Modelling Excess Zeros in Count Data with Application to Antenatal Care Utilisation

Abstract

Poisson and negative binomial regression models have been used as a standard for modelling count outcomes; but these methods do not take into account the problems associated with excess zeros. However, zero-inflated and hurdle models have been proposed to model count data with excess zeros. The study therefore compared the performance of Zero-inflated (Zero-inflated Poisson (ZIP) and Zero-inflated negative binomial (ZINB)), and hurdle (Hurdle Poisson (HP) and Hurdle negative binomial (HNB)) models in determining the factors associated with the number of Antenatal Care (ANC) visits in Nigeria. Using the 2013 Nigeria Demographic and Health Survey dataset, a sample of 19 652 women of reproductive age who gave birth five years prior to the survey and provided information about ANC visits was utilised. Data were analysed using descriptive statistics, ZIP, ZINB, HP and HNB models, and information criteria (AIC/BIC) was used to assess model fit. Participants’ mean age was 29.5 ± 7.3 years and median number of ANC visits was 4 (range: 0 - 30). About half (54.9%) of the participants had at least 4 ANC visits while 33.9% had none. The ZINB (AIC = 83 039.4; BIC = 83 470.3) fitted the data better than the ZIP or HP; however, HNB (AIC = 83 041.4; BIC = 83 472.3) competed favorably well with it. The Zero-inflated negative binomial model provided the better fit for the data. We suggest the Zero-inflated negative binomial model for count data with excess zeros of unknown sources such as the number of ANC visits in Nigeria.