Completion of Maternal and Child Health Continuum of Care and Associated Factors Among Women in Gode District, Shebele Zone, Eastern Ethiopia ,2022

doi:10.21203/rs.3.rs-3553435/v1

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Research Article

Completion of Maternal and Child Health Continuum of Care and Associated Factors Among Women in Gode District, Shebele Zone, Eastern Ethiopia ,2022

https://doi.org/10.21203/rs.3.rs-3553435/v1

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Background

The Continuum of care for reproductive, maternal, newborn, and child health includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood. In Ethiopia, the magnitude of antenatal care, skilled delivery, postnatal care, and immunization for children have shown improvement. Despite this, there was limited research on the percentage of mothers who have completed maternal and child continuum care.

Objective

To assess the Completion of Maternal and Child Health Continuum of Care and Associated Factors among women in Gode District, Shebele Zone, Eastern Ethiopia ,2022.

Method

A community-based cross-sectional study design applied from November 1–15, 2022. A stratified sampling method was applied. A woman who gave birth in the last year preceding the data collection period will be included in the study. An interviewer-administered semi-structured questioner will be used for data collection. Data collected by using kobo collect and analyzed using STATA version 17. Both Bivariable and multivariable logistic regression analyses will be done. In multivariable analysis, variables having P-values less than 0.05 will be taken as factors associated with the completion of the maternal and child health continuum of care.

Result

The Completion of MCH continuum of care was 13.5% (10.7%-17.0%) in Gode district,2022. Accordingly, Husband occupation (Government employee) [AOR = 2.3, 95%CI:(1.2–4.7)] and perceived time to reach health facility (less than 30 minutes) [AOR = 2.96, 95%CI:(1.2–7.5)] were factors showing significant association with maternal and child health continuum of care among mothers in Gode district, Somali regional State;2023 at P-value ≤ 0.05.

Conclusion and recommendation: Only

13.5% of mothers in Gode district received all of the recommended maternal and child health services during their pregnancy, childbirth, and postpartum period. The study found that two factors were associated with a higher likelihood of receiving MCH continuum of care: husband occupation and perceived time to reach a health facility. Governments can play a key role in increasing the maternal and child health continuum of care by investing in health care infrastructure

Maternal and child health continuum of care

Completion & associated factors

The Continuum of Care for reproductive, maternal, newborn, and child health (RMNCH) includes integrated service delivery for mothers and children from pre-pregnancy to delivery, the immediate postnatal period, and childhood (1). COC is one of the important long-term plans for reducing maternal and neonatal deaths and improving the health and well-being of mothers and newborns (2, 3).

Continuum of care is built on two main dimensions: time and place. CoC at its time dimension refers to a situation where a woman and her child receive maternal, newborn, and child health (MNCH) services from pre-pregnancy, pregnancy, childbirth, and postpartum to childhood. The place dimension focuses on integration among household level, community-level, and facility-level MNCH care, and referral to advanced-level care if needed (4–6).

The World Health Organization (WHO) and other allied organizations have been working since the last decade on advocating and calling for the continuum of care to improve the health of mothers, newborns, and child health (MNCH) in the world. The CoC gives an important package of intervention points to MNCH programs, which leads to the way that maternal and neonatal burdens of morbidity and mortality are reduced (4, 5).

Previous works focused on the continuum of care for child survival, but a continuum of care is also very important for maternal health. A continuum of care (CoC) links essential interventions through pregnancy, delivery, postpartum, and immunization (EPI) for mothers and children(4, 5).

Ethiopia's Maternal Health Policy focuses on the adoption of evidence-based high outcomes of interventions in Maternal and Neonatal Health (MNH) by delivering appropriate health services in a continuum of care approach (7). The advantage of the continuum of care (CoC) is that each stage builds on the success of the previous stage (8). However, evidence from around the world suggests that women completing the continuum of maternal and child health care services are extremely low and that women do not have serious access to RMNCH services along the continuum of care (1, 9).

A reduction in child mortality has been observed over the last two decades through the reduction is disproportional among different age groups. In this regard, even though neonatal death rates fell by 41%, from 31 per 1000 live births in 2000 to 18 in 2018, the reduction was smaller as compared with mortality for children aged 1 − 59 months (9). Despite substantial progress over the last two decades, inadequate or non-existent care during pregnancy and delivery was largely responsible for the annual deaths of an estimated 211per 100,000 mothers in 2018 (10).

Globally 86% of pregnant women access antenatal care with skilled health personnel at least once, only two in three (65%) receive at least four antenatal visits in 2018. In regions with the highest rates of maternal mortality, such as Sub-Saharan Africa and South Asia, even fewer women received at least four antenatal visits (52% and 49% respectively), and just over half of all births (57 percent) were delivered in a health facility in Sub-Saharan Africa (11). The 2020 world health organization (WHO) report indicated that despite historic achievements in maternal and child health in the past decade, many low and middle-income countries remained far behind their high-income counterparts (12).

According to the Ethiopian Demographic Health Survey (EDHS), women show some progress in maternal care utilization, that at least four prenatal care services ranged from 32–43%, skilled delivery assistance from 28–50%, and postnatal care from 17–34%. Full immunization for children also ranged from 39–43% in EDHS 2016 and mini-EDHS 2019(13, 14). Even though these trends of reproductive health indicators from 2000–2019 showed that there is satisfactory progress in maternal health care services utilization, the gap in the continuum of maternal health care services remains remarkably high (15).

By 2030 the world sustainable development goal planned to reduce the global burden of maternal mortality from 216 per 100000 live births in 2015 to less than 70 per 100000 live births, neonatal mortality to reduce to at least 12 per 1000 live births, and under-five mortality to reduce at least as low as 25 per 1000 live births. Nowadays, nearly all maternal and neonatal deaths can be preventable by increasing the accessibility of appropriate and quality care during the critical periods of pregnancy, childbirth, and after childbirth (16).

Policies and programs are shifting attention towards maternal, newborn, and child health (MNCH) continuum of care (6).

The continuums of care concept in MNCH have become one of the fundamental program frameworks for setting- up and evaluating strategies in the existing health system packages (17). The effective and powerful full continuum of care (CoC) interconnects the critical MNCH elements throughout pregnancy, childbirth, and post-partum stages (18). Care given to the mother in pregnancy, during and immediately after birth reduce the risk of death or disabilities for both the mother and baby and discontinuation of appropriate care at any level of continuum of care (CoC) is associated with poor maternal, newborns and child health (MNCH) consequence (15, 16).

The maternity continuum of care has a plethora of advantages; that is why different scholars tried to address the issue and factors associated with it. The overall literature review; ranges from 60% in Cambodia to 27% in Pakistan (19, 20). In Africa, it ranges from 8% in Ghana to 31% in Nigeria (8, 21). According to a study done in Ethiopia, the magnitude of maternal, newborn, and child health continuum of care in 2019 was 9.1% (22).

The respondent's age, educational status, essential ANC components, occupational status, parity, women who planned for pregnancy, mothers who use contraceptives before pregnancy, and wealth status were the factors associated with the maternity continuum of care. But some variables were not addressed in previous studies like birth preparedness, and complication readiness, maternal waiting use, provider's attitude, maternal satisfaction, information on maternal health services, and knowledge on key danger signs of pregnancy, delivery, and the postpartum period is not well addressed in the study area as well as in Ethiopia.

There is a significant drop in maternal and child health continuum of care and still, little progress has been made in closing the gap between maternal and child health services. This lack of quality of care reflects lost opportunities and a risk factor for adverse results in maternal and child health. Despite this, many pregnant women have not completed the recommended maternal health services in Ethiopia, including the Gode district. Besides, there is minimal awareness or scarcity of research on the percentage of mothers who have completed continuum care and the variables that boost the completion of the care continuum for maternal and child health in the district of Gode. Identifying the factors that impact the continuum of care for maternal and child health helps to design effective plans and policies to increase the use of resources and thereby minimize maternal, neonatal, and child mortality.

Study area and period

The study was conducted in Gode district, found in Shebelle Zone. Gode district is bordered on the south by Shebelle River which separates it from Adadle,on the northwest by Imiberi, on the north by Danan, on the northeast by Korahe zone and on southeast by Kelafo. Gode town is in eastern Ethiopia (1224 km) from Addis Ababa, has latitude and longitude of 5.952655’N and 43.551579’E, respectively. Gode city encompasses 15 kebeles with a total population of 61,994 according to the 2007 census (23). Gode has 2 health centers and 1 General Hospital, Gode General Hospital, which serves 1 million people. Gode General Hospital has 456 staff and 198 Beds. The study was conducted from November 1–15/2022.

Study Design

A community-based cross-sectional study was employed.

Population

Source Population

All women who gave birth in the last year preceding the data collection period in Gode district, Shebelle zone, Eastern Ethiopia.

Study population

Randomly selected women who gave birth in the last year preceding the data collection period in Gode district, Shebelle zone, Eastern Ethiopia.

Inclusion and Exclusion Criteria

Inclusion Criteria

Women whose child is alive at the time of data collection

Exclusion Criteria

Mothers are unable to communicate due to severe illness, limiting the speaking and responding activity of the respondents at the time of data collection.

Sample Size Calculation

The sample size calculated using the single population proportion formula with the following assumptions: 5% margin of error, 95% confidence level, and considering the continuum of maternity and childcare 50% and adding 20% non-response rate, 461, was larger than other sample sizes calculated using the double population proportion formula.

Sampling Procedure

A stratified sampling technique was used. In the initial stage, Kebeles was discovered in the Gode district, which was divided into urban and rural areas. Then, a lottery method was used to choose 6 kebeles (2,5,6,7,11 &13) of the total on Gode city and 4 rural kebeles (Hadhawe,Ilan,Badila'ad, and Barsan). For selected kebeles, the determined sample size is distributed proportionally. Finally, each study participant was chosen at random. Before data collection, a list of women who gave birth in the previous year was gathered from kebeles, as well as the delivery and immunization registration book of health extension workers.

Data Collection Tool and Procedure

The questionnaire is prepared in English and translated into Somali language. The questioner incorporates socio-demographic, household-related, community, reproductive and obstetric, and institutional factors. The tool was first pretested in the Kebridhar district. Data collected by a semi-structured questionnaire through face-to-face interviews using a kobo collect toolbox. Ten midwives for data collection and four public health officers with a bachelor's degree as supervisors were involved. The data collectors and supervisors got training for one day about the objective of the study, study design, and the content of the questionnaires.

Mothers absent at the time of data collection re-checked for the other day. The entire filled questionnaire is checked after it is filled in by data collectors for completeness and consistency.

Study Variables

Dependent Variable

Maternal and child health continuum of care (completed, not completed)

Independent Variable

Socio-Demographic Characteristics: - age, marital status, mother's educational status, mother's occupation, and husband’s occupation

Reproductive and Obstetric factors: - Parity of women, age at 1st birth, planned Pregnancy, pre-pregnancy contraceptive utilization, birth preparedness, and complication readiness, preconception contraceptives utilization, the timing of ANC, knowledge on key danger signs of pregnancy, delivery and postpartum, essential elements of ANC service provided, and mode of delivery

Households related factors

Wealth index, information on maternal and child health services, Decision-making autonomy

Community factors

- means of transportation to the health facility, distance from the district hospital, place of residence.

Institutional related factors

- the behavior of health professionals, satisfaction with service delivery, and availability of drug and medical equipment

Data Quality Control

The questionnaire is first prepared in English and then translated to Somali language and finally back translated to English by different individuals to check its accuracy and consistency. Before data collection, the aim of the study was told to the study participants. Intensive training has been given to data collectors and supervisors. The questionnaire was pretested outside the study area at Kebridhar district with 5% of the sample size to check the language clarity and appropriateness of the questionnaire, and corrections was taken. The data collection process was supervised daily, and each questionnaire was checked for completeness.

Operational Definition and Definition of Terms

Maternal and Child Health Continuum of Care

A woman and her child were considered having completed the continuum of care when a woman; had four or more ANC visits by skilled health personnel (medical doctors, midwives, nurses, health officers) and childbirth by SBA at health institution and PNC at least once after discharge from the health facilities within six weeks by skilled health personnel at the health facility or with in the first week by community health extension workers during their home visit, and her child completed the immunization. Otherwise, a woman-child pair is not considered or classified as completed the continuum of care if they miss any one of the above visits or attendance at any level of care (27, 28).

Fully Vaccinated Child

A child is considered fully vaccinated when a child receives one dose of BCG, three doses of pentavalent, Pneumococcal Conjugate (PCV), Oral Polio Vaccines (OPV), two doses of Rotavirus, and one dose of measles vaccines (29).

Not Immunized

A child aged 12–23 months who did not receive any vaccine before this study is considered not immunized (28).

Essential Elements of ANC Service Provided

Women were classified as received full ANC services when they receive the seven selected essential antenatal care services (a thorough physical examination, blood tests for infection screening and anemia, a urine test, tetanus toxoid injections, iron and folate supplements, and HIV test). Full services were considered as not received when one of the seven selected elements of antenatal care services is not provided during ANC visit (13, 30).

Data processing and Analysis

Data collected by using kobo collect and exported to Stata 17 for analysis. Descriptive statistics was done to quantify the proportion of women who complete the continuum of care for maternal and child health services. Findings summarized in tables and graphs using frequencies and percentages.

Initially, Bivariable logistic regression analysis was performed between the dependent variable and each of the independent variables in sequence. Variables having a p-value of < 0.25 in Bivariable logistic regression selected as candidates for multivariable logistic regression analysis. Model fitness was checked by Hosmer and Lemeshow goodness of test and multicollinearity between the explanatory variables checked using a variance inflation factor. Association between an outcome variable and explanatory variables are reported by using adjusted odds ratio and its 95% CI, and variables having p-values less than 0.05 in the multivariable logistic regression model is considered as statistically significant.

Ethical clearance

Ethical clearances obtained from the Ethics research review committee of Jigjiga University and further approval gained from Shebelle zone health office and the purpose or aim of the study be briefly explained for the respondents and written informed consent obtained from each respondent. During data collection the study participants informed us that the information collected would be kept anonymous and confidential. The mothers can withdrawal from the study or automatically ignore and their permission of involvement decided by mothers.

Dissemination of results

The finding of this study will be presented in Jigjiga university research symposium. It can be also being disseminated for Somali regional health office. The study findings will be disseminated to the relevant organization and stakeholders. The study could be published in scientific journals.

Sociodemographic characteristics

Out of 461 samples a total of 459 mothers were interviewed making a response rate of 99.6%. Regarding an age, 86 (17. %) of the women were under 24 years old, while 210 (45.6%) were between 25 and 34 years old. The mean age with standard deviation of the participant was 31.4(± 7.5) years. Most of participants 454(98.9%) are Somali in ethnicity and 456 (99.4%) are Muslim in religion. According to the study, 478 (95.6%) of the participants were married. More than half of the participants 236(51.5%) did not have a formal education and were unable to read and write. Of 423 (92.2%) of them, the husband is the head of the household. In 307 (66.9%) of these households, the husband is the breadwinner while 114 (24.8%) are the wives and husbands. The average family size in Gode district is 5.9 people. Of them, 262 (85.6%) had two children under the age of five. The average family income in the household was 8097.5 birr.

Table 1

Sociodemographic characteristics of women in Gode districts, Somali regional state; Ethiopia;2023
Variables	Category	Frequency	Percentage
Age of women in years	15–24	86	18.7
	25–34	210	45.8
	35–49	163	35.5
Ethnicity	Somali	454	98.9
	Amhara	3	0.7
	Oromo	2	0.4
Religion	Muslim	456	99.4
	Orthodox	2	0.4
	Protestant	1	0.2
Marital Status	Married	433	94.3
	Widowed	7	1.5
	Divorced	19	4.1

Table 2

Sociodemographic characteristics of women in Gode districts, Somali regional state; Ethiopia;2023(continued)
Variables	Category	Frequency	Percentage
Educational Status	No Education (Unable to read and write)	236	51.4
	Primary Education (1–8)	173	37.7
	Secondary and above	50	10.9
Maternal Occupation	Government Employee	116	25.3
	Marchant	85	18.5
	Farmer	80	17.4
	Housewife	178	38.8
Husband Occupation	Government Employee	167	37.0
	Farmer	135	29.9
	Marchant	71	15.7
	Others	78	17.3
Head of the household	Husband	423	92.2
Head of the household	Wife	36	7.8
Bread Winner (Who brings income?)	Husband	307	66.9
	Wife	38	8.3
	Both	114	24.8
Family Size	Less than five	246	53.6
	Six up to Ten	186	40.5
	Eleven up to Fifteen	27	5.9
Under five children	One	131	28.5
	Two	262	85.6
	Three	66	14.4
Family income (In Birr)	< 5,000	147	32.0
	5,000–10,000	170	37.0
	10,000–20,000	111	24.2
	> 20,000	31	6.8

Reproductive and obstetrics characters is of the study participants

Antenatal Care

Most participants, 434 (94.6%), thought that prenatal care visits were crucial. A total of 142 people, or 31%, thought that starting antenatal care at 16 weeks or more was appropriate. Regarding gravidity, 42 (9% of them) are primigravida, 230 (50%) are gravida 2–4, and 160 (34.8%) are gravida 5–9. In the same way, 61 (13.3%) are Primipara, 244 (53.2%) are paras 2–4, and 135 (29.4%) are paras 5–9. Three fourths of all 341(74.3%) had planned pregnancy (Fig. 1). Many of the 360 (78.4%) had male child preference. Most of participants started ANC less than 16 weeks of gestational age. Many participants, 447 (97.3%), began ANC 16 weeks before gestation.

Table 3

Antenatal care characteristics of women in Gode districts, Somali regional state; Ethiopia;2023
Variables	Category	Frequency	Percentage
ANC importance	Yes	434	94.6
ANC importance	No	25	5.5
Appropriate time to begin ANC (in weeks)	Before 16 weeks	142	31
Appropriate time to begin ANC (in weeks)	16 weeks and more	317	69.1
Gravidity	1	42	9.2
	2–4	230	50.1
	5–9	160	34.9
	10–13	27	5.9
Parity	Primi Para	61	13.3
	2–4	244	53.2
	5–9	135	29.4
	10–13	19	4.1
Types of pregnancy	Planned	341	74.3
Types of pregnancy	Unplanned	118	25.7

Table 4

Antenatal care characteristics of women in Gode districts, Somali regional state; Ethiopia;2023(continued)
Variables	Category	Frequency	Percentage
Need of sex preference	Male	360	78.4
Need of sex preference	Female	99	21.6
Month of first ANC	Less than 16 weeks	447	97.4
Month of first ANC	16 and more weeks	12	2.6
ANC in previous pregnancy	Yes	417	90.9
Number of ANC visit	No	42	9.2
	Once	83	19.9
	Twice	137	32.9
	Three	117	28.1
	Four and more	80	19.2
Told about Birth preparedness and complication readiness plan	Yes	409	89.1
	No	50	10.9

Childbirth related characteristics

Table 5

Childbirth related characteristics of women’s in Gode district, Somali Regional State;2023
Variables	Category	Frequency	Percentage
Place of delivery	Health facility	407	88.7
Place of delivery	Home	52	11.3
Mode of delivery	Spontaneous vaginal delivery	436	95
Mode of delivery	Instrumental/Caesarean delivery	23	5.0
Informed about danger signs before delivery in health facility	Yes	409	89.1
	No	50	10.9
Danger sign during birth	Yes	219	47.7
Danger sign during birth	No	240	52.3

Postnatal care and Immunization

The prevalence of postnatal care utilization was found to be 376(81.9%) in the study area. Within two days of birth, postnatal care was received by 297(75.4%) of the patients. Two hundred and eighty-five of the participants, or 67.9%, had postpartum visits at the health center and 104(24.8%) at hospital. In terms of time spent at PNC, 142 (34.4%) and 138 (33.4%) of participants had one and two visits, respectively (Fig. 2). Additionally, 341 (74.4%) of the participants had immunizations that were complete or up to date, whereas 423 (92.3%) of the participants received child vaccinations.

Table 6

Postnatal care and immunization characteristics of women’s in Gode district, Somali Regional State;2023
Variables	Category	Frequency	Percentage
PNC attendance	Yes	376	81.9
PNC attendance	No	83	18.1
First PNC attendance	Within two days	297	75.4
	Three days to seven days	74	18.8
	Seven days to two weeks	16	4.1
	Two weeks to six weeks	7	1.8
Place of PNC	Hospital	104	24.8
	Health Center	285	67.9
	Health Post	14	3.3
	Own Home	17	4.1
Time to Attended PNC	One time	142	34.4
	Two time	138	33.4
	Three time	62	15.0
	Four and more	71	17.2
Received child vaccination	Yes	423	92.2
Received child vaccination	No	36	7.8
Immunization up-to-date or complete	Yes	341	74.3
Immunization up-to-date or complete	No	118	25.7

Community related factors

More than half of the respondents 263(57.3%) were urban dwellers. Three fourths of them travel less than five kilometers to reach the health facility. The perceived travel time to a health institution was less than 30 minutes, according to 348 (75.2%) of the respondents.

Table 7

Community related factor of women’s in Gode district, Somali Regional State;2023
Variables	Category	Frequency	Percentage
Residence	Urban	263	57.3
Residence	Rural	196	42.7
Distance to the health facility (km)	Less than five	344	75
	Five to nine	64	14
	Ten and more	51	11
Perceived time to reach health facility	< 30 minutes	348	75.8
Perceived time to reach health facility	≥ 30 minutes	111	24.18

Institutional Related Factors

A total of 320 respondents, or 69.7%, claimed that the behavior of the healthcare workers during the provision of care was good, while 25.5% felt that it was fair. Many respondents (389, or 84.8%) were satisfied with the services delivered during their most recent visit. More than half of respondents, 255 (55.6%), said that there is a maternity waiting room in the nearby health facility. The availability of medical equipment and drugs was observed by 322(70%) of participants.

Table 8

Institution related factors of women’s in Gode district, Somali Regional State;2023
Variables	Category	Frequency	Percentage
Health Professional Behavior	Good	320	69.7
	Fair	117	25.5
	Bad	22	4.8
Satisfaction with service given in last visit	Yes	389	84.8
Satisfaction with service given in last visit	No	70	15.3
Drug and medical equipment access	Yes	322	70.2
Drug and medical equipment access	No	137	29.9
Maternity waiting room in nearby health facility	Yes	255	55.6
Maternity waiting room in nearby health facility	No	204	44.4

Prevalence of MCH continuum of care

Prevalence of MCH continuum of care was 13.5% (10.7%-17.0%) in Gode district,2022(Fig. 3).

Factors associated with maternal and child health continuum of care

Sociodemographic characteristics with MCHCC

Crude analysis of socio-demographic characteristics through bivariate logistic regression showed that age of women 25–34 years (COR = 2.4,95% CI = 0.96–5.96, p-value = 0.06), (COR = 2.3,95% CI = 0.9–5.9,p-value = 0.08),Ethnicity(Somali) (COR = 0.1,95%CI = 0.02–0.6, p value = 0.0012), Religion (Muslim) (COR = 0.3,95% CI = 0.03–3.5,p-value = 0.340),marital status(married) (COR = 0.6,95%CI = 0.2–1.8,p-value = 0.383),Educational status(Primary education 1–8 grade)( COR = 2.0,95%CI = 1.1–3.5,p-value = 0.017),Maternal occupation Government employee (COR = 1.6,95%CI = 0.9–2.9,p-value = 0.096),Husband occupation(Government employee (COR = 1.7,95% CI = 0.99–2.96,p-value = 0.053),head of the house hold(husband) (COR = 0.96,95% CI = 0.36–2.59,p-value = 0.944),Bread winner wife(COR = 2.0,95% CI = 0.8–4.9,p-value = 0.128) & both (COR = 2.4,95% CI = 1.3–4.3,p-value = 0.004),Family size(6-100) (CI = 1.5,95% CI = 0.9–2.6,p-value = 0.154),Under five children (3) (CI = 2.7,95% CI = 1.2-6.0,p-value = 0.154) and family income in birr(5000–10000) (CI = 1.7,95% CI = 0.8–3.3,p-value = 0.140) ) are candidate variable for multivariate analysis with P value < 0.25.

Table 9

A bivariate analysis table shows the correlation between socio-demographic characteristics with maternal and child health continuum of care in Gode district, Somali regional State;2023
Variables	Category	MCH continuum of care		COR ((95% CI)	P-value
Variables	Category	Yes	No	COR ((95% CI)	P-value
Age of women in years	15–24	6(6.98%)	80(93.02%)	1
	25–34	32(15.24%)	178(84.76%)	2.4(0.96–5.96)	0.06
	35–49	24(14.72%)	139(85.28%)	2.3(0.9–5.86)	0.081
Ethnicity	Somali	59(13%)	395(87%)	0.1(0.02–0.6)	0.012
Ethnicity	Others	3(60%)	2(40%)	1
Religion	Muslim	59(95.16%)	395(99.5%)	0.3(0.03–3.5)	0.340
Religion	Others	3(4.84%)	2(0.5%)	1
Marital Status	Married	57(13.16%)	376(86.84%)	0.6(0.2–1.8)	0.383
Marital Status	Others	5(19.23%)	21(80.77%)	1
Educational Status	No Education (Unable to read and write)	24(38.71%)	212(53.4%)	1
	Primary Education (1–8)	32(51.61%)	141(35.52%)	2.0(1.1–3.5)	0.017
	Secondary Education and above	6(9.68%	44(11.08%)	1.2(0.5–3.1)	0.702
Maternal Occupation	Government Employee	21(33.87%)	95(23.93%)	1.6(0.9–2.9)	0.096
Maternal Occupation	others	41(12%)	302(88%)	1
Husband Occupation	Government Employee	29(48.33%)	138(35.29%)	1.71(0.99–2.96)	0.053
Husband Occupation	Others	31(10.9 2%)	253(89.08%)	1

Table 10

A bivariate analysis table shows the correlation between socio-demographic characteristics with maternal and child health continuum of care in Gode district, Somali regional State;2023(Continued)
Variables	Category	MCH continuum of care		COR (95% CI)	P value
Variables	Category	Yes	No	COR (95% CI)	P value
Head of the household	Husband	57(91.94%)	366(92.19)	0.96(0.36–2.59)	0.944
Head of the household	Wife	5(8.06%)	31(7.81%)	1
Bread Winner (Who brings income?)	Husband	31(50%)	276(69.52%)	1
	Wife	7(11.29%)	31(7.81%)	2.0(0.8–4.9)	0.128
	Both	24(38.71%)	90(22.67%)	2.4(1.3–4.3)	0.004
Family Size	Less than five	28(45.16%)	218(54.91%)	1
	Six up to Ten	30(48.39%)	156(39.29%)	1.5(0.9–2.6)	0.154
	Eleven up to Fifteen	4(6.45%)	23(5.79%)	1.4(0.4–4.2)	0.600
Under five children	One	13(20.97%)	118(29.72%)	1
	Two	34(54.84%)	228(57.43%)	1.4(0.7–2.7)	0.381
	Three	15(24.19%)	51(12.85%)	2.7(1.2-6.0)	0.018
Family income (In Birr)	< 5,000	15(24.19%)	132(33.25%)	1
	5,000–10,000	27(43.55%)	143(36.02%)	1.7(0.8–3.3)	0.140
	10,000–20,000	15(24.19%)	96(24.18%)	1.4(0.6–2.9)	0.413
	> 20,000	5(8.06%)	26(6.55%)	1.7(0.6–5.1)	0.347

Pregnancy related characteristics with MCHCC

Crude analysis of socio-demographic characteristics through bivariate logistic regression showed that types of pregnancy (Planned) (COR = 1.9,95% CI = 1.0–4.0, p-value = 0.067) is a candidate variable to multivariate analysis with p value < 0.25.

Table 11

A bivariate analysis table shows the correlation between pregnancy related characteristics with maternal and child health continuum of care in Gode district, Somali regional State;2023
Variables	Category	MCH continuum of care		COR (95%CI)	P value
Variables	Category	Yes	No
Appropriate time to begin ANC (in weeks)	Before 16 weeks	22(15.49%)	120(84.51%)	1.3(0.7–2.2)	0.406
Appropriate time to begin ANC (in weeks)	16 weeks and more	40(12.62%)	277(87.38%)	1
Gravidity	< 5	35(12.87%)	237(87.13%)	1
Gravidity	≥ 5	27(14.44%)	160(85.56%)	1.1(0.7-2.0)	0.629
Parity	Less than five	43(14.1%)	262(85.9%)	1
Parity	Five and more	19(12.34%)	135(87.66%)	0.9(0.5–1.5)	0.603
Types of pregnancy	Planned	52(15.25%)	289(84.75%)	1.9(1.0–4.0)	0.067
Types of pregnancy	Unplanned	10(8.47%)	108(91.53%)	1
Need of sex preference of HCP	Male	17(12.23%)	122(87.77%)	1
Need of sex preference of HCP	Female	45(14.06%)	275(85.94%)	1.3(0.7–2.4)	0.384

Community related factors with MCHCC

Crude analysis of community related factors through bivariate logistic regression showed that residence (rural) (COR = 2.1,95% CI = 1.0–3.0, p-value = 0.039) and perceived time to reach health facility (< 30 minutes) (COR = 2.8,95% CI = 1.2–6.3, p-value = 0.014) is a candidate variable to multivariate analysis with p value < 0.25.

Table 12

A bivariate analysis table shows the correlation between community related factor with maternal and child health continuum of care in Gode district, Somali regional State;2023
Variables	Category	MCH continuum of care
Variables		Yes	No	COR with CI	P value
Residence	Urban	28(10.7%)	235(89.4%)	1
Residence	Rural	34(17.4%)	162(82.7%)	2.1(1.0–3.0)	0.039
Distance to the health facility (km)	Less than five	43(12.5%)	301(87.5%)	1
	Five to nine	11(17.2%)	53(82.8%)	1.5(0.7–2.99)	0.312
	Ten and more	8(15.7%)	43(84.3%)	1.3(0.6–2.95)	0.528
Perceived time to reach health facility	< 30 minutes	55(15.8%)	293(84.2%)	2.8(1.2–6.3)	0.014
Perceived time to reach health facility	≥ 30 minutes	7(6.3%)	104(93.7%)	1

Institutional related factors with MCHCC

Crude analysis of institutional related factors through bivariate logistic regression showed that health professional behavior (good) (COR = 0.6,95% CI = 0.3-1.0, p-value = 0.06), Drug and medical equipment access(no) (COR = 2.0,95% CI = 1.2–3.5, p-value = 0.012) and Maternity waiting room in nearby health facility (COR = 1.5,95% CI = 0.9–2.7, p-value = 0.129) are a candidate variable to multivariate analysis with p value < 0.25.

Table 13

A bivariate analysis table shows the correlation between Institutional related factors with maternal and child health continuum of care in Gode district, Somali regional State;2023
Variables	Category	MCH continuum of care
Variables	Category	Yes	No	OR (95% CI)	P-value
Health Professional Behavior	Good	37(11.6%)	283(88.4%)	0.6(0.34–1.04)	0.06
Health Professional Behavior	Not Good	25(18.0%)	114(82.0%)	1
Drug and medical equipment access	Yes	35(10.9%)	287(89.1%)	1
Drug and medical equipment access	No	27(19.7%)	110(80.3%)	2.0(1.2–3.5)	0.012
Maternity waiting room in nearby health facility	Yes	40(15.7%)	215(84.3%)	1.5(0.9–2.7	0.129
Maternity waiting room in nearby health facility	No	22(10.8%)	182(89.2%)	1

Multivariate logistic regression

Multivariable logistic regression was performed to control the confounding effect of variables. Accordingly, Husband occupation (Government employee) [AOR = 2.3, 95%CI:(1.2–4.7)] and perceived time to reach health facility (less than 30 minutes) [AOR = 2.96, 95%CI:(1.2–7.5)] were factors showing significant association with maternal and child health continuum of care among mothers in Gode district, Somali regional State;2023 at P-value ≤ 0.05.

The odds of maternal and child health continuum of care among mothers had husband employed in government organization 2.3 times [AOR = 2.3, 95%CI:(1.2–4.7)] higher than others.

The odds of maternal and child health continuum of care among mothers perceived that distance to reach health facility less than 30 minutes 2.96 times [AOR = 2.96, 95%CI:(1.2–7.5)] higher than those perceived as greater than 30 minutes.

Table 14

A multivariate analysis on maternal and child health continuum of care in Gode district, Somali regional State;2023
Variables	Category	MCH continuum of care
Variables		Yes	No	COR (95% CI)		AOR (95% CI)	P-value
Age of women in years	15–24	6(7%)	80(93.0%)		1
	25–34	32(15%)	178(84.8%)	2.4(0.96–5.96)		1.9(0.7–5.3)	0.226
	35–49	24(14.7%)	139(85.3%)	2.3(0.9–5.86)		1.9(0.6–6.5)	0.282
Ethnicity	Somali	59(13%)	395(87%)	0.1(0.02–0.6)		0.2(0.02–1.2)	0.079
Ethnicity	Others	3(60%)	2(40%)	1		1
Educational Status	No Education (Unable to read and write)	24(38.7%)	212(53.4%)	1		1
	Primary Education (1–8)	32(51.6%)	141(35.5%)	2.0(1.1–3.5)		1.5(0.8–3.1)	0.244
	Secondary Education and above	6(9.7%)	44(11.1%)	1.2(0.5–3.1)		1.1(0.3–3.5)	0.896
Husband occupation	Government Employee	29(48.3%)	138(35.3%)	1.71(0.99–2.96)		2.3(1.2–4.7)	0.016
Husband occupation	Others	31(10.9%)	253(89.1%)	1		1
Head of the household	Husband	57(91.9%)	366(92.2)	0.96(0.36–2.59)		3.3(0.3–32.2)	0.306
Head of the household	Wife	5(8.1%)	31(7.8%)	1		1

Table 15

A multivariate analysis on maternal and child health continuum of care in Gode district, Somali regional State;2023(continued)
Variables	Category	MCH continuum of care		COR (95%CI)	AOR (95%CI)	P value
Variables	Category	Yes	No	COR (95%CI)	AOR (95%CI)	P value
Bread Winner (Who brings income?)	Husband	31(50%)	276(69.5%)	1	1
	Wife	7(11.3%)	31(7.8%)	2.0(0.8–4.9)	5.6(0.7–41.4)	0.094
	Both	24(38.7%)	90(22.7%)	2.4(1.3–4.3)	1.9(0.9–3.9)	0.078
Family Size	Less than five	28(45.2%)	218(54.9%)	1
	Six up to Ten	30(48.4%)	156(39.3%)	1.5(0.9–2.6)	1.5(0.7–3.3)	0.277
	Eleven up to Fifteen	4(6.5%)	23(5.8%)	1.4(0.4–4.2)	2.4(0.6–10.5)	0.243
No. of Under five children	One	13(21.0%)	118(29.7%)	1	1
	Two	34(54.9%)	228(57.4%)	1.4(0.7–2.7)	1.2(0.5–2.5)	0.702
	Three	15(24.2%)	51(12.9%)	2.7(1.2-6.0)	1.7(0.7–4.4)	0.266
Types of pregnancy	Planned	52(15.3%)	289(84.8%)	1.9(1.0–4.0)	1.2(0.5-3.0)	0.626
Types of pregnancy	Unplanned	10(8.5%)	108(91.5%)	1	1
Residence	Urban	28(10.7%)	235(89.4%)	1	1
Residence	Rural	34(17.4%)	162(82.7%)	2.1(1.0–3.0)	0.6(0.25–1.23)
Perceived time to reach health facility	< 30 minutes	55(15.8%)	293(84.2%)	2.8(1.2–6.3)	2.96(1.17–7.5)	0.022
Perceived time to reach health facility	≥ 30 minutes	7(6.3%)	104(93.7%)	1	1

In this study most of the participants 447(90.9%) had at least one ANC in previous pregnancy. But 80(19.2) of the participants only had Four or more ANC visit. In contrast, prevalence of antenatal care utilization was 62.8% in Ethiopia(32). Utilization of antenatal care services varied across the different regions and city administrations; for instance, the highest number of four or more antenatal care visits were reported in Addis Ababa (83.3%), followed by Dire Dewa (61.6%) and the Somali Region (10.5%). According to the 2019 Ethiopia Demographic and Health Survey (EDHS), only 44.0% of pregnant women received at least four ANC visits(33). There are several factors that contribute to the low utilization of ANC services in Somali regional state including geographic barriers, economic barriers, cultural barriers, and lack of knowledge.

Of the participants, 407 (86.7%) had given birth in a health facility and 436(95%) of them had spontaneous vaginal delivery. Before delivery, 409 (89.1%) women at a healthcare facility received information about danger signs. In Ethiopia, 53.9% of deliveries took place in a health facility with a skilled attendant(33). It is like the World Health Organization (WHO) target of 90%(34). This could be due to a government effort in expanding access to delivery care and raising awareness of the importance of institutional deliveries if it is to achieve the goal of universal coverage.

The prevalence of postnatal care utilization was found to be 376(81.9%) in the study area. Within two days of birth, postnatal care was received by 297(75.4%) of the patients. The finding of this study was consistent with a cross sectional study conducted in Adwa Town which found that 264(78.3%) mothers had attended postnatal care service(35). In contrast, in Ethiopia only 36.1% of mothers received postnatal care within the first 6 weeks and only 33.8% received any within the first 48 hours (about 2 days) after delivery(33). An explanation for this might be the Ethiopian government has taken several steps to increase the use of postnatal care services, including increasing access to health services, offering free or inexpensive postnatal care, and increasing public knowledge of the value of postnatal care.

In this study 341 (74.4%) of the participants had immunizations that were complete or up to date, whereas 423 (92.3%) of the participants received child vaccinations. It is higher than a pooled prevalence of immunization among 12–23 -month-old children in Ethiopia was found to be 47%(36). A subgroup analysis results of different regions showed the lowest coverage was in Afar region, 21% and the highest in the Amhara region, 89%(36) .

This study finding showed that the prevalence of MCH continuum of care was 13.5% (10.7%-17.0%). This finding is lower than a study finding in different part of Ethiopia such as, Wayu district 16.1% and Debrebrhan town 37.2% North west Ethiopia 21.60% (37) (38, 39). However, this finding is higher than a study finding in Ethiopia (2%)(40).It is also higher than findings of different part of the world Cambodia and Korea, which were 5.0% (41)and 6.8% (42)respectively. The probable reason for such variation could be different access to health care services, economic status, and education.

The odds of maternal and child health continuum of care among mothers had husband employed in government organization 2.3 times higher than others. Occupational status being other than a farmer, clinical/sales employed and not involved in agricultural activities are more likely to get the maternal, newborn and child health continuum of care respectively compared to their counterparts in Studies finding in Lao PDR in rural Khammouane, Nigeria, and Ethiopia (21, 24, 25). But in Pakistan, occupational status was not a significant factor (19). A husband's occupation can have a significant impact on the maternal and child health continuum of care. Women with husbands who have higher-paying jobs are more likely to receive prenatal care, deliver in a hospital, and have their babies vaccinated.

The odds of maternal and child health continuum of care among mothers perceived that distance to reach health facility less than 30 minutes 3.0 times higher than those perceived as greater than 30 minutes. It is similar with study finding on Wayu district and northwest Ethiopia (39) (43).Women who perceive that it will take a long time to reach a health facility are less likely to seek prenatal care, deliver in a hospital, and have their babies vaccinated. It could be due to logistical challenges in getting to a health facility.

Prevalence of MCH continuum of care was 13.5% (10.7%-17.0%) in Gode district,2022. In this study most of the participants 447(90.9%) had at least one ANC in previous pregnancy. But 80(19.2) of the participants only had Four and more ANC visit. Of the participants, 407 (86.7%) had given birth in a health facility. The prevalence of postnatal care utilization was found to be 376(81.9%) in the study area. This study showed that, 341 (74.4%) of the participants had immunizations that were complete or up to date, whereas 423 (92.3%) of the participants received child vaccinations. Accordingly, Husband occupation (Government employee) [AOR = 2.3, 95%CI:(1.2–4.7)] and perceived time to reach health facility (less than 30 minutes) [AOR = 2.96, 95%CI:(1.2–7.5)] were factors showing significant association with maternal and child health continuum of care among mothers in Gode district, Somali regional State;2023 at P-value ≤ 0.05.

RECOMMENDATION

Health care provider

Health care providers can play a key role in increasing the maternal and child health continuum of care by providing quality care to mothers and children, educating mothers about their health, and working with communities to promote healthy behaviors.

Government

Governments can play a key role in increasing the maternal and child health continuum of care by investing in health care infrastructure, training health care workers, and providing financial support for maternal and child health programs.

Communities

Communities can play a key role in increasing the maternal and child health continuum of care by supporting mothers and children, providing social support, and advocating for better health care for mothers and children.

Non-governmental organizations (NGOs): NGOs can play a key role in increasing the maternal and child health continuum of care by providing direct care to mothers and children, advocating for better health care for mothers and children, and conducting research on maternal and child health.

ANC

Antenatal Care

AOR

Adjusted Odd Ratio

BPCR

Birth Preparedness and Complication Readiness

CoC

Continuum of Care

COR

Crude Odd Ratio

CSA

Central Statistics Agency

Family Planning

HIV

Human Immunodeficiency Virus

MNCH

Maternal Neonatal and Child Health

MCH

Maternal and Child Health

PNC

Post Natal Care

SBA

Skilled Birth Attendance

SPSS

Statistical Package for Social Sciences

WHO

World Health Organization

Acknowledgment

We would like to thank Jigjiga University for supporting this research. We forward appreciation to Somali regional health office for their provision of information related to our research topic. Our gratitude also goes to our colleagues for their encouragement and meticulous support while conducting this research. Finally, I would like to thank the data collectors, supervisors and all research participants who took part in the study

Authors’ contributions
LM designed the research, analyzed the data, interpreted the findings, and drafted the manuscript. SH, ZS & MT are also involved in all the processes of this research. All authors read and approved the final manuscript for publication.

Funding
Not applicable.

Availability of data and materials

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.

Consent for publication

Not applicable.
Competing interests

There is no competing interest among the authors.

Author details

¹College of Medicine and Health sciences, department of Public Health, Jigjiga University, Jigjiga, Ethiopia.

² College of Medicine and Health sciences, department of Neonatal Nursing, Jigjiga University, Jigjiga, Ethiopia.

³ Department of Reproductive Health and Population Studies, College of Medicine and Health Science, School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia

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NGO
Amhara and Oromo
Orthodox and protestant
Widowed & divorced
Farmer, Marchant & Housewife

No competing interests reported.

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You are reading this latest preprint version

Completion of Maternal and Child Health Continuum of Care and Associated Factors Among Women in Gode District, Shebele Zone, Eastern Ethiopia ,2022

Status:

Version 1

Abstract

Background

Objective

Method

Result

Conclusion and recommendation: Only

Figures

INTRODUCTION

Methods

RESULT

Childbirth related characteristics

Postnatal care and Immunization

Institutional Related Factors

Sociodemographic characteristics with MCHCC

Pregnancy related characteristics with MCHCC

Community related factors with MCHCC

Institutional related factors with MCHCC

Multivariate logistic regression

DISSCUSION

CONCLUSION

RECOMMENDATION

Abbreviations

Declarations

References

Footnotes

Additional Declarations

Status:

Version 1