Multilevel analysis of continuation of maternal healthcare services utilization and its associated factors in Ethiopia: A cross-sectional study.

Abstract

Continuum of care (CoC) has been recognized as a crucial strategy for minimizing maternal, neonatal, and child mortality. CoC promotes integrated Maternal Neonatal and Child Health (MNCH) services by linking together three aspects of maternal health care antenatal care, skilled birth attendance, and postnatal care. The study aimed to assess continuation of maternal healthcare services utilization and its associated factors among reproductive age women at pregnancy, delivery and postnatal stages in Ethiopia. Cross-sectional study design conducted using Ethiopian 2016 Demographic and Health Survey data. All women with the most recent live birth in the last five years preceding the 2016 survey were the study population. The sample size was 7590, 2415, and 1342 at service entry (ANC use), COC at a delivery level, and CoC at Postpartum level respectively. COC was measured at three levels of maternal health care (during pregnancy, delivery, and postpartum). The CoC is constructed from four or more antenatal care visits (ANC4+), skilled birth attendance (SBA), and postnatal care (PNC). About 9.1% of women received all components of CoC. Educational attainment, wealth quintile, and media exposure were associated with four or more antenatal care visits and COC at the delivery level. Perception of getting money for healthcare, having blood pressure measured and urine sample taken during ANC was associated with continuity of care at the delivery level and continuity of care at a postpartum level. Birth order, residence, and region were common factors associated with each outcome of interest. The proportion of women who received all ANC4+, SBA, and PNC across the CoC was low in Ethiopia. Effort needed to increase CoC at each stage. The study shows that focusing on place of residence and regional state variation is necessary to improve CoC at each level. Thus, contextualizing the strategies and further research are critical.