Predictors of dropout from maternal continuum of care in Ethiopia: evidence from the 2016 population-based health survey

Abstract

IntroductionIntegrated primary health care service provided by skilled birth attendants is linked to safe childbirth and postnatal care, vitally improves maternal, newborn, and child health outcomes. Despite a significant reduction in maternal and neonatal mortality in Ethiopia, low maternal service utilization, and dropout from the maternal continuum of care continues to be a major challenge. Therefore, this study aimed to investigate the individual and community predictors of dropout from the maternal continuum of care in Ethiopia.MethodsWe used data from the 2016 Ethiopian demographic and health survey (EDHS). Women who had a birth in the 5 years preceding the survey were included. Dropout from the maternal continuum of care was the outcome of this study. This includes, attending less than four antenatal care visits (<4 ANC), a dropout from skilled birth attendance (SBA) after having 4 or more ANC, and dropout from postnatal care (PNC) after having SBA. Multilevel logistic regression analysis was employed. The mixed effect and variation in the outcome were expressed by the intracluster correlation coefficient (ICC).ResultsHigher dropouts from SBA to PNC (85%) and from ≥4 ANC to SBA (43.4%) in the maternal continuum of care were observed. Women from the poorest wealth quantile (AOR=2.31,95% CI 1.69,3.16), not covered by health insurance (AOR=1.44, 95% CI, 1.01,2.06), and residing in a community with high poverty (AOR=1.28,95% CI, 1.01,1.63) were more likely to attend inadequate ANC. On the other side, distance from a health facility (AOR=1.45, 95% CI, 1.12,1.88), lower community media exposure (AOR=1.6, 95% CI, 1.14,2.23) and rural residency (AOR=3.03, 95% CI, 1.75,5.26) were associated with dropout from SBA after attending ANC visits. Living in Somali, Harari, and Dire Dawa significantly associated with drop out from the PNC after SBA.ConclusionThe pattern of dropout from the maternal continuum of care was higher in Ethiopia. Maternal education, wealth index, community media exposure, and distance from a health facility were the factors associated with dropouts from the maternal continuum of care. Home care strategies and contextual understanding of the barriers to the PNC service is needed.

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

“…Women who were not exposed to media were more likely to drop out of the PNC. The finding of a strong media effect is consistent with findings of previous studies (8,9,(15)(16)(17). Mass media is an important technology that allows women to access maternal health-related information, the importance of regular health-seeking behavior, and challenge negative social norms, which helps women to improve their knowledge, attitude, and practice continuum of maternity care.…”

“…However, the dropout rate of this study was lower than that in the study conducted in Nigeria, where 38.1% of women dropped out and never met with skilled assistants at delivery ( 6 ). It is also lower than 46.5% dropout from institutional delivery and 87.1% from postnatal care visits in Ethiopia ( 9 ), as well as lower than 43.4% dropouts from ≥4 ANC to SBA and 85% from SBA to PNC in the maternal continuum of care ( 16 ). This might be attributable to older ages at the first birth, better awareness of healthcare services, a better level of education, and a favorable attitude toward maternal and child healthcare in the present study.…”

“…The poorest communities in Tanzania significantly dropped out of the care continuum and made fewer points of contact for care ( 7 ). Women from the poorest wealth quantile and residing in a community with high poverty were less likely to complete the recommended ANC contact ( 16 ). Although in Ethiopia, MNCH services are being provided for free, most women buy essential drugs on their own as these drugs are often not available in the facilities.…”