Socio-demographic characteristics of the participants
In this study, a total of 585 women were interviewed with a response rate of 92.9% of which: 286 with a response rate of 90.8% were women who booked for ANC service before the covid-19 and the 299 with a response rate of 94.9% were women who book for ANC service during covid-19.
The mean age ± standard deviation (SD) of women booked for ANC during and before the covid-19 pandemic was 27.78 (± 4.86) and 28.45(± 5.24) years respectively. Three of five (60.49% and 60.54% of women booked for ANC before and during covid-19) women were in the age group of 25-34 years.
Regarding the educational status, 38.46% and 38.80% of women booked for ANC before and during the covid-19 have completed their primary school. Whereas, significant proportion of women, 22.73% and 28.09 % of women booked for ANC before and during the covid-19, attained college and above educational level.
The majority of the respondent, 87.41% of women booked before and 94.31% of women booked during the covid-19 were married. And the majority, 63.99% of women booked before, and 69.57% of women booked for ANC service during the covid-19 case were housewives (Table 1).
Table 1:Socio-Demographic Characteristics of women who gave birth in the past two years before and during the COVID-19 pandemic in Addis Ababa,2021(n=585)
Variable
|
Category
|
Frequency (%)
|
Before covid-19(n=286)
|
During covid-19(n=299)
|
Age
|
15-24
|
69 (24.13)
|
79(26.42)
|
25-34
|
173 (60.49)
|
181(60.54)
|
35-49
|
44(15.38)
|
39(13.04)
|
Religion
|
Orthodox
|
145(50.70)
|
179(59.87)
|
Muslim
|
69 (24.13)
|
62(20.74)
|
Protestant
|
57(19.93)
|
49(16.39)
|
Catholic
|
10(3.50)
|
6(2.01)
|
Others*
|
5(1.75)
|
3(1.00)
|
Women educational status
|
≤ primary education
|
143(50.00)
|
147(49.16)
|
secondary education
|
78(27.27)
|
84(28.09)
|
college and above
|
65(22.73)
|
68(22.74)
|
Women Occupation
|
Housewife
|
183(63.99)
|
208(69.57)
|
Self-employee
|
37(12.94)
|
28(9.36)
|
Daily worker
|
8(2.80)
|
7 (2.34)
|
Government employee
|
26 (9.09)
|
30(10.03)
|
Private employee
|
24(8.39)
|
23 (7.69)
|
Student
|
8(2.80)
|
3(1.00)
|
Marital status
|
Married
|
250(87.41)
|
282 (94.31)
|
Single
|
21(7.34)
|
10(3.34)
|
Divorced
|
12(4.20)
|
6 (2.01)
|
Widowed
|
1(0.35)
|
0(0)
|
separated
|
2(0.70)
|
1 (0.33)
|
Husband education status
|
no formal education
|
24(9.52)
|
26(9.19)
|
primary education
|
86(34.13)
|
87(30.74)
|
secondary education (9-12)
|
70(27.78)
|
105(37.10)
|
college and above
|
72(28.57)
|
65(22.97)
|
Husband occupation
|
self-employee
|
106(42.06)
|
125(44.17)
|
Government Employed
|
35(13.89)
|
46(16.25)
|
Private employee
|
66(26.19)
|
55(19.43)
|
Daily worker
|
45(17.86)
|
51(18.02)
|
Other**
|
0 (0)
|
6(2.12)
|
Family monthly income (ETB)
|
below and equal 500
|
14 (4.90)
|
6(2.01)
|
501-1500
|
17(5.94)
|
26(8.70)
|
1501-2500
|
27 (9.44)
|
26(8.70)
|
2501 and above
|
228(79.72)
|
241(80.60)
|
Information About maternal health care
|
Yes
|
194(67.83)
|
210 (70.23)
|
No
|
92(32.17)
|
89 (29.77)
|
Source of information
|
Radio / Tv
|
Yes
|
31(15.98)
|
42 (20.00)
|
No
|
163(84.02)
|
168 (80.00)
|
Health Professional
|
Yes
|
166(85.57)
|
181(86.19)
|
No
|
28(14.43)
|
29(13.81)
|
School
|
Yes
|
25(12.95)
|
20 (9.52)
|
No
|
169(87.05)
|
190(90.48)
|
Relative
|
Yes
|
4(2.06)
|
3(1.43)
|
No
|
190(97.94)
|
207(99.04)
|
Frequency to watch and hear the radio/ Television
|
Always
|
25(80.65)
|
36(85.71)
|
Once a week
|
2(6.45)
|
1(2.38)
|
More than once a week
|
4(12.90)
|
5(11.90)
|
*Jehovah witness, seven-day Adventist, **Have no job, lives out of the country
Health service accessibility of the participants
Furthermore, more than two-thirds (81.12% and 84.28% of women booked for ANC service before and during the covid-19 pandemic) spends less than 30 minutes to reach the health facility respectively. And more than half,59.44 and 57.19 before and during the pandemic respectively, of the women booked for ANC service uses walking to go to the health facility. Comparably, 94.06% of women booked for ANC before, and 94.31% of women booked for ANC during the covid-19 pandemic use health centers to get ANC service. and 40.91% of the women booked for ANC before covid-19 and 43.14% of the women booked for ANC during covid-19 have more than three PNC visits during delivery (Table 2).
Table 2:Health service accessibility-related characteristics of women who gave birth in the past two years before and during the COVID-19 pandemic in Addis Ababa,2021(n=585)
Variable
|
Category
|
Frequency (%)
|
Before covid-19(n=286)
|
during covid-19 (n=299)
|
Women autonomy
|
Not autonomous
|
7 (2.45)
|
11(3.68)
|
Autonomous
|
279 (97.55)
|
288(96.32)
|
Distance from the health facility (minute)
|
< 30 minutes
|
232(81.12)
|
252 (84.28)
|
≥30 minutes
|
54(18.88)
|
47(15.72)
|
Means of transportation to health facilities
|
by car
|
116(40.56)
|
128(42.81)
|
Walking on foot
|
170(59.44)
|
171(57.19)
|
Place of ANC visit
|
Gov’t hospital
|
4 (1.40)
|
4(1.34)
|
health center
|
269 (94.06
|
282(94.31)
|
Private hospital
|
7(2.45)
|
10(3.34)
|
Private clinic
|
3(1.05)
|
1(0.33)
|
Marie stops
|
3(1.05)
|
2(0.67)
|
place of delivery
|
health institution
|
282(98.60)
|
290 (96.99)
|
out of health institution
|
4(1.40)
|
9(3.01)
|
Reason for not delivering in health facility
|
Shifting of human resource to covid-19
|
0
|
1(11.11)
|
Shifting of medical supplies to covid-19
|
0
|
1(11.11)
|
Closures of health facilities due to covid-19
|
0
|
3(33.33)
|
|
Other*
|
0
|
4(44.44)
|
Start PNC service within 48 hr. after delivery
|
Yes
|
160(55.94)
|
140(46.82)
|
No
|
126(44.06)
|
159(53.18)
|
Number of PNC visit
|
0
|
70(24.48)
|
56(18.73)
|
1-2
|
99(34.62)
|
114(38.13)
|
3 and above
|
117(40.91)
|
129(43.14)
|
Reason for missing PNC service
|
Shifting human resources to covid-19 prevention
|
0
|
4(7.14)
|
Shifting budget to covid-19 prevention
|
0
|
4(7.14)
|
Shifting medical supplies to covid-19 prevention
|
0
|
2(3.57)
|
lockdown
|
0
|
17(30.36)
|
Closures of health facilities due to covid-19
|
0
|
19(33.93)
|
Other**
|
0
|
10(17.86)
|
Place of PNC service
|
Government hospital
|
5(2.31)
|
10(4.12)
|
health center
|
197(91.20)
|
224(92.18)
|
Private hospital
|
8(3.70)
|
9(3.70)
|
Private clinic
|
6(2.78)
|
0
|
Frequency of visit by health care provider immediately after birth
|
Every 15 minutes
|
117(41.20)
|
81(27.65)
|
Every 30 Minute
|
73(25.70)
|
71(24.23)
|
Every one hour
|
55 (19.37)
|
57(19.45)
|
two hour and above
|
39 (13.73)
|
84(28.67)
|
Reasons for the less frequent visit by health care providers
|
Shortage of health care providers
|
2 (5.26)
|
17(20.24)
|
Health care providers were busy
|
22(57.89)
|
38(45.24)
|
Health care providers negligence
|
10(26.32)
|
24(28.57)
|
Other***
|
5(1.75)
|
5(5.95)
|
Time spent in health facility after delivery
|
≥24 Hour
|
177(62.32)
|
156 (53.24)
|
<24 Hour
|
107(37.68)
|
137(46.76)
|
Reasons for staying less than 24 hours
|
Shortage of beds
|
52(48.60)
|
62(45.26)
|
Shortage of health care providers
|
3(2.80)
|
6(4.38)
|
Others****
|
52 (48.60)
|
69(50.36)
|
Receive appropriate care
|
Yes
|
259(90.56)
|
218(72.91)
|
No
|
27(9.44)
|
81(27.09)
|
Reasons for not getting appropriate care
|
Fear of covid-19 health care providers
|
0
|
42(51.85)
|
Shortage of medical supplies
|
7(25.93)
|
21(25.93)
|
Shortage of health care providers
|
12(44.44)
|
18(22.22)
|
Other*****
|
8(29.63)
|
0
|
*The labor was emergent** I did not think it was necessary, I was lost my child, they did not give me an appointment, to do what? already I give birth safely. *** there was covid 19, I was healthy, they fear covid 19, **** I was healthy, there was covid-19, financial problem, referral to hospital, stillbirth, *****they sit and talk, discrimination, negligence, they give me wrong medication and they were busy with social media.
Obstetrics characteristics of the participants
More than three-fourth (81.82%) of women booked for ANC service before and 86.29% of the women booked for ANC service during the covid-19 pandemic were planned/wanted to deliver their child. Additionally, 80.07% of the women who received maternal health care service before covid-19 and 72.58% of the women who received maternal health care service during the covid-19 pandemic starts their first ANC service before the 16 weeks of pregnancy. And most,72.03% and 63.55% of the women booked before and during the covid-19 pandemic respectively were informed when to return for PNC service. The majority of the women, 61.89% of women booked for ANC before, and 72.58% of women booked for ANC during the covid-19 pandemic, were not prepared to deliver their child (Table 3).
Table 3:Obstetrics characteristics of women who gave birth in the past two years before and during the COVID-19 pandemic in Addis Ababa,2021
Variable
|
Category
|
Frequency (%)
|
Before covid-19
|
During covid-19
|
Pre-pregnancy utilization of contraception
|
Yes
|
202(70.63)
|
190(63.55)
|
No
|
84(29.37)
|
109 (36.45)
|
Type of contraception
|
Pills
|
42(20.79)
|
49(25.79)
|
Implants
|
67(33.17)
|
47(24.74)
|
IUCD
|
7(3.47)
|
11(5.79)
|
Depo
|
86(42.57)
|
83(43.68)
|
Total number of pregnancies (Gravidity)
|
1
|
103(36.01)
|
128 (42.81)
|
2-3
|
153(53.50)
|
145(48.49)
|
4 and above
|
30(10.49)
|
26(8.70)
|
Total number live of births (Parity)
|
0
|
2(0.70)
|
5(1.67)
|
1
|
110(38.46)
|
129(43.14)
|
2-3
|
151(52.80)
|
141 (47.16)
|
4 and above
|
23(8.04)
|
24 (8.03)
|
Number of children
currently alive
|
0
|
2(0.70)
|
5 (1.67)
|
1
|
110(38.46)
|
129 (43.14)
|
2-4
|
173(60.49)
|
141(47.16)
|
5 and above
|
1 (0.35)
|
24(8.03)
|
Had Planned/wanted current pregnancy
|
Yes
|
234(81.82)
|
258 (86.29)
|
No
|
52(18.18)
|
41(13.71)
|
Time to be pregnant
|
I want to stay
|
40(76.92)
|
35(85.37)
|
I did not want
|
12(23.08)
|
6 (14.63)
|
Gestational age at first ANC visit (weeks.)
|
at and before 16 weeks
|
229(80.07)
|
217 (72.58)
|
during 16weeks
|
57(19.93)
|
82(27.42)
|
Number of ANC visit
|
<4 times
|
67(23.43)
|
119 (39.80)
|
≥4times
|
219(76.57)
|
180(60.20)
|
Reason for missing ANC visit
|
Shifting of medical supplies to covid-
|
0
|
3(2.52)
|
Cancellation of regular ANC appointment
|
0
|
46(38.66)
|
Lockdown
|
0
|
44(36.97)
|
Others*
|
0
|
26(21.85)
|
Mode of delivery
|
SVD
|
228(79.72)
|
223(74.58)
|
CS
|
54(18.88)
|
69(23.08)
|
Instrumental
|
4(1.40)
|
7(2.34)
|
|
History of pregnancy-related complications
|
Yes
|
102 (35.66)
|
104 (34.78)
|
|
No
|
184(64.34)
|
195(65.22)
|
|
Complications
|
Abortion
|
25(24.51)
|
24(23.08)
|
|
still birth
|
7 (6.86)
|
9(8.65)
|
|
Obstetric bleeding (APH/PPH)
|
2(1.96)
|
3(2.88)
|
|
Birth by operation
|
51(50.00)
|
57(54.81)
|
|
pregnancy related Diabetes
|
7(6.86)
|
3(2.88)
|
|
Preeclampsia/Eclampsia
|
10(9.80)
|
8(7.69)
|
|
Knowing postpartum danger sign
|
Yes
|
177(61.89)
|
167(55.85)
|
|
No
|
109(38.11)
|
132 (44.15)
|
|
Type danger signs?
|
Vaginal bleeding
|
113(63.84)
|
103(61.68)
|
|
Increased body temp (fever)
|
25(14.12)
|
27(16.17)
|
|
Offensive vaginal Discharge
|
39(22.03)
|
33(19.76)
|
|
Other’s**
|
|
4(2.40)
|
|
Information about PNC checkup
|
Yes
|
206(72.03)
|
190 (63.55)
|
|
No
|
80(27.97)
|
109(36.45)
|
|
Birth preparedness and complication readiness
|
Not well prepared
|
177(61.89)
|
217(72.58)
|
|
Well prepared
|
109(38.11)
|
82(27.42)
|
* I was afraid of covid 19, closure of health facility due to covid-19, I did not know I was pregnant, I was busy at work ** body tremor, foot swelling, infection, swelling of the foot.
Knowledge, Attitude, and Fear about COVID-19
Among women booked for ANC service during the covid-19 pandemic, more than half (51.84%) of the participants did not know about the covid-19 pandemic. And more than half (52.17%) of the participants have a favorable attitude towards the covid-19 pandemic. additionally, more than half (57.53%) of the women booked for ANC were fearful (Table 4).
Table 4:COVID-19 related Knowledge, Attitude and Fear of women who gave birth in the past two years before and during the COVID-19 pandemic in Addis Ababa,2021
Variable
|
Category
|
Frequency(n=299)
|
Percentage
|
Knowledge
|
Un- knowledgeable
|
155
|
51.84
|
Knowledgeable
|
144
|
48.16
|
Attitude
|
Un-favorable
|
143
|
47.83
|
favorable
|
156
|
52.17
|
Fear
|
not fearful
|
127
|
42.47
|
fearful
|
172
|
57.53
|
The dropout rate of continuum maternal healthcare services
Among women booked for ANC before covid-19 58.39% (95% CI: 52.56-64.00) dropped out from the continuum of maternal healthcare. but 41.61% (95% CI: 35.99-47.44) completed their recommended maternal health care service. Likewise, among women booked for ANC service during the covid 19 pandemics 73.24% (95% CI: 67.91-77.98) dropped out from the continuum of maternal healthcare. However, 26.76% (22.01-32.09) completed their recommended maternal health care service (Figure 2).
Factors associated with the dropout rate of the COMHC
Factors Associated with the dropout rate of the COMHC before the COVID-19
Bivariable and multivariable logistic regression analyses were fitted to identify factors associated with the dropout rate of the continuum of maternal health care service. Hence, information about maternal health care services, means of transportation to health facilities, pre-pregnancy utilization of contraception, planned-ness/wanted-ness of current pregnancy, birth preparedness and complication readiness, knowing postpartum danger signs, and informed about PNC checkup was found variables with p-value <0.2 in bivariable logistic regression and candidate for multivariable logistic regression.
Likewise, planned-ness/wanted-ness of current pregnancy, knowing postpartum danger signs, and having information about maternal health care services were factors significantly associated with the dropout rate of the continuum of maternal health care service in the multivariable logistic regression.
Accordingly, women who had unwanted or unplanned pregnancies were 3 times (AOR= 3.35, 95% CI: 1.60-7.04) more likely to discontinue from the continuum of maternal health care than those women who had planned or wanted pregnancy.
The odds of dropout from the continuum of maternal healthcare were 1.79 times (AOR=1.79,95% CI: 1.03-3.12) higher among women who did not know postpartum danger signs than their counterparts.
Simultaneously, the dropout rate of the continuum of maternal healthcare is almost two times (AOR= 1.85, 95% CI: 1.06-3.23) higher among women who had no Information About maternal health care services than their counterparts (Table 5).
Table 5:Bivariable and Multivariable Logistic Regression Analyses of factors Associated with the dropout rate of the continuum of maternal health care service among women who gave birth before the COVID-19 pandemic in Addis Ababa,2021
Variable
|
Category
|
COMHC*
|
COR** (95% CI)
|
AOR*** (95% CI)
|
complete
|
Dropout
|
Informed About maternal health care services
|
Yes
|
92
|
102
|
1
|
1
|
No
|
27
|
65
|
2.17(1.28-3.69)
|
1.85(1.06-3.23) ****
|
Means of transportation to health facilities
|
with car
|
59
|
57
|
1
|
1
|
Walking
|
60
|
110
|
1.90(1.17-3.07)
|
1.67(0.99-2.80)
|
Pre-pregnancy
utilization of contraception
|
Yes
|
90
|
112
|
1
|
1
|
No
|
29
|
55
|
1.52(0.89-2.59)
|
1.33(0.75-2.34)
|
Had planned/wanted current pregnancy
|
Yes
|
108
|
126
|
1
|
1
|
No
|
11
|
41
|
3.19(1.57-6.52)
|
3.35(1.60-7.04) ****
|
Birth preparedness and complication readiness
|
Not well prepared
|
65
|
112
|
1
|
1
|
Well prepared
|
54
|
55
|
0.59(0.36-0.96)
|
0.87(0.51-1.48)
|
Knowing postpartum danger signs
|
Yes
|
85
|
92
|
1
|
1
|
No
|
34
|
75
|
2.04(1.23-3.36)
|
1.79(1.03-3.12) ****
|
Informed about PNC checkup
|
Yes
|
92
|
114
|
1
|
1
|
No
|
27
|
53
|
1.58(0.92-2.71)
|
1.26(0.69-2.29)
|
*Continuum of maternal healthcare, **crude odds ratio, ***adjusted odds ratio, ****significant at P<0.05
Factors Associated with the dropout rate of the COMHC during the COVID-19
Information about maternal health care services, receive appropriate care, knowledge about covid-19, planned-ness/wanted-ness of current pregnancy, birth preparedness and complication readiness, knowing postpartum danger signs, information about PNC checkup, and History of pregnancy-related complications were variables which have P-value <0.2 on bivariable logistic regression.
Comparably, on multivariable logistic regression being informed about PNC checkups, women receiving appropriate care, having information about maternal health care services, birth preparedness, and complication readiness, and experience of pregnancy-related complications were significantly associated with a dropout from the continuum of maternal Health care.
Women who had no a history of pregnancy-related complications had 2 times (AOR=2.07, 95% CI: 1.17-3.68) more chance to discontinue from the continuum of maternal health care service than their counterparts.
Likewise, the odds of drop out of the continuum of maternal health care is 2 times (AOR =1.88, 95% CI: 1.01-3.50) higher among women who had not been informed about PNC checkups than those who had been informed about PNC checkup.
In addition to this, women who perceive they did not receive appropriate care had 4 times (AOR = 3.92, 95% CI: 1.84-8.37) increased chance of dropout from the continuum of maternal health care than those who perceive they receive appropriate maternal healthcare service.
Similarly, women who had information about maternal health care services were 2.57 times (AOR=2.57, 95% CI: 1.28-5.16) more likely to discontinue the continuum of maternal health care than women who had not information about maternal health care services.
This study also shows that the likelihood of dropout from the continuum of maternal healthcare decreased by 53% (AOR=0.47, 95% CI: 0.26-0.86) among women well prepared for birth and complication than those women who did not have birth preparedness and complication readiness (Table 6).
Table 6: Bivariable and Multivariable Logistic Regression Analyses of factors Associated with the dropout rate of the continuum of maternal health care service among women who gave birth during the COVID-19 pandemic in Addis Ababa,2021
Variable
|
Category
|
COMHC*
|
COR** (95% CI)
|
AOR*** (95% CI)
|
Complete
|
Dropout
|
Informed About maternal health care services
|
Yes
|
67
|
143
|
1
|
1
|
No
|
13
|
76
|
2.74(1.42-5.28)
|
2.57(1.28-5.16) ****
|
Receive appropriate care
|
yes
|
70
|
148
|
1
|
1
|
No
|
10
|
71
|
3.36(1.63-6.90)
|
3.92(1.84-8.37) ****
|
Knowledge about covid-19
|
Un- knowledgeable
|
48
|
112
|
1
|
1
|
Knowledgeable
|
32
|
107
|
1.43(0.85-2.41)
|
1.43(0.81-2.51)
|
Planned/wanted current pregnancy
|
Yes
|
74
|
184
|
1
|
1
|
No
|
6
|
35
|
2.35(0.95-5.81)
|
1.84 (0.69-4.95)
|
Birth preparedness and complication readiness
|
Not well prepared
|
48
|
169
|
1
|
1
|
Well prepared
|
32
|
50
|
0.44(0.26-0.76)
|
0.47(0.26-0.86) ****
|
Knowing postpartum danger sign
|
Yes
|
51
|
116
|
1
|
1
|
No
|
29
|
103
|
1.56(0.92-2.65)
|
1.13(0.63-2.02)
|
Information about PNC checkup
|
Yes
|
60
|
130
|
1
|
1
|
No
|
20
|
89
|
2.05(1.10-3.64)
|
1.88(1.01-3.50) ****
|
History of pregnancy-related complications
|
Yes
|
36
|
68
|
1
|
1
|
No
|
44
|
151
|
1.82(1.07-3.07)
|
2.07(1.17-3.68) ****
|
*Continuum of maternal healthcare, **crude odds ratio, ***adjusted odds ratio, ***significant at P<0.05