International Research Centre of Excellence, Institute of Human Virology, Nigeria (IHVN), Abuja (FCT), Nigeria.
Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
Sci Rep. 2023 Nov 27;13(1):20863. doi: 10.1038/s41598-023-48240-z.
Understanding population discrepancy in maternity continuum of care (CoC) completion, particularly in sub-Saharan Africa is significant for interventional plan to achieve optimal pregnancy outcome and child survival. This study thus investigated the magnitudes, distribution, and drivers of maternity CoC completion in Nigeria. A secondary analysis of 19,474 reproductive age (15-49 years) women with at least a birth (level 1) in 1400 communities (level 2) across 37 states covered in the 2018 cross-sectional survey. Stepwise regression initially identified important variables at 10% cutoff point. Multilevel analysis was performed to determine the likelihood and significance of individual and community factors. Intra-cluster correlation assessed the degree of clustering and deviance statistics identified the optimal model. Only 6.5% of the women completed the CoC. Completion rate is significantly different between communities "4.3% in urban and 2.2% in rural" (χ = 392.42, p < 0.001) and was higher in southern subnational than the north. Education (AOR = 1.61, 95% CI 1.20-2.16), wealth (AOR = 1.73, 95% CI 1.35-2.46), media exposure (AOR = 1.22, 95% CI 1.06-1.40), women deciding own health (AOR = 1.37, 95% CI 1.13-1.66), taking iron drug (AOR = 1.84, 95% CI 1.43-2.35) and at least 2 dose of tetanus-toxoid vaccine during pregnancy (AOR = 1.35, 95% CI 1.02-1.78) are associated individual factors. Rural residency (AOR = 1.84, 95% CI = 1.43-2.35), region (AOR = 1.84, 95% CI 1.43-2.35) and rural population proportion (AOR = 1.84, 95% CI 1.43-2.35) are community predictors of the CoC completion. About 63.2% of the total variation in CoC completion was explained by the community predictors. Magnitude of maternity CoC completion is generally low and below the recommended level in Nigeria. Completion rate in urban is twice rural and more likely in the southern than northern subnational. Women residence and region are harmful and beneficial community drivers respectively. Strengthening women health autonomy, sensitization, and education programs particularly in the rural north are essential to curtail the community disparity and optimize maternity CoC practice.
了解孕产妇连续护理（CoC）完成情况在人口方面的差异，特别是在撒哈拉以南非洲地区，对于制定干预计划以实现最佳妊娠结局和儿童生存至关重要。因此，本研究调查了尼日利亚孕产妇 CoC 完成情况的规模、分布和驱动因素。对 2018 年横断面调查中覆盖的 37 个州的 1400 个社区（第 2 级）中至少有一次分娩（第 1 级）的 19474 名育龄妇女（15-49 岁）进行了二次分析。逐步回归最初在 10%的截止点确定了重要变量。多水平分析用于确定个体和社区因素的可能性和意义。群内相关系数评估了聚类的程度，偏差统计数据确定了最佳模型。只有 6.5%的妇女完成了 CoC。社区之间的完成率有显著差异，“城市为 4.3%，农村为 2.2%”（χ=392.42，p<0.001），南部的完成率高于北部。教育（AOR=1.61，95%CI 1.20-2.16）、财富（AOR=1.73，95%CI 1.35-2.46）、媒体接触（AOR=1.22，95%CI 1.06-1.40）、妇女决定自己的健康（AOR=1.37，95%CI 1.13-1.66）、服用铁剂（AOR=1.84，95%CI 1.43-2.35）和至少两次破伤风类毒素疫苗接种（AOR=1.35，95%CI 1.02-1.78）是与个人相关的因素。农村居住（AOR=1.84，95%CI=1.43-2.35）、地区（AOR=1.84，95%CI 1.43-2.35）和农村人口比例（AOR=1.84，95%CI 1.43-2.35）是社区完成 CoC 的预测因素。社区预测因素解释了 CoC 完成情况总变异的约 63.2%。孕产妇 CoC 完成的规模普遍较低，低于尼日利亚的建议水平。城市的完成率是农村的两倍，在南部比在北部更有可能。妇女居住和地区分别是有害和有益的社区驱动因素。加强妇女健康自主权、宣传和教育计划，特别是在农村北部，对于缩小社区差异和优化孕产妇 CoC 实践至关重要。
