Dropout from maternity continuum of care and associated factors among women in Debre Markos town, Northwest Ethiopia

Abstract

Introduction: Maternity continuum of care is the continuity of maternity health care services that a woman uses antenatal care, skill birth attendant, and postnatal care. This Continuum of care in maternal health has become one of the government concern and program for planning and evaluating strategies within currently existing maternal health system of Ethiopia. It is an important intervention in reducing maternal and neonatal morbidity and mortality. However, there is no clear information on the proportion of dropout from maternity continuum of care in Ethiopia. Objective:The aim of this study was to assess proportion and associated factors of dropout from maternity continuum of care among mothers who gave birth in the last 12 months in Debre Markos town, Northwest Ethiopia, 2018. Methods:A community-based cross-sectional study with cluster sampling technique was conducted among 605 mothers who gave birth in the last 12 months in Debre Markos town. The data were collected from August 1-30/ 2018 by face to face interview through pretested and semi-structured questionnaire. Binary logistic regressions (Bivariable and Multivariable) logistic regression model were done. In multivariable analysis variables with P-value < 0.05 in 95% confidence interval for Adjusted odds ratio (AOR) was used to determine factors associated with dropout from maternity continuum of care. Results:The proportion of drop out from maternity continuum of care was found to be 32.2 %( 95%CI: 28.4-36.2). Have not exposure to media (AOR= 2.62, CI: 1.465-4.675), women who heard about PNC (AOR= 0.07, 95%CI: 0.035-0.154), unplanned pregnancy (AOR= 3.40, CI: 1.114-10.389), and having<4 ANC follow up (AOR = 3.0 3, CI: 1.963-4.685) were statistically significant variable with the dropout from maternity continuum of care. Conclusion and recommendationsIn this study, the proportion of dropout from maternity continuum of care is found to be high. The greatest gap and predictors for dropout was observed at postnatal care level, to reduce this drop out interventions on specified associated factors need to be implemented.

Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia

“…Respondents with the number of antenatal care 3-4 are two times to complete maternity continuum of care as compared to the respondent with antenatal care 1-2. This finding is supported by different studies [10,18,[36][37][38]. The possible explanation could be women with a greater number of antenatal care visit have greater contact with health care provider this can be important to gate the full services of antenatal care including birth preparedness and complication readiness then a woman who prepared for birth have a higher chance to avail on time to the health institution and delivered by skilled birth attendant and having immediate postpartum care as well.…”

High dropout rate from maternity continuum of care after antenatal care booking and its associated factors among reproductive age women in Ethiopia, Evidence from Demographic and Health Survey 2016

“…Unmarried women had nearly 50% (AOR = 0.58, 95%CI: 0.38, 0.88) fewer odds of dropout from antenatal care service after being registered for it compared to married. On the contrary, some studies conducted elsewhere have noted that marital status was not significantly associated with dropout from the maternity continuum of care [6,7,12,13,15,18,19]. This might be due to the effect of reduced women's autonomy on decision making.…”

“…The dropout rate from maternity continuum of care was high compared to other studies conducted in Nigeria of which women 38.1% and 50.8% of the women who receive ANC were dropped out from skilled delivery and PNC respectively [18], Cambodia About 90% had at least one ANC, 60% of them 4 and above, 74% Skill birth attendance and 71% had at least one postnatal checkup [13], and Debremarkos where women had 32.2% dropout from all continuum of care, while 66.4% and 84.1% had four and above ANC, and institutional delivery respectively [15]. The difference might be due to variation in the population, quality, and…”

“…Women in developing countries including Ethiopia were vulnerable to high dropout rates from the maternal continuum of care sequentially from Antenatal Care (ANC) to institutional delivery, and from institutional delivery to Postnatal Care (PNC) services [12][13][14][15][16][17].…”

“…Poverty, distance from the health facility, lack of information, inadequate and poor quality services, cultural beliefs, and practices were the main factors that affect women in developing countries to receive care during pregnancy and childbirth [1,18]. Different factors also contribute to completion/dropout rate of the maternal continuum of care age at first birth, the number of children, with higher education, belonging to richest quintile, place of residence, women autonomy, and mass media exposure [12,15,16,19].…”