Mohamed Adam A, Akın Ays'e, Mihciokur Sare, Üner Sarp, Gele Abdi
Department of Public Health, Institute of Health Sciences, Başkent University, Ankara, Turkey.
Department of Program Quality & Development, Save the Children International, Mogadishu, Somalia.
PLOS Glob Public Health. 2025 Jan 10;5(1):e0004102. doi: 10.1371/journal.pgph.0004102. eCollection 2025.
Somalia is continuing to recover from three decades of underdevelopment, political instability, civil unrest, and protracted humanitarian crises. However, Somalia has one of the lowest maternal health indicators in the world. For instance, the maternal mortality ratio is 621 per 100,000 live births. Extra efforts are needed to improve maternal health. In this study, we aim to investigate the level of completion and coverage along the maternity continuum of care in Somalia.
The study used data from the Somalia Health and Demographic Survey 2020. We restricted our analysis to ever-married women who had a live birth in the five years preceding the survey (n = 2432). Completion of the continuum of maternity care was the outcome variable for this study. It was constructed into a binary variable with complete coded as one and incomplete coded as 0. We categorized it into three models: ANC4+ as the first model, ANC4+ & SBA as the second model, and ANC4+ & SBA & PNC as the third model.
More than half of the women (53.1%) had their most recent births at ≤19 years old. Of all the mothers (n = 2432), only 235 (9.7%) had at least four or more of the recommended antenatal care (ANC4+), and 68 (2.8%) of them utilized skilled birth attendants. Only 14 (0.6%) women received all three maternal healthcare services (ANC4+, SBA, and PNC within 48 hours). About 78.1% of the mothers did not attend any of the three CoC services.
Maternal health care utilization decreases as they progress from ANC4+ to PNC utilization. The government and partners should design and implement strategies to improve maternal healthcare utilization specific to rural and nomads, less educated, not working, low income, and have less power in decision-making.
索马里正在从三十年的发展不足、政治不稳定、内乱和长期人道主义危机中持续恢复。然而，索马里是世界上孕产妇健康指标最低的国家之一。例如，孕产妇死亡率为每10万例活产621例。需要做出额外努力来改善孕产妇健康。在本研究中，我们旨在调查索马里孕产妇连续护理过程中的完成水平和覆盖范围。
该研究使用了2020年索马里卫生与人口调查的数据。我们将分析限制在调查前五年内有活产的已婚妇女（n = 2432）。孕产妇连续护理的完成情况是本研究的结果变量。它被构建为一个二元变量，完整编码为1，不完整编码为0。我们将其分为三个模型：第一个模型为四次及以上产前检查（ANC4+），第二个模型为四次及以上产前检查&熟练接生（ANC4+ & SBA），第三个模型为四次及以上产前检查&熟练接生&产后护理（ANC4+ & SBA & PNC）。
超过一半的妇女（53.1%）在19岁及以下生育了最近一个孩子。在所有母亲（n = 2432）中，只有235名（9.7%）接受了至少四次或更多次推荐的产前检查（ANC4+），其中68名（2.8%）使用了熟练接生员。只有14名（0.6%）妇女接受了所有三项孕产妇保健服务（四次及以上产前检查、熟练接生和产后48小时内的产后护理）。约78.1%的母亲未接受三项连续护理服务中的任何一项。
随着孕产妇从接受四次及以上产前检查到接受产后护理，孕产妇保健服务的利用率逐渐降低。政府和合作伙伴应设计并实施战略，以提高农村和游牧地区、受教育程度较低、无工作、低收入且决策权力较小的妇女对孕产妇保健服务的利用率。
