The pooled prevalence and associated factors of dropout from maternal continuum of care among mothers in 41 low- and middle-income countries, after the Sustainable Development Goals: a multilevel analysis

Background: This study aimed to assess the pooled proportion of dropouts from the continuum of maternity care (CoC) and its associated factors in LMICs. Methods: A cross-sectional study was conducted based on the data from the Demographic and Health Surveys of 41 low- and middle-income countries after the Sustainable Development Goals. A total of 217,083 (weighted 213,474) women were included. Using STATA v.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from CoC. The adjusted odds ratios with p-values < 0.05 were statistically significant in the final model. The Intra-class Correlation Coefficient, Proportional Change in Variance, and Median Odds Ratio were used to identify the measures of variation for the random effect. Results: The pooled proportion of dropout from CoC was 50% (95% CI: 45% to 56%). Factors associated with higher odds of dropout were multi parity (AOR=1.26, 95% CI: 1.22 to 1.29), grand multi parity (AOR=1.58, 95% CI:1.50 to 1.65), delayed first ANC (AOR=2.87, 95% CI:2.79 to 2.95), WHO regions compared to North Africa/West Asia/Europe region; from SSA (AOR=2.59, 95% CI:2.30 to 2.91), Central Asia (AOR=1.55, 95%CI:1.24 to 1.93), South and Southeast Asia (AOR=2.38, 95% CI: 2.12 to 2.67), Oceania (AOR=2.66, 95% CI:2.20 to 3.23), Latin America and the Caribbean (AOR=9.06 95% CI:7.33 to 11.21), distance from health facility (AOR=1.15, 95% CI:1.12 to 1.19), getting permission (AOR= 1.23, 95% CI:1.19 to 1.28), pregnancy intention (AOR=0.81 95% CI:0.78 to 0.84) and rural residence (AOR=1.52, 95% CI:1.46 to 1.59). While primary education (AOR=0.80, 95% CI: 0.77 to 0.83), secondary education (AOR=0.58, 95% CI: 0.55 to 0.60), higher education (AOR=0.44, 95% CI: 0.42 to 0.47), middle wealth index (AOR=0.80, 95% CI: 0.78 to 0.83), rich wealth index (AOR=0.67, 95% CI: 0.65 to 0.70), media exposure (AOR=0.73, 95% CI: 0.71 to 0.75), women aged between 20 and 34 (AOR=0.80, 95% CI: 0.76 to 0.84), and age > 35 years (AOR=0.63, 95% CI: 0.59 to 0.67) were associated with lower odds of dropout. Conclusions: Improving women's education, media exposure, women's decision-making power, accessibility of health facilities to remote settings, and decreasing teenage pregnancy were found to be factors to reduce dropouts.