethiopia Demographic and Health Survey conducted in 2016. This study contains 11,729 women who have had at least one episode of sexual intercourse in their lifetime. Interviewers for voluntary HIV testing collected finger-prick blood specimens from women who agreed to be tested for HIV. Based on factors at the individual and community levels, a multilevel logistic regression model was used. Results: The study found that 2% of 11,729 sexually active women tested positive for HIV from all regions who received voluntary counseling and testing. The intraclass correlation coefficient findings showed that 32.844% of HIV/AIDS transmission among sexually active women was the result of community-level factors. Variables at the individual level were women of age 16-24 (AOR = 0.18; 95% CI: 0.11-0.29), women of age 25-34 (AOR = 0.733; 95% CI: 0.55-0.98), women with primary education level (AOR = 1.8; 95% CI: 1.23-2.57), more than one sexual accomplice (AOR = 1.33; 95% CI: 0.613-2.87), and women's age at first sexual intercourse between 25 and 34 (AOR = 0.57, 95% CI: 0.301, 1.06); these were the most significant determinants of HIV/AIDS infection. According to community-level factors, there was a lower HIV prevalence rate among rural women (AOR = 0.22; 95 percent CI: 0.13-0.36), and women in the Gambela region (AOR = 4.1; 95 percent CI: 1.99-8.34) also had higher HIV prevalence rates. Conclusions: The prevalence of HIV infection among sexually active women varies by region, with urban women more likely to contract the virus. Women who had more than one regular sexual partner and had their first sexual encounter at a younger age are at an increased risk of contracting HIV/AIDS. According to the study, the government should focus more support on high-risk clusters, mainly in urban areas, as well as on regions with high rates of HIV/AIDS infection.

Risk Factors for Disability Upgrading Among Leprosy Patients During Treatment: Multilevel Modeling Analysis.

Background: Leprosy not only brings about bodily incapacity but also creates a nasty image of affected individuals, triggering discrimination and social stigma. The purpose of this study was to evaluate the status of leprosy disability in patients registered at the All African TB and Leprosy Rehabilitation and Training Center. Methods: The study consists of 205 leprosy patients who were undergoing treatment at the All African TB and Leprosy Rehabilitation and Training Center from January 2015 to December 2019. Regional states of the patients were used as a clustering effect in the multilevel logistic regression model. Results: In total, 205 (66.3%) completed records revealed patients with leprosy were disabled. Among these, 64.88% of them were males. In multilevel binary logistic regression analysis, the individual-level variables, such as median age (AOR = 1.1; 95% CI: 1.043, 1.13) of patients, patients with duration of symptom [7-12 months (AOR = 2.26; 95% CI: 1.50, 3.39), 13-24 months (AOR = 2.13; 95% CI: 1.44, 3.15), and more than 24 months (AOR = 2.67; 95% CI: 1.8, 4.02)], the absence of sensory loss (AOR = 0.84; 95% CI: 0.72, 0.96), and patients with asymmetry lesion distribution (AOR = 0.74; 95% CI: 0.65, 0.85), were the most significant determinant factors of disability. The default leprosy patient (AOR = 15.53; 95% CI: 1.82, 134.96) and new leprosy patient (AOR = 0.51; 95% CI: 0.33, 1.68) were the significant determinant factors of disability due to leprosy patients. Conclusion: An individual-level factor on the risk of disability was higher as age increased and for patients with a longer duration of symptoms. The risk of disability was lower for patients who do not lose their sensation and for patients whose lesion distribution is asymmetrical. The community-level factor, patient categories, was also a significant factor in disability due to leprosy. Furthermore, programs should emphasize raising community awareness, focusing on key messages and early case detection campaigns, such as active surveys, as well as the availability of leprosy care in a public health facility.

The effects of individual and community-level factors on community-based health insurance enrollment of households in Ethiopia.

INTRODUCTION: Community-based health insurance (CBHI) is a type of volunteer health insurance that has been adopted all over the world in which people of the community pool funds to protect themselves from the high costs of seeking medical care and treatment for the disease. In Ethiopia, healthcare services are underutilized due to a lack of resources in the healthcare system. The study aims to identify the individual and community level factors associated with community-based health insurance enrollment of households in Ethiopia. METHODS: Data from the Ethiopian mini demographic and health survey 2019 were used to identify factors associated with community-based health insurance enrollment of households in Ethiopia. Multilevel logistic regression analysis was used on a nationally representative sample of 8,663 households nested within 305 communities, considering the data's layered structure. We used a p-value<0.05 with a 95% confidence interval for the results. RESULT: The prevalence of community-based health insurance enrollment in Ethiopia was 20.2%. The enrollment rate of households in the scheme was high in both Amhara (57.9), and Tigray (57.9%) regions and low (3.0%) in the Afar region. At the individual level; the age of household heads, number of children 5 and under, number of household members, has land for agriculture, has a mobile telephone, receiving cash of food from the safety Net Program, Owning livestock, and herds of farm animals, wealth index, and at the community level; the region had a significant association with community-based health insurance enrollment. CONCLUSION: Both individual and community-level characteristics were significant predictors of community-based health insurance enrollment in households. Furthermore, the ministry of health, health bureaus, and other concerning bodies prioritize clusters with low health insurance coverage to strengthen health system financing and intervene in factors that negatively affect the CBHI enrollment of households.

Factors associated with non-use of modern contraceptives among sexually active women in Ethiopia: a multi-level mixed effect analysis of 2016 Ethiopian Demographic and Health Survey.

BACKGROUND: Appropriate contraceptive use prevents unintended pregnancy, protects the health of mother and child, and promotes women's well-being. Use of modern Family planning in Ethiopia was still very low. The purpose of this study was to assess the factors that are associated with non-use of modern family planning services among women of reproductive age. METHOD: A nationally representative 2016 EDHS women data were used for analysis. A total of 15,683 women in the reproductive age group were included in this study. Descriptive and multilevel multivariable binary logistic regression models were used to summarize descriptive data and measure statistical association between the dependent and the individual and community level variable, respectively. Adjusted Odds Ratio (AOR) and confidence interval were respectively used to measure association and its statistical significance. RESULT: Among women in the reproductive age group 79.49% (95% CI: 78.85%, 80.12%) did not use a modern contraceptive method. Women age between 25-34 years (AOR = 0.54, 95% CI: 0.47-0.61) and age between 34-49 year (AOR = 0.62, 95% CI: 0.55-0.71), having primary educated women (AOR = 0.0.77, 95% CI: 0.68-0.87),secondary and above educational (AOR = 0.88, CI: 0.75-1.03), Secondary and above-educated husband (AOR = 0.84, 95% CI: 0.72-0.96), rich women (AOR = 0.74,95%CI:0.65-0.85), health facility delivery (AOR = 0.84, 95%CI: 0.73-0.0.98), being watching TV (AOR = 0.74, 95% CI: 0.65-0.85), having 1-2 living children (AOR = 0.21, 95% CI: 0.19-0.23) are less likely to not use contraception were identified. Furthermore, Muslim women (AOR = 1.43, 95% CI: 1.23-1.62), women living in rural area (AOR = 3.43; 95% CI: 2.72-4.32), and ANC visit 1.25(1.07-1.47) were more likely to not use contraception. Further, Women in Afar, Somali, Gambela, Harari, and Dire Dawa were less likely to use modern contraception methods than women in Tigray, but Amhara region had a lower rate of non-use. CONCLUSION: Family planning interventions should target younger women, women living in rural areas, the poor, and Muslim women. Moreover, initiatives to empower women associated to family planning programs would be beneficial in increasing contraceptive uptake among sexually active women in Ethiopia.

Geographical variation and determinants of women unemployment status in Ethiopia; A multilevel and spatial analysis from 2016 Ethiopia Demographic and Health Survey data.

BACKGROUND: Unemployment is a major problem in both developed and developing countries. In Ethiopia, women unemployment is particularly high, and this makes it a grave socio-economic concern. The aim of this study is to assess the spatial distribution and identify the determinant factors of women unemployment in Ethiopia. METHODS: The data used for the study is the Ethiopian Demographic and Health Surveys of 2016. A total of 15683 women are involved in the study. Global Moran's I statistic and Poisson-based purely spatial scan statistics are employed to explore spatial patterns and detect spatial clusters of women unemployment, respectively. To identify factors associated with women unemployment, multilevel logistic regression model is used. RESULTS: A spatial analysis showed that there was a major spatial difference in women unemployment in Ethiopia with Global Moran's index value of 0.3 (p<0.001). The spatial distribution of women's unemployment varied significantly across the country. The major areas of unemployment were Afar and Somalia; southwest Tigray; North and west Oromia, and Eastern and southern parts of Amhara. Women with primary level of education(AOR = 0.88, 95%CI: 0.80, 0.98), secondary and above level of education (AOR = 0.71, 95%CI: 0.62, 0.82), women with rich wealth index (AOR = 0.79, 95% CI: 0.70, 0.90), pregnant women (AOR = 1.24, 95% CI: 1.06, 1.5), women with a male household head(AOR = 1.4, 95% CI: 1.28, 1.50), and urban women(AOR = 0.60, 95% CI: 0.50, 0.70) statistically associated with women unemployment. CONCLUSION: The unemployment rate of women in Ethiopia showed variation across different clusters. Improving entrepreneurship and women's education, sharing business experiences, supporting entrepreneurs are potential tools for reducing the unemployment women. Moreover, creating community-based programs that prioritize participation of poor households and rural women as well as improving their access to mass media and the labor market is crucial.

Multilevel log linear model to estimate the risk factors associated with infant mortality in Ethiopia: further analysis of 2016 EDHS.

BACKGROUND: Infant mortality is defined as the death of a child at any time after birth and before the child's first birthday. Sub-Saharan Africa has the highest infant and child mortality rate in the world. Infant and child mortality rates are higher in Ethiopia. A study was carried out to estimate the risk factors that affect infant mortality in Ethiopia. METHOD: The EDHS- 2016 data set was used for this study. A total of 10,547 mothers from 11 regions were included in the study's findings. To estimate the risk factors associated with infant mortality in Ethiopia, several count models (Poisson, Negative Binomial, Zero-Infated Poisson, Zero-Infated Negative Binomial, Hurdle Poisson, and Hurdle Negative Binomial) were considered. RESULT: The average number of infant deaths was 0.526, with a variance of 0.994, indicating over-dispersion. The highest mean number of infant death occurred in Somali (0.69) and the lowest in Addis Ababa (0.089). Among the multilevel log linear models, the ZINB regression model with deviance (17,868.74), AIC (17,938.74), and BIC (1892.97) are chosen as the best model for estimating the risk factors affecting infant mortality in Ethiopia. However, the results of a multilevel ZINB model with a random intercept and slope model revealed that residence, mother's age, household size, mother's age at first birth, breast feeding, child weight, contraceptive use, birth order, wealth index, father education level, and birth interval are associated with infant mortality in Ethiopia. CONCLUSION: Infant deaths remains high and infant deaths per mother differ across regions. An optimal fit was found to the data based on a multilevel ZINB model. We suggest fitting the ZINB model to count data with excess zeros originating from unknown sources such as infant mortality.

Time-to-Disability Determinants Among Leprosy Patients Enrolled for Treatment at ALERT Center, Addis Ababa, Ethiopia: A Survival Analysis.

Background: Mycobacterium leprae causes leprosy, which is a long-term or recurrent infection. The causative agent's collusion with Schwann cells results in the irreversible loss of fringe nerve tissue; followed by incapacity, which includes not just actual impotence but also mental incapacity, creates a bad image of the transformed, resulting in segregation and societal humiliation of leprosy patients, as well as their families. Methods: This study's survival analysis includes a sample of 205 patients who were taking leprosy medication and had all essential data from January 2015 to December 2019 G.C. at the All African TB and Leprosy Rehabilitation and Training Centre. The Cox proportional hazard model was used to figure out what factors influence leprosy patients' survival status during treatment. Results: Among the 205 leprosy patients, 71 (34.63%) had at least one type of impairment grade during treatment. The Cox proportional model revealed that the most significant variables of impairment among leprosy patients were age, symptom duration, treatment category, living place, and sensory loss. Conclusion: The study investigated and revealed characteristics associated with the survival status of leprosy patients in ALRT centers using survival analysis. Patients' risk of worsening disability grade increased with age, was greater for patients with a long duration of symptom, was higher for defaulter patients, and was lower for patients who did not lose their sensibility throughout therapy. The existence of a difference in the survival curves between two or more groups of factors for the patient's survival function was also discovered in this inquiry. Female patients, particularly those who were new to the medication, were shown to be more in their survival.

Factors Associated With Community Based Health Insurance Healthcare Service Utilization of Households in South Gondar Zone, Amhara, Ethiopia. A Community-Based Cross-Sectional Study.

In Ethiopia, community-based health insurance was implemented to promote equitable access to sustainable quality health care and increase financial protection. The purpose of this study was to identify factors associated with community-based Health Insurance, Health Care Service Utilization of Households in the South Gondar Zone. A community-based cross-sectional study was employed. Data were collected among 619 randomly selected households in the south Gondar zone. Chi-square and binary logistic regression analyses with a P-Value of less than .05 were used to determine the association. Out of the total households, 511(82.6%) were using the CBHI scheme for health care service utilization. Residence, marital status, education level, occupation status, family size, presence of under-five children in the household, presence of elders in the households, nearest health institution, presence of chronic illness in the household's, time taken to reach health institution, an attitude of a household were the determinant factors of community-based health insurance scheme health care service utilization of households. It is recommended that the local, regional and national governments, policymakers on optimal actions, NGOs, and other supporting organizations shall improve or scale-up the scheme by providing awareness to the community based on these significant factors and the attitude of households.

Geographical disparities and determinants of adherence to iron folate supplementation among pregnant women in Ethiopia: spatial and multilevel analysis of the Ethiopian Mini Demographic and Health Survey of 2019.

OBJECTIVE: This study aimed to investigate geographic disparities and determinants of adherence to iron and folate supplementation among pregnant women in Ethiopia. METHOD: A secondary data analysis was performed using data from the Ethiopian Mini Demographic and Health Survey 2019. A total of 2235 pregnant women aged 15-49 years were included in the analysis. ArcGIS V.10.8 and SaTScan V.9.6 were used for spatial analysis. Multilevel logistic regression analysis was used to determinants. RESULT: Of the total number of participants, 80.3% of pregnant mothers took iron and folate supplements for less than the recommended days. Adherence to iron folate supplementation among pregnant women in Ethiopia was spatially clustered with Moran's global I=0.15868. The SaTScan analysis identified the most likely significant clusters found in the eastern Tigray, northeast Amhara and northwest Afar regions. Multivariable multilevel analysis showed that mothers who were living apart from their partner (adjusted OR (AOR)=10.05, 95% CI 1.84 to 55.04), had antenatal care (ANC) visits at least four times (AOR=0.53, 95% CI 0.41 to 0.69), a higher education level (AOR=0.39, 95% CI 0.25 to 0.63), big distance from health facilities (AOR=1.7, 95% CI 1.51 to 1.97) were significant factors of adherence to iron-folate supplementation. Mothers living in the Amhara and Addis Ababa regions were 0.35 (AOR=0.35, 95% CI 0.19 to 0.621), and 0.29 (AOR=0.29, 95% CI 0.15 to 0.7) times lower iron-folate supplementation intake than mother's in Tigray region. CONCLUSION: In this study, 8 out of 10 pregnant women did not take iron and folate supplements during the recommended period. As a result, health education activities were necessary to raise awareness among women and the community about the importance of iron folate supplementation during pregnancy, and public health programmes should increase iron folate supplementation through women's education, ANC visits and mothers living in low-iron areas.

Time to first antenatal care visit among pregnant women in Ethiopia: secondary analysis of EDHS 2016; application of AFT shared frailty models.

BACKGROUND: The survival of pregnant women is one of great interest of the world and especially to a developing country like Ethiopia which had the highest maternal mortality ratios in the world due to low utilization of maternal health services including antenatal care (ANC). Survival analysis is a statistical method for data analysis where the outcome variable of interest is the time to occurrence of an event. This study demonstrates the applications of the Accelerated Failure Time (AFT) model with gamma and inverse Gaussian frailty distributions to estimate the effect of different factors on time to first ANC visit of pregnant women in Ethiopia. METHODS: This study was conducted by using 2016 EDHS data about factors associated with the time to first ANC visit of pregnant women in Ethiopia. A total of 4328 women from nine regions and two city administrations whose age group between 15 and 49 years were included in the study AFT models with gamma and inverse Gaussian frailty distributions have been compared using Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) to select the best model. RESULTS: The factors residence, media exposure, wealth index, education level of women, education level of husband and husband occupation are found to be statistically significant (P-value < 0.05) for the survival time of time to first ANC visit of pregnant women in Ethiopia. Inverse Gaussian shared frailty model with Weibull as baseline distribution is found to be the best model for the time to first ANC visit of pregnant women in Ethiopia. The model also reflected there is strong evidence of the high degree of heterogeneity between regions of pregnant women for the time to first ANC visit. CONCLUSION: The median time of the first ANC visit for pregnant women was 5 months. From different candidate models, Inverse Gaussian shared frailty model with Weibull baseline is an appropriate approach for analyzing time to first ANC visit of pregnant women data than without frailty model. It is essential that maternal and child health policies and strategies better target women's development and design and implement interventions aimed at increasing the timely activation of prenatal care by pregnant women. The researchers also recommend using more powerful designs (such as cohorts) for the research to establish timeliness and reduce death.