Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries

Understanding Socioeconomic Inequalities in Zero-Dose Children for Vaccination in Underserved Settings of Ethiopia: Decomposition Analysis Approach

Despite considerable global efforts to enhance vaccine distribution in low-income countries, a significant number of children remain unvaccinated, particularly in Ethiopia. The underlying socioeconomic challenges in these regions are recognized as primary contributors to the low vaccination rates. However, the reasons for this persistent disparity in Ethiopia's remote and underserved regions need further analysis. The study employed a cross-sectional design and was conducted as part of the Project HOPE Zero-Dose Evaluation from 1 February to 31 July 2022. Concentration indices were utilized to quantify the extent of inequality, with further decomposition aimed at identifying contributing factors to this disparity. The findings underscored that populations with lower socioeconomic status encounter high numbers of children receiving no vaccinations. Key factors influencing the number of zero-dose children included distance from healthcare facilities (61.03%), economic status of the household (38.93%), absence of skilled birth assistance (20.36%), underutilization of antenatal care services ( Collapse

Key Words

• Ethiopia
• concentration index
• decomposition analysis
• immunization
• zero-dose

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MESH Headings

• Ethiopia
• Humans
• Cross-Sectional Studies
• Socioeconomic Factors
• Vaccination/statistics & numerical data
• Female
• Infant
• Child, Preschool
• Male
• Healthcare Disparities/statistics & numerical data

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Grants

• NV 018567 Bill & Melinda Gates Foundation

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Affiliation(s)

Gashaw Andargie Biks Project HOPE, Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (F.S.); (D.A.T.)
Fisseha Shiferie Project HOPE, Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (F.S.); (D.A.T.)
Dawit Abraham Tsegaye Project HOPE, Ethiopia Country Office, Addis Ababa P.O. Box 45, Ethiopia; (F.S.); (D.A.T.)
Wondwossen Asefa Project HOPE Headquarter, 1220 19th St NW #800, Washington, DC 20036, USA;
Frank DelPizzo Bill & Melinda Gates Foundation, 500 5th Ave N, Seattle, WA 98109, USA;
Samson Gebremedhin School of Public Health, Addis Ababa University, Addis Ababa P.O. Box 1176, Ethiopia;

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Do timing and frequency of antenatal care make a difference in maternal micronutrient intake and breastfeeding practices? Insights from a multi-country study in South Asia

Despite the established benefits of vitamins and minerals for maternal and neonatal health, global micronutrient deficiency remains a significant concern. As such, the World Health Organization advocates timely antenatal care (ANC) initiation and micronutrient supplementation for expectant mothers. This study investigates the association between ANC timing and frequency and maternal health behaviours, specifically iron-folic acid (IFA) intake, early breastfeeding initiation, and exclusive breastfeeding among married women in South Asia. By utilizing recent Demographic and Health Survey data, this study focuses on married women aged 15-49 in Bangladesh (N = 966), India (N = 89,472), and Pakistan (N = 1,005), specifically primiparous women with children aged 0-23 months living with the motherMultivariable analysis revealed that women receiving ≥4 ANC visits were more likely to consume IFA ≥90 days compared to those with fewer visits in Bangladesh (AOR: 1.85, 95% CI [1.30, 2.63]), India (AOR: 1.87, 95% CI [1.81, 1.94]), and Pakistan (AOR: 1.92, 95% CI [1.24, 2.97]). Women receiving first ANC in the second or third trimester were less likely to consume IFC for ≥90 days compared to those with first-trimester ANC. While the ANC timing did not significantly influence early breastfeeding initiation, ANC frequency was inversely associated with delayed initiation in all countries. Breastfeeding advice during ANC visits was significantly associated with reduced odds of delayed breastfeeding initiation. Neither ANC timing nor frequency significantly predicted exclusive breastfeeding, except for breastfeeding advice in India. This study highlights the importance of ANC in maternal and child health outcomes. ANC timing and frequency, along with breastfeeding advice during ANC, notably influence maternal IFA consumption and early breastfeeding initiation. These findings underscore the need for targeted interventions during ANC visits to enhance maternal and child health practices in low- and middle-income countries.

Factors determining antenatal care utilization among mothers of deceased perinates in Ethiopia

Introduction

Receiving adequate antenatal care (ANC) had an integral role in improving maternal and child health outcomes. However, several factors influence the utilization of ANC from the individual level up to the community level factors. Thus, this study aims to investigate factors that determine ANC service utilization among mothers of deceased perinate using the proper count regression model.

Method

Secondary data analysis was performed on perinatal death surveillance data. A total of 3,814 mothers of deceased perinates were included in this study. Hurdle Poisson regression with a random intercept at both count-and zero-part (MHPR.ERE) model was selected as a best-fitted model. The result of the model was presented in two ways, the first part of the count segment of the model was presented using the incidence rate ratio (IRR), while the zero parts of the model utilized the adjusted odds ratio (AOR).

Result

This study revealed that 33.0% of mothers of deceased perinates had four ANC visits. Being in advanced maternal age [IRR = 1.03; 95CI: (1.01-1.09)], attending primary level education [IRR = 1.08; 95 CI: (1.02-1.15)], having an advanced education (secondary and above) [IRR = 1.14; 95 CI: (1.07-1.21)] and being resident of a city administration [IRR = 1.17; 95 CI: (1.05-1.31)] were associated with a significantly higher frequency of ANC visits. On the other hand, women with secondary and above education [AOR = 0.37; 95CI: (0.26-0.53)] and women who live in urban areas [AOR = 0.42; 95 CI: (0.33-0.54)] were less likely to have unbooked ANC visit, while women who resided in pastoralist regions [AOR = 2.63; 95 CI: (1.02-6.81)] were more likely to have no ANC visit.

Conclusion

The uptake of ANC service among mothers having a deceased perinate was determined by both individual (maternal age and educational status) and community (residence and type of region) level factors. Thus, a concerted effort is needed to improve community awareness through various means of communication by targeting younger women. Furthermore, efforts should be intensified to narrow down inequalities observed in ANC service provision due to the residence of the mothers by availing necessary personnel and improving the accessibility of service in rural areas.

First trimester antenatal care contact in Africa: a systematic review and meta-analysis of prevalence and contributing factors

BACKGROUND

Early detection, prevention, and management of diseases associated with pregnancy and pregnancy-related conditions depend on the beginning of antenatal care contact in the first trimester. Across Africa, regional and national differences are observed in the proportion of first-trimester ANC contact and the factors contributing to it. To create a suitable intervention plan, it is crucial to overcome these differences through single standard and uniform guidelines. This can be achieved through meta-analysis and systematic reviews. Therefore, this systematic review aimed to assess the pooled prevalence of first trimester ANC contact and the factors contributing to it in Africa.

METHODS

Observational studies conducted in Africa were retrieved from PubMed, Google Scholar, EMASE, CINHAL, Cochrane Library, Hinari databases and Mednar using combinations of search terms with Boolean operators. The JBI 2020 Critical Appraisal Checklist was used to assess the methodological quality of the studies. To assess publication bias, a funnel plot and Egger's test were used to and I-squared was used to check the heterogeneity of the included studies. Data were extracted using Microsoft Excel and exported to Stata 16 software for analysis.

RESULTS

A total of 86 articles with 224,317 study participants from 19 African countries were included. The overall pooled prevalence of first-trimester ANC contact was 37.15% (95% CI: 33.3-41.0; I2 = 99.8%). The following factors were found to be significantly associated with first-trimester ANC contact: urban residence (OR = 2.2; 95% CI: 1.5-3.1; I2 = 98.5%); women under the age of 25 (OR = 1.5; 95% CI: 1.2-1.9; I2 = 94.1%);, educational status (OR = 1.8; 95% CI: 1.4-2.2; I2 = 96.1%), primiparity (OR: 1.7; 95% CI: 1.2-2.4: I2 = 97.4%), having planned pregnancies (OR: 2.1; 95% CI: 1.5-2.7; I2 = 95.5%) and employed women (OR = 1.7; 95% CI: 1.7-2.1; I2 = 94.4%).

CONCLUSION

Because so few women in Africa initiate first-trimester ANC contact, it is clear that increasing maternal healthcare service uptake is still a challenge and will require significant effort to scale up the services. When working to improve maternal health in Africa, each nation's government and nongovernmental organizations should prioritize raising women's educational levels and providing pertinent information to rural women, focusing on reducing unintended pregnancies, women who live far from health facilities, women with low socioeconomic statuses, multiparous women and older women.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic reviews (ID: CRD42023401711).

Time to initiation of antenatal care visit and its predictors among reproductive age women in Ethiopia: Gompertz inverse Gaussian shared frailty model

Background

Early initiation of antenatal care (ANC) is essential for the early detection of pregnancy-related problems and unfavorable pregnancy outcomes. However, a significant number of mothers do not initiate ANC at the recommended time. Therefore, this study aimed to determine the median time of ANC initiation and its predictors among reproductive-age women in Ethiopia.

Methods

We used the Ethiopian Demographic and Health Survey (EDHS) 2016 data set. The proportional hazard assumption was assessed using Schoenfeld residual test and log-log plot. A life table was used to determine the median survival time (time of ANC initiation). The Gompertz inverse Gaussian shared frailty model was the best-fitting model for identifying the predictors for the early initiation of ANC booking. Finally, the adjusted hazard ratio (AHR) with a 95% confidence interval (CI) was used to determine the significance of predictors.

Results

A total of 7,501 reproductive-aged women gave recent birth in the last 5 years preceding the survey. Nearly three in five women [61.95% (95% CI: 60.85-63.04%)] booked their first ANC visit with a median time of 4.4 months. Women who attended primary education (AHR = 1.10, 95% CI: 1.01-1.20), secondary and above (AHR = 1.26, 95% CI: 1.11-1.44), media exposure (AHR = 1.07, 95% CI: 1.00-1.16), rich wealthy (AHR = 1.17, 95% CI: 1.06-1.30), grand multiparous (AHR = 0.82, 95% CI: 0.72-0.93), unwanted pregnancy (AHR = 0.88, 95% CI: 0.81-0.96), small periphery region (AHR = 0.58, 95% CI: 0.51-0.67), and rural residence (AHR = 0.86, 95% CI: 0.75-0.99) were significantly associated with first ANC visit.

Conclusion

According to this study, a significant number of women missed their first ANC visit. The education status of women, place of residence, region, wealth index, media exposure, unintended pregnancy, and multi-parity were significantly associated with the time of initiation of the first ANC visit. Therefore, policymakers should focus on improving the socioeconomic status (education, media coverage, and wealth) of reproductive-aged women by prioritizing women who live in small periphery regions and rural residences to improve the early initiation of ANC.

Interprofessional qualification of prenatal care in the context of primary health care

This study aims to describe and analyze an interprofessional educational intervention for the qualification of prenatal care in the context of primary health care.

METHOD

action-research comprising a prenatal care qualification course with 65 primary health care professionals. Collaborative learning activities were conducted in synchronous and asynchronous meetings.

RESULTS

the reflexive thematic analysis of participants' experiences, views and perceptions on the meanings of the intervention revealed three categories: quality of prenatal care: conceptions and meanings; collaborative learning: strategy to overcome linear and isolated care; the need to evolve from acting locally to thinking globally.

CONCLUSION

the analysis of the interprofessional educational intervention for the qualification of prenatal care in the context of primary health care showed that constructivist, participatory and interprofessional approaches are relevant and pertinent to broaden theoretical perceptions and give new meanings to the work process at different settings of the health network.

Breastfeeding Trends and it's Related Factors in Indonesia: A National Survey

This cross-sectional study aimed to examine breastfeeding trends and factors in Indonesia using Demographic Health Survey (DHS) data from 2007 to 2017. The research data were obtained from three Indonesia Demographic Health Surveys. The data covered households and women aged 15‒49 years old, including 40,701 households and 32,895 women in 2007; 43,852 households and 45,607 women in 2012; and 47,963 households and 49,627 women in 2017. Descriptive statistics was deployed to analyze the sociodemographic factors of the respondents. A questionnaire was employed to obtain data on the mothers' age, residence, education, economic status, mother working, marital status, literacy, place of delivery, first Antenatal Care (ANC) place, child size at birth, and gender of the child. Multinomial logistic regression analysis was used to analyze factors related to breastfeeding and how big the impact is. The findings indicate that the trend of breastfeeding in Indonesia significantly decreased based on the characteristics of mothers and children. The rates of breastfeeding (exclusive breastfeeding infants aged 0‒5 months who received only breast milk) among mothers living in urban areas decreased significantly from 41.6% in 2012 to 38.4% in 2017. In 2017, children with normal birth weight (OR=0.87, 95% CI:0.53‒1.45), boys (OR=1.01, 95% CI:0.92‒1.10), and non-illiterate mothers (OR=0.50, 95% CI:0.46‒0.55) had higher odds of breastfeeding compared to children with small birth weight, girls, and illiterate mothers. Factors associated with breastfeeding also change every year. In 2012, breastfeeding was related to marital status and delivery, but in 2017 it was not associated with those factors. Factors related to breastfeeding in Indonesia are age, residence, education, weight index, size of child at birth, mother’s occupation, marital status, literacy, place of delivery, and first ANC place. These results are important for developing policies to improve maternal and child health in Indonesia by increasing education and mother training for early initiation of breastfeeding.

Inequalities in adherence to the continuum of maternal and child health service utilization in Ethiopia: multilevel analysis

BACKGROUND

Despite progress made to improve access to child health services, mothers' consistent utilization of these services has been constrained by several factors. This study is aimed at assessing the inequalities in key child health service utilization and assess the role of antenatal care (ANC) on subsequent service use.

METHOD

The analysis of the present study was based on the Ethiopian Demographic and Health Surveys, a nationally representative sample of 10,641 children. A health service utilization score was constructed from the affirmative responses of six key child health interventions associated with the most recent birth: ANC service, delivery of the last child at health facilities, postnatal care services, vitamin A intake, iron supplementation and intake of deworming pills by the index child. A mixed effect Poisson regression model was used to examine the predictors of health service utilization and three separate mixed effect logistic regression models for assessing the role of ANC for continued use of delivery and postnatal care services.

RESULTS

The results of mixed effect Poisson regression indicate that the expected mean score of health service utilization was lower among non-first birth order children, older and high parity women, those living in polygamous families and women living in households with no access to radio. The score was higher for respondents with better education, women who had previous experience of terminated pregnancy, residing in more affluent households, and women with experiences of mild to high intimate partner violence. Further analysis of the three key health services (ANC, delivery, and postnatal care), using three models of mixed effect logistic regression, indicates consistent positive impacts of ANC on the continuum of utilizing delivery and postnatal care services. ANC had the strongest effects on both institutional delivery and postnatal care service utilization.

CONCLUSION

The findings implicated that maternal and child health services appear as continuum actions/behavior where utilization of one affects the likelihood of the next service types. The study indicated that promoting proper ANC services is very beneficial in increasing the likelihood of mothers utilizing subsequent services such as delivery and postnatal care services.

Integrative Strategies for Preventing Nutritional Problems in the Development of Children in Brazil

Child healthcare has been a priority subject in several programs and public policies developed over the decades. However, initiatives implemented seem insufficient to overcome the challenges regarding the integral development and improvement of the nutritional status of children in Brazil. The initial developmental stages of a child include pregnancy, breastfeeding, and complementary feeding, which are determinants in future aspects of health and nutritional status. Therefore, the strategies addressing problems during these three periods of life have the potential to positively impact the promotion of healthy eating habits and food security throughout life. Developing countries with huge dimensions and vast inequalities, like Brazil, are marked by differences in regional, cultural, and social contexts that may hinder the implementation of programs and policies with a broad scope. Extensive operational and professional costs, in addition to time-consuming activities that are necessary to apply, monitor, and evaluate interventions may jeopardize the proper assessment of programs and policy goals, generating the inefficiency and waste of resources in the health system. Thus, programs and policies aimed at creating and modifying habits should consider an intersectoral action within local contexts, involving health professionals, universities, policy managers, and the community. Therefore, this article aimed to discuss the preliminary conception of an integrated approach of decentralized strategies to promote healthy eating habits and food security of children in Brazil.

Prevalence of common symptoms of neonatal illness in Northwest Ethiopia: A repeated measure cross-sectional study

BACKGROUND

The neonatal period is the most vulnerable stage of life. In Ethiopia, neonatal illness is common and the reduction in neonatal mortality is not as significant as for under-five mortality.

OBJECTIVES

To determine the prevalence and factors associated with neonatal illness symptoms reported by mothers delivering in health facilities in Northwest Ethiopia.

METHODS

A repeated measure cross-sectional study design was employed to collect data from 358 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. A pretested and interviewer-administered structured questionnaire adapted from the literature was employed to record neonatal outcomes (illnesses and/or deaths) at birth, 24 hours, 7th, 14th and 28th day from birth. Cleaned data was exported to STATA version 14 software for analysis. Multilevel analysis was used to identify individual and facility-level characteristics associated with neonatal illness symptoms.

RESULTS

The prevalence of neonatal illness symptoms was 27.8% (95% CI; 23.2, 32.8) of the 338 babies born alive and the neonatal mortality rate was 41/1000 live births (14/338). The most common symptoms or conditions of neonatal illness reported by mothers' in the study area were possible serious bacterial infections (95.8%, 90/94), localized bacterial infections (43.6%, 41/94), low birth weight (23.4%, 22/94), diarrhea (18.1%, 17/94), prematurity (14.9%, 14/94), and jaundice (7.5%, 7/94). Among the babies who died, neonates who had possible serious bacterial infections, low birth weight, localized bacterial infections, and prematurity took the highest proportions with 100% (14/14), 64.3% (9/14), 50% (7/14), and 42.9% (6/14), respectively. Having a maximum of 3 children (AOR = 1.96; 95% CI = 1.1-3.6), having twins or triplets during pregnancy (AOR = 2.43; 95% CI = 1.1-6.1), and lack of antenatal counseling (AOR = 1.83; 95% CI = 1.1-3.3) were among the maternal factors associated with neonatal illness. Having low birth length (AOR = 7.93; 95% CI = 3.6-17.3), and having a poor breastfeeding quality (AOR = 2.37; 95% CI = 1.4-4.0) were found to be the neonatal factors associated with neonatal illness.

CONCLUSIONS

This study indicated a high prevalence of neonatal illness symptoms in Northwest Ethiopia. Therefore, early detection, referral and better management of symptoms or conditions with a high mortality, like sepsis and low birth weight are compulsory to save the lives of many neonates. Strengthening the health extension programme to improve antenatal care service utilization and breastfeeding quality of neonates among postpartum women is crucial.

Are Ghanaian women meeting the WHO recommended maternal healthcare (MCH) utilisation? Evidence from a national survey

Background

To achieve the Sustainable Development Goal target 3.1, the World Health Organisation recommends that all pregnant women receive antenatal care (ANC) from skilled providers, utilise the services of a skilled birth attendant at birth and receive their first postnatal care (PNC) within the first 24 h after birth. In this paper, we examined the maternal characteristics that determine utilisation of skilled ANC, skilled birth attendance (SBA), and PNC within the first 24 h after delivery in Ghana.

Methods

We used data from the 2014 Ghana Demographic and Health Survey. Women aged 15-49 with birth history not exceeding five before the survey were included in the study. A total of 2839 women were included. Binary logistic regression was employed at a 95% level of significance to determine the association between maternal factors and maternal healthcare (MCH) utilisation. Bivariate and multivariate regression was subsequently used to assess the drivers.

Results

High proportion of women had ANC (93.2%) with skilled providers compared to the proportion that had SBA (76.9%) and PNC within the first 24 h after delivery (25.8%). Only 21.2% utilised all three components of MCH. Women who were covered by national health insurance scheme (NHIS) had a higher likelihood (AOR = 1.31, CI = 1.04 – 1.64) of utilising all three components of MCH as compared to those who were not covered by NHIS. Women with poorer wealth status (AOR = 0.72, CI = 0.53 – 0.97) and those living with partners (AOR = 0.65, CI = 0.49 – 0.86) were less likely to utilise all three MCH components compared to women with poorest wealth status and the married respectively.

Conclusion

The realisation that poorer women, those unsubscribed to NHIS and women living with partners have a lower likelihood of utilising the WHO recommended MCH strongly suggest that it is crucial for the Ministry of Health and the Ghana Health Service to take pragmatic steps to increase education about the importance of having ANC with a skilled provider, SBA, and benefits of having the first 24 h recommended PNC.

Maternal height associated with cesarean section. A cross-sectional study using the 2014-2015 national maternal-child health survey in Guatemala

BACKGROUND

Socioeconomic status is associated with cesarean section (CS). Maternal height, however, may be another related factor to CS. In Guatemala, a quarter of women between 15 and 49 years of age are shorter than 145 cm. Therefore, this study aims to examine the association of maternal height with cesarean section in Guatemala.

METHODS

We carried out a secondary analysis study using data from the 2014-15 Guatemalan national maternal and child health survey-9542 mothers aged 15-49 and 12,426 live births were analyzed. We obtained the prevalence ratio of the association between maternal height and CS based on three Poisson regression models. One model included all live births, another the first live birth, and a third model the last live birth. For each model, we accounted for covariates and sampling design.

RESULTS

The national prevalence of CS was 26.3% (95%CI: 25.0, 27.7). The adjusted prevalence ratio of CS, including all live births, was 1.63 (95%CI: 1.37, 1.94) more likely in mothers shorter than 145 cm compared with those equal or greater than 170 cm. This figure was 1.45 (95%CI: 1.19, 1.76) in the model with the first live birth. In the model with the last birth, maternal height was not associated with CS after accounting for previous CS as one of the covariates.

CONCLUSIONS

Prevalence of CS in this setting was high and above international recommendations. Further, very short mothers were more likely to experience CS compared to taller mothers after accounting for covariates, except when a previous CS was present. Maternal height should be included in clinical assessments during prenatal care.

Factors Associated with U5M in the Afar Region of Ethiopia

Background. Ethiopia has experienced a significant reduction of under-five mortality over the past few decades. But still, the country is far from the Sustainable Development Goals (SDGs) of 2030. This study aims to identify the potential associated factors of under-five mortality in the Afar region, Ethiopia. Methods. Data from a national representative cross-sectional survey of Ethiopian Demographic and Health Survey of the year 2016 were used. Data were collected from the population of all under-five children in randomly selected enumeration areas of the Afar region of Ethiopia. Chi-squared and binary logistic regression analyses were employed. Results. The result revealed that twin child [(AOR = 5.37; 95%CI: 2.12–13.62)], age of mothers at first birth [(AOR = 0.47; 95%CI: 0.35–0.62) of greater than 16], current breastfeeders (AOR = 0.41; 95%CI: 0.32–0.54), rural residents (AOR: 2.54; 95%CI: 2.49–2.58), used current contraceptive methods (AOR = 0.38; 95%CI: 0.15–0.94), vaccinated the child (AOR = 0.40; 95%CI: 0.27–0.59), family size [(AOR = 0.65; 95%CI: 0.41–0.92) for 4–6 household members and (AOR = 0.49; 95%CI: 0.29–0.80) for seven and more household members], rich households (AOR = 0.03; 95%CI: 0.01–0.16), mother’s age group [(AOR = 3.24; 95%CI: 1.90–5.54) (age 20–29), (AOR = 12.43; 95%CI: 6.86–22.51) (age 30–39), and (AOR = 46.31; 95%CI: 21.74–98.67) (age 40 and above), and antenatal visits ((AOR = 0.48; 95%CI: 0.31–0.74) (1–3 visits) and (AOR = 0.44; 95%CI: 0.24–0.81) (4 and more visits)) significantly determined the under-five mortality. Conclusions. The study showed that giving birth at an early age, low coverage and quality of health access, unimproved breastfeeding culture, nonaccessibility to contraceptive methods, absence of awareness of mothers on vaccination of a child, low economic status of households, and low status of mothers’ antenatal visits lead to the highest under-five mortality in the area. Therefore, community-based educational programs and public health interventions focused on improving the survival of children by providing awareness to the community and specifically to mothers should be improved.

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

Background

Maternal continuums of care were vital to reducing maternal and neonatal mortalities. While the dropout rate remains high and limited studies were found on risk factors associated with a high dropout rate of the maternal continuum of care.

Objective

This study aimed to assess the magnitude of dropout rate and its associated factors of maternity continuum of care in Ethiopia, 2016

Methods

An in-depth secondary data analysis was conducted from the Ethiopian Demographic and Health Survey 2016 data. A total of 4,693 women who were booked for antenatal care visit were included to the final analysis. A community-based cross-sectional study design and a pre-tested and standardized questionnaire were used to collect the survey data. Data were weighted using women data weighting variables. Chi-square and multicollinearity assumptions were checked for independent variables. Bi-variable and multivariable logistics regression used to identify associated factors with a cut of the p-value of 0.2 and 0.05 respectively. Adjusted Odds Ratio (AOR) with 95%CI was reported for the final model.

Results

Of the total 4,693 women who were booked for antenatal care visits, 2,092(44.58%), 2,183 (46.52%), and 4,086(87.07%) dropped from a recommended number of ANC, Institutional delivery and postnatal care visit respectively. Only 308 (6.56%, 95%CI: 5.89, 7.31) women used all the complete continuum of care. Not married, and poorest wealth index were significantly associated with dropout from ANC visit. Being a protestant religious follower was significantly associated with dropout from PNC after antenatal care booking. While not exposed to media, distance from health facility as a big problem, protestant affiliation, parity of 2 to 4 and above4, Wealth index of the poorest, poorer, middle, and richer significantly associated with dropout from institutional delivery. Not being informed about pregnancy complications during their ANC visit was significantly associated with dropout from ANC, PNC, and institutional delivery.

Conclusions

Dropout of women from the maternity continuum of care after antenatal care booking was a public health problem in Ethiopia. Socio-demographic, pregnancy, and health service-related factors were significant determinants of dropout from the maternity continuum of care. Improving the family wealth index, increasing access to health facilities, media exposure, and giving more information during the antenatal care visit is important to reduce the dropout rate from the maternity continuum of care.