Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project

Atnafu, Asmamaw; Kebede, Adane; Misganaw, Bisrat; Teshome, Destaw Fetene; Biks, Gashaw Andargie; Demissie, Getu Debalkie; Wolde, Haileab Fekadu; Gelaye, Kassahun Alemu; Yitayal, Mezgebu; Ayele, Tadesse Awoke; Azale, Telake; Derso, Terefe; Gebremedhin, Tsegaye; Dellie, Endalkachew

doi:10.1155/2020/4318197

Cited by 43 publications

(67 citation statements)

References 36 publications

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“…Moreover, women who heard about danger sign and women who delivered their second youngest child at health facility were more likely to have higher intensity of continuum of care. This finding is in line with the findings of previous studies in which women who received health education on maternal healthcare services were more likely to complete the continuum of care [ 34 , 44 ]. It is because of a good consultation including reminding on danger signs, and persuade the users to understand their health status increases the attachment of the women with the facility.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 92%

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

et al. 2021

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show abstract

“…Moreover, women who heard about danger sign and women who delivered their 2nd youngest child at health facility were more likely to have higher intensity of continuum of care. This nding is in line with the ndings of previous studies in which women who received health education on maternal healthcare services were more likely to complete the continuum of care (33,43). It is because of a good consultation including reminding on danger signs, and persuade the users to understand their health status increases the attachment of the women with the facility.…”

Section: Discussionsupporting

confidence: 89%

Continuum of Maternity Care Among Rural Women in Ethiopia: Does Place and Frequency of Antenatal Care Visit Matter?

Dadi

Medhin

Kasaye

et al. 2021

Preprint

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Introduction: The ministry of health (MOH) of Ethiopia recommends 4 or more focused antenatal care (ANC) visits at health centre or at a higher level of health facility. 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. Method: We used data collected from 1431 eligible women included in the National Health Extension Program (HEP) assessment survey that covered 6364 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 of the collected data, Propensity Score Matching was used to estimate the effect of place of ANC-1 visit on completion of CoC, and 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 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 2nd 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 2nd 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.

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“…Predictors in the models include women's socio-demographic (1), socio-economic (2) and cultural (3) factors which were found in the previous literatures to be associated with the use of maternal health services [25][26][27][28][29][30].…”

Section: B Independent Variablesmentioning

confidence: 99%

Determinants of the Continuum of Maternal Health Care in Cambodia: an analysis of the Cambodia Demographic Health Survey 2014

Chham¹,

Radovich

Buffel

et al. 2021

Preprint

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Introduction: Cambodia has achieved significant progress in maternal health, yet remains in the group of countries with the highest maternal mortality ratio in South-East Asia. Extra efforts are needed to improve maternal health through assessing the coverage of maternal health services as a continuum of care (CoC) and identifying the gaps. Our study aims to explore the coverage level of the Optimal CoC by (1) measuring the continuity of optimal antenatal care (ANC), skilled birth attendance (SBA) and optimal post-natal care (PNC), (2) identifying the determinants of dropping out from one service to another and (3) of not achieving the complete CoC. Method: The study employed data from the Cambodia Demographic Health Survey 2014. We restricted our analysis to married women who had a live birth in the five years preceding the survey (n=5678). Bi-variate and multivariate logistic regression were performed using STATA version 14. Results: Almost 50% of women had achieved the complete optimal CoC, while the remaining have used only one or two of the services. The result shows that the level of women’s education was positively associated with the use of optimal ANC, the continuation to using optimal PNC and achieving the complete CoC. More power of women in household decision making was also positively associated with receiving the complete CoC. The birth order was negatively associated with achieving the complete CoC, while exposure to the mass media and having health insurance increased the odds of achieving the complete CoC. Household wealth consequently emerged as an influential predictor of dropping out and not achieving the complete CoC. Receiving all different elements of ANC care improved the continuity of care from optimal ANC to SBA and from SBA to optimal ANC. Conclusion: The findings urge policy makers to approach maternal health care as a continuum of care with different determinants at each step. Household wealth was found to be the most influential factor, yet the study discovered also other barriers to optimal maternal health care which need to be addressed: future intervention should thus not only aim to increase wealth or health insurance coverage but also stimulate the education of women and empower women to claim power in household decision-making.

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Determinants of the Continuum of Maternal Healthcare Services in Northwest Ethiopia: Findings from the Primary Health Care Project

Cited by 43 publications

References 36 publications

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

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

Continuum of Maternity Care Among Rural Women in Ethiopia: Does Place and Frequency of Antenatal Care Visit Matter?

Determinants of the Continuum of Maternal Health Care in Cambodia: an analysis of the Cambodia Demographic Health Survey 2014

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