Abstract
BackgroundThe maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria.MethodUsing women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6 weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95 % confidence interval (CI).ResultsOverall, 12,392 (60.6 %) of all women received antenatal care among whom 38.1 % dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8 % did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (OR = 1.18, CI: 1.04–1.34), distance to health facility (OR = 1.31, CI: 1.13–1.52), lack of formal education, being in poor wealth quintile (OR = 2.22, CI: 1.85–2.67), residing in rural areas (OR = 1.98, CI: 1.63–2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout.ConclusionThe rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.
Highlights
The maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits
Between delivery and postnatal visit, the same factors were associated with dropout
The rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems
Summary
The maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. As part of efforts to fast track the progress in child survival and maternal health, the continuum of care for Akinyemi et al BMC Pregnancy and Childbirth (2016) 16:282 maternal, neonatal and child health was designed [3] It includes healthcare services for mothers and children from pre-pregnancy to delivery, postnatal and childhood. The continuum provides for healthcare packages over time and at different points with an overall aim of promoting maternal, newborn and child survival [5] These specific time points are pre-pregancy, pregnancy, birth, newborn/postnatal and childhood. Wenjuyan et al [6] provided evidence on the trends and factors affecting utilisation of maternal and child health services in developing countries by focusing on antenatal, delivery and postnatal care. While the likelihood of use of these services was associated with urban residence, higher education and rich/richer wealth quintiles, the trends varied across countries
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