Predictors of dropout from maternal continuum of care in Ethiopia: evidence from the 2016 population-based health survey

Abstract IntroductionIntegrated primary health care service provided by skilled birth attendants is linked to safe childbirth and postnatal care, vitally improves maternal, newborn, and child health outcomes. Despite a significant reduction in maternal and neonatal mortality in Ethiopia, low maternal service utilization, and dropout from the maternal continuum of care continues to be a major challenge. Therefore, this study aimed to investigate the individual and community predictors of dropout from the maternal continuum of care in Ethiopia.MethodsWe used data from the 2016 Ethiopian demographic and health survey (EDHS). Women who had a birth in the 5 years preceding the survey were included. Dropout from the maternal continuum of care was the outcome of this study. This includes, attending less than four antenatal care visits (<4 ANC), a dropout from skilled birth attendance (SBA) after having 4 or more ANC, and dropout from postnatal care (PNC) after having SBA. Multilevel logistic regression analysis was employed. The mixed effect and variation in the outcome were expressed by the intracluster correlation coefficient (ICC).ResultsHigher dropouts from SBA to PNC (85%) and from ≥4 ANC to SBA (43.4%) in the maternal continuum of care were observed. Women from the poorest wealth quantile (AOR=2.31,95% CI 1.69,3.16), not covered by health insurance (AOR=1.44, 95% CI, 1.01,2.06), and residing in a community with high poverty (AOR=1.28,95% CI, 1.01,1.63) were more likely to attend inadequate ANC. On the other side, distance from a health facility (AOR=1.45, 95% CI, 1.12,1.88), lower community media exposure (AOR=1.6, 95% CI, 1.14,2.23) and rural residency (AOR=3.03, 95% CI, 1.75,5.26) were associated with dropout from SBA after attending ANC visits. Living in Somali, Harari, and Dire Dawa significantly associated with drop out from the PNC after SBA.ConclusionThe pattern of dropout from the maternal continuum of care was higher in Ethiopia. Maternal education, wealth index, community media exposure, and distance from a health facility were the factors associated with dropouts from the maternal continuum of care. Home care strategies and contextual understanding of the barriers to the PNC service is needed.