The Last Ten Kilometers (L10K) Project, JSI Research & Training Institute, Inc., Addis Ababa, Ethiopia.
Addis Continental Institute of Public Health, Addis Ababa, Ethiopia.
PLoS One. 2022 Feb 25;17(2):e0264612. doi: 10.1371/journal.pone.0264612. eCollection 2022.
The continuum of care for maternal and newborn health is a systematic approach for delivery of an integrated effective package of life-saving interventions throughout pregnancy, childbirth, and postpartum as well as across levels of service delivery to women and newborns. Nonetheless, in low-income countries, coverage of these interventions across the life cycle continuum is low. This study examined the predictors of utilization of maternal and newborn health care services along the continuum of care in Ethiopia.
This was a cross-sectional population-based study. We measured maternal and newborn health care utilization practices among women who had live births in the last 12 months preceding the survey in Amhara, Oromia, SNNP, and Tigray regions of Ethiopia. We fitted multilevel random-effects logistic regression models to examine the predictors of the continuum of care accounting for the survey design, and individual, and contextual characteristics of the respondents.
Our analysis revealed that only one-fifth of women utilized maternal and newborn health services across the antepartum, intrapartum, and postpartum continuum; most women discontinued at the postpartum stage. Continued use of services varied significantly across wealth, model family, prenatal stay at maternity waiting homes, antenatal care in the first trimester, complete antenatal care service, and the administrative region at all antepartum, intrapartum, and postpartum stages. Moreover, family conversation during pregnancy [AOR: 2.12; 95% CI: 1.56-2.88], delivery by cesarean [AOR: 2.70; 95% CI: 1.82-4.02] and birth notified to health extension workers [AOR: 1.95; 95% CI: 1.56-2.43] were found to be predictors of the continuum of care at the postpartum stage.
In Ethiopia, despite good access to antepartum care, compliance with continuity of care across the pathway decreased with significant inequitable distributions, the poorest segment of the population being at most disadvantage. The main modifiable program factors connected to the continued uptake of maternal health services include family conversation, pregnant women conference, complete antenatal care, antenatal care in the first trimester, and birth notification.
孕产妇和新生儿健康照护连续体是一种系统方法，旨在在整个妊娠、分娩和产后期间以及在各级服务提供层面为妇女和新生儿提供综合有效的一整套救命干预措施。然而，在低收入国家，整个生命周期连续体的这些干预措施的覆盖率很低。本研究旨在探讨埃塞俄比亚孕产妇和新生儿保健服务在连续体中的使用情况的预测因素。
这是一项横断面的基于人群的研究。我们测量了在调查前的过去 12 个月内有活产的妇女的孕产妇和新生儿保健服务使用情况，这些妇女分别来自埃塞俄比亚的阿姆哈拉、奥罗莫、南苏丹和提格雷地区。我们使用多水平随机效应逻辑回归模型来检验连续体的预测因素，同时考虑了调查设计以及受访者的个人和背景特征。
我们的分析表明，只有五分之一的妇女在产前、产时和产后连续体中使用了孕产妇和新生儿保健服务；大多数妇女在产后阶段就停止了服务。服务的持续使用在财富、家庭模式、产前在产妇等候家中的停留时间、孕早期的产前护理、完整的产前护理服务以及所有产前、产时和产后阶段的行政区等方面都有显著差异。此外，孕期家庭对话[优势比：2.12；95%置信区间：1.56-2.88]、剖宫产分娩[优势比：2.70；95%置信区间：1.82-4.02]和向卫生推广工作者报告分娩[优势比：1.95；95%置信区间：1.56-2.43]被发现是产后连续体的预测因素。
在埃塞俄比亚，尽管产前护理的可及性良好，但随着服务路径的连续性下降，不平等分布显著，最贫困人口处于最不利地位。与继续接受孕产妇保健服务相关的主要可修改的项目因素包括家庭对话、孕妇会议、完整的产前护理、孕早期的产前护理和分娩通知。
