Continuum of maternity care among rural women in Ethiopia: does place and frequency of antenatal care visit matter?

Abstract

Introduction The ministry of health (MOH) of Ethiopia recommends 4 or more focused antenatal care (ANC) visits at health centre (HC) or at a higher level of health facility (HF). In Ethiopia, few studies investigated time dimension of maternal health continuum of care but lack data regarding place dimension and its effect on continuum of care. The aim of this study is to estimate effect of place of ANC-1 visit and adherence to MOH’s recommendations of MOH for ANC visits on continuum of care rural in Ethiopia. Methods We used data collected from 1431 eligible women included in the National Health Extension Program (HEP) assessment survey that covered 6324 households from 62 woredas in nine regions. The main outcome variable is continuum of care (CoC), which is the uptake of all recommended ANC visits, institutional delivery and postnatal care services. Following descriptive analysis, Propensity Score Matching was used to estimate the effect of place of ANC-1 visit on completion of CoC. Zero inflated Poisson regression was used to model the effect of adherence to MOH recommendation of ANC visits on intensity of maternal health continuum of care. Result Only 13.9% of eligible women completed the continuum of care, and place of first antenatal care (ANC) visit was not significantly associated with the completion of continuum of care (β = 0.04, 95% CI = -0.02, 0.09). Adherence of ANC visit to the MOH recommendation (at least 4 ANC visits at higher HFs than health posts (HPs)) increased the likelihood of higher intensity of continuum of care (aIRR = 1.29, 95% CI: 1.26, 1.33). Moreover, the intensity of continuum of care was positively associated with being in agrarian areas (aIRR = 1.17, 95% CI: 1.06, 1.29), exposed to HEP (IRR = 1.22, 95% CI: 1.16, 1.28), being informed about danger signs (aIRR = 1.14, 95% CI: 1.11, 1.18) and delivery of second youngest child at HF (IRR = 1.16, 95% CI: 1.13, 1.20). Increasing age of women was negatively associated with use of services (IRR = 0.90, 95% CI: 0.87, 0.94). Conclusion Completion of maternal health continuum of care is very low in Ethiopia, however most of the women use at least one of the services. Completion of continuum of care was not affected by place of first ANC visit. Adherence to MOH recommendation of ANC visit increased the intensity of continuum of care. Intensity of continuum of care was positively associated with residing in agrarian areas, HEP exposure, danger sign told, delivery of second youngest child at health facility. To boost the uptake of all maternal health services, it is crucial to work on quality of health facilities, upgrading the infrastructures of HPs and promoting adherence to MOH recommendations of ANC visit.

Multilevel analysis of the predictors of completion of the continuum of maternity care in Ethiopia; using the recent 2019 Ethiopia mini demographic and health survey

“…The study found that the overall magnitude of the completion of the continuum of maternity care was 12.9% (95%CI: 11.1 – 14.9%). This result was in line with studies done in Ethiopia (13.9%) [ 31 ], Nigeria (11.7%) [ 44 ], and Sub-Saharan Africa (13.6%) [ 45 ]. However, the finding was higher than studies done in Ethiopia, for instance, Arbaminch (9.7%) [ 46 ] and EDHS 2016 (6.56%) [ 28 ].…”

“…Previously studies done in Ethiopia identified that the completion of continuum of maternity care was impending by different factors like age [ 31 ], place of residence [ 31 – 33 ], educational status [ 31 – 34 ], marital status [ 28 ], religion [ 28 ], wealth status [ 28 ], parity [ 28 ], birth order [ 28 , 33 , 35 ], sex of household head [ 27 ], contraceptive use [ 33 ], being informed on pregnancy complications/danger signs during pregnancy [ 28 , 31 , 34 ], distance to health facilities [ 28 , 31 , 33 ], knowledge on the continuum of care [ 33 ], media exposure [ 28 , 32 ], woman’s decision making power [ 31 , 33 ], exposed to health extension program [ 31 ], pregnancy-related complication [ 31 ], timing of first initiation of ANC [ 31 , 34 ], and number of ANC visits [ 31 ].…”

Pooled Prevalence and Determinants of Completion of Maternity Continuum of Care in Sub-Saharan Africa: A Multi-Country Analysis of Recent Demographic and Health Surveys

“…Participants who had been told about pregnancy complications are 2.73 times more likely to complete the maternity continuum of care as compared with those who had not been told about pregnancy complications. The finding of this study is conclusive to the previous study stated as the odds of completion of the maternity continuum of care were higher among women informed about danger signs/pregnancy complications ( 22 , 25 ). The possible explanation could be due to the health-seeking behavior of women with information about pregnancy complications might be higher compared with those with no information ( 38 ) and this makes them conscious to fully engage across the continuum of care.…”

“…This might inflate the prevalence compared with the current study, as education is one factor significantly associated with the outcome variables. On the other hand, the current study finds a higher prevalence compared with the previous study done at Arbaminch Ethiopia 9.5% ( 24 ), in Ethiopia from EDHS data analysis 13% ( 16 ), in rural women Ethiopia 13.9% ( 25 ), Nigeria 18% ( 26 ), Ghana 8% ( 27 ), and Tanzania 10% ( 28 ). The possible explanation for the higher prevalence of completion of the maternity continuum of care compared with the previous study done in Ethiopia might be due to the variation in the demarcation of the operational definition of the outcome variable.…”

Dropout from a maternal and newborn continuum of care after antenatal care booking and its associated factors in Debre Berhan town, northeast Ethiopia

“…Similarly, mothers whose husbands were aged between 40 and 49 years were three times more likely to drop out of the PNC than those aged between 20 and 29 years. A National Health Extension Program assessment in Ethiopia showed that increasing age was negatively associated with the continuum of maternity care ( 25 ). Similarly, a community-based cross-sectional study in East Gojjam reported that being in the age range of 15–24 years increases the odds of early initiation and continuation of ANC visits ( 26 ).…”