From 592 women who had given birth in the past nine months recruited, only 564 participated in the study, yielding a response rate of 95.3%. Two hundred and twelve (37.6%) of the respondents were resided in the urban area while the rest 62.4% resided in the rural area. More than half, 61.2%, of the study respondents were within the age range of 20–29 years with mean (± SD) age of 27.17 (± 5.88) years. The majority, 64.7%, of the study respondents married at the age of 18–24 years. The study further revealed that about a third of the respondents, 29.1%, married at 10–17 years and only 6.2% were married at age of ≥ 25 years with mean ((± SD) age of 18.89 ((± 3.02) years (Table 1).
Table 1
Respondents socio-demographic characteristics in Assosa Zone, North Western Ethiopia (N = 564).
Variables | Category | Frequency | Percent | |
---|
Age category | 15–19 years | 35 | 6.2 | Mean age = 27.17 SD = 5.88 |
| 20–24 years | 159 | 28.2 |
| 25–29 years | 186 | 33.0 |
| 30–34 years | 96 | 17.0 |
| 35–39 years | 66 | 11.7 |
Religion | Orthodox Tewahedo | 154 | 27.3 | |
| Muslim | 379 | 67.2 | |
| Protestant | 31 | 5.5 | |
Ethnicity | Benishangul | 226 | 40.1 | |
| Amhara | 237 | 42.0 | |
| Others* | 101 | 17.9 | |
Residence | Urban | 212 | 37.6 | |
| Rural | 352 | 62.4 | |
Marital status | Married | 542 | 96.1 | |
| Others** | 22 | 3.9 | |
Age of first marriage | 10–17 years | 164 | 29.1 | Mean = 18.89 SD = 3.02 |
| 18–24 years | 365 | 64.7 |
| >=25 years | 35 | 6.2 |
Educational status | No formal education | 121 | 21.5 | |
| Primary education | 243 | 43.1 | |
| Secondary | 111 | 19.7 | |
| College and above | 89 | 15.8 | |
Occupational status | Farmer | 149 | 26.4 | |
| Housewife | 295 | 52.3 | |
| Employee | 61 | 10.8 | |
| Merchant | 16 | 2.8 | |
| Others *** | 43 | 7.6 | |
Household monthly income (ETB) | < 3,500 | 370 | 65.6 | Mean = 3,588.41 SD = 3923.62 |
3,500-4,900 | 60 | 10.6 |
5,000–9,000 | 102 | 18.1 |
>= 10,000 | 32 | 5.7 |
* Oromo = 95, Tigre = 3, Gurage = 1 and shinasha = 2, ** (Cohabiting, divorced, widowed and single,*** student, daily laborers |
The study shows that two-thirds (67.2%) and 27.3% of study respondents were following Muslim and Orthodox Tewahedo faiths, respectively. The rest of the study respondents were Protestant. Regarding to ethnicity, Amhara comprised 42.0%, Benishangul 40.1%, and all others comprised 17.9% (Table 1).
The education variable in Table 1 reflects that the majority, 78.5%, had formal education from elementary to higher level while 21.5% did not have formal education. From a sample of 564, more than half, 52.3%, of the respondents were housewives, 26.4% were farmers, 13.6% were employed and merchant and the rest ,7.6%, were other employment status. An analysis of household income revealed that about 65.6% respondents had lower than 3,500 Ethiopian birr (ETB) household income per month and the analysis further shows that 34.4% of the respondents had higher than and equal to 3,500 ETB income per month with mean ((± SD) monthly income of 3,588.41 (± 3,923.32) ETB as revealed in Table 1 below.
The sociocultural, household and family characteristics of respondents
Table 2 of the study revealed that the occupation of more than half respondents’ partners, 60%, was farming/they were farmers. Only 21.6% were employees while 8.5% were merchants and 9.0% were of other occupations. Pertaining to decision making, most of women, 78.2%, utilised CoC services with decisions made with their partners. The study found that 11.7% women made decisions independently regarding reproductive matters and 10.1% desired to have permission from their partners. The study shows that 92.0% of women who had given births in the last nine months had support from their partner/family to use maternal and neonatal CoC services from the recognised health facilities, but the rest did not have support (Table 2).
Table 2
Scio-cultural, household and family characteristics of women who had given birth in the last nine months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Category | Frequency | Percent |
---|
Partner occupation | Farmer | 343 | 60.8 |
| Employee | 122 | 21.6 |
| Merchant | 48 | 8.5 |
| Others* | 51 | 9.0 |
Primary decision maker for maternal and neonatal CoC utilization | Woman herself | 66 | 11.7 |
Husband | 57 | 10.1 |
Both | 436 | 78.2 |
Had partner/family support to used CoC services | Yes | 522 | 92.6 |
No | 42 | 7.4 |
Got information related to maternal and neonatal CoC | Yes | 472 | 83.7 |
No | 92 | 16.3 |
Source of information on CoC (N = 472) | HEWs | 223 | 39.5 |
| Health workers | 209 | 37.1 |
| Others ** | 40 | 8.4 |
Listen radio or watch television | Every day | 273 | 48.4 |
| Once a week | 68 | 12.1 |
| Once a month | 16 | 2.8 |
| Not at all | 207 | 36.7 |
Distance of health facility | Up to 30 minutes | 352 | 62.4 |
| 31–60 minutes | 151 | 26.8 |
| 61–120 minutes | 45 | 8.0 |
| > 120 minutes | 16 | 2.8 |
Mode of transport to health facilities | On foot | 304 | 53.9 |
| By ambulance | 59 | 10.5 |
| By public transport | 201 | 35.6 |
,* students and daily laborers, **HDA = 35, relatives = 1, community leaders = 2, neighbors = 1 and media = 5 |
This study indicated that 83.7% of respondents got information that was related to maternal and neonatal CoC services from health extension workers (HEWs), health workers, health development army (HDA), relatives, community leaders, neighbors and media. This study further indicates that 63.3% of respondents had mass media exposure but 36.7% of respondents did not have mass media exposure (Table 2).
About 62.4% of women who had given birth in the last nine months have travelled up to 30 minutes to receive CoC services and only 37.6% have travelled more than 30 minutes to reach health facilities to receive CoC services. The mode of transports used to reach health facilities were on foot, by ambulance and by public transports. In this study 53.9% of women travelled on foot to reach health facilities (Table 2).
The obstetric characteristics of respondents
In this study, about 70.4% respondents had two and more pregnancies and the remaining had only one pregnancy. Slightly more than two-third, 67.7%, respondents had two and more surviving children and 32.3% respondents had only one surviving child. More than half, 52.1%, women who had given birth in the past nine months wanted to have five and more children, 37.8% them wanted to have 1–4 children and 10.1% of them did not plan to have additional children (Table 3).
Table 3
Obstetric characteristics of women who had given birth in the last nine months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Category | Frequency | Percent |
---|
Number of pregnancies | One | 167 | 29.6 |
| Two | 138 | 24.5 |
| Three | 100 | 17.7 |
| Four and more | 159 | 28.2 |
Number of children | One | 182 | 32.3 |
| Two | 140 | 24.8 |
| Three | 103 | 18.3 |
| Four and more | 139 | 24.6 |
The interval between the birth of the last child and his/her immediate elder child | Not applicable* | 167 | 29.6 |
< 24 months | 99 | 17.6 |
| 24–35 months | 91 | 16.1 |
| 36–59 months | 152 | 27.0 |
| >= 60 months | 55 | 9.8 |
No of children the woman wants to have | No child | 57 | 10.1 |
| 1–4 children | 213 | 37.8 |
| >=5 children | 294 | 52.1 |
Had complication during previous pregnancy (N = 397) | Yes | 31 | 7.8 |
No | 366 | 92.2 |
Complications during pregnancy includes (N = 31) ** | Vaginal bleeding | 13 | 22.4 |
Vaginal gush of fluid | 11 | 19.0 |
| Severe headache | 11 | 19.0 |
| Blurred vision | 6 | 10.3 |
| Pressure | 6 | 10.3 |
| Anemia | 6 | 10.3 |
| High fever | 3 | 5.2 |
| Severe abdominal pain | 1 | 1.7 |
| Convulsion | 1 | 1.7 |
History of adverse outcome before current child (N = 397) | Yes | 74 | 18.6 |
No | 323 | 81.4 |
Adverse pregnancy outcome before current child (N = 74) ** | Preterm | 14 | 13.9 |
History of still birth | 18 | 17.8 |
| History of neonatal death | 22 | 21.8 |
| History of abortion | 21 | 20.8 |
| neonatal low weight | 5 | 5.0 |
| Previous cesarean section | 21 | 20.8 |
Wanted pregnancy | Yes | 484 | 85.8 |
| No | 80 | 14.2 |
Modern family planning used to delay the last pregnancy | Yes | 386 | 68.4 |
No | 178 | 31.6 |
Reasons for unwanted pregnancy (N = 80)** | Lack of awareness | 26 | 28.6 |
| Fear of side effect | 19 | 20.9 |
| Partner disapproval | 19 | 20.9 |
| Because of breast feeding | 22 | 24.2 |
| Health worker error | 5 | 5.5 |
Note: *the women have only one child, ** analysis was done using multiple responses |
The birth interval between the present child and his/her elder siblings were less than 24 months among 17.6% of respondents, 25–35 months among 16.1% of respondents and greater than or equal to 36 months among 36.8% of respondents. This study revealed that 92.2% of women did not have history of complications during pregnancy. However, only 7.8% women had history of previous complications during their pregnancy. The major complications during pregnancies includes vaginal bleeding among 22.4%, vaginal fluid or gush among 19.0%, severe headache among 19.0%, blurred vision among 10.3%, pressure among 10.3%, anaemia among 10.3%, severe abdominal pain among 1.7% and convulsions among 1.7% of respondents. The adverse outcomes include preterm, history of still birth, history of neonatal death, history of abortion, low neonatal weight and previous cesarean section (Table 3).
In this study, 68.4% women used family planning to delay their recent pregnancy but 31.6% of them did not use family planning to delay their last pregnancy. The analysis of this study indicates that 14.2% of respondents’ recent pregnancies were unwanted. The major causes of unwanted pregnancy in this study were lack of women awareness, fear of family planning side effects, presence of partner disapproval, because of breastfeeding and family planning failure as indicated in the present study (Table 3).
Respondents’ knowledge on maternal and neonatal health
This study found that 75.7% of women who had given birth in the past nine months heard about the interbirth interval between two consecutive births. From the total respondents, 67.7% of women knew that the optimum years between the two consecutive birth intervals could be 3–5 years. In this study, 87.5% of respondents knew that short birth interval had negatives health outcomes for neonates and it could result low birth weight, prematurity and neonate deaths. However, small proportion,7.3%, of women did not know the consequence of short birth interval and 5.2% of women considered that short birth interval did not have health disadvantage for neonates. In the same vein, 82.9% of respondents listed that short birth interval may result anaemia, bleeding and death outcomes for the mothers. Nevertheless, 6.4% of women did not consider the disadvantage of short birth intervals and 10.8% did not know the health disadvantages (Table 4).
Table 4
Knowledge of maternal and neonatal health among women had given birth in the past nine months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Category | Frequency | Percent |
---|
Heard about optimal birth interval between two consecutive births | Yes | 427 | 75.7 |
No | 137 | 24.3 |
Knew the optimum number of birth intervals | < 3 Years | 100 | 17.7 |
3–5 Years | 382 | 67.7 |
| > 5 Years | 82 | 14.5 |
Knew disadvantage of short birth interval for neonate (N = 564) * | Low birth weight | 379 | 49.3 |
Preterm baby | 166 | 21.6 |
Death | 128 | 16.6 |
| No problem | 40 | 5.2 |
| Don’t know | 56 | 7.3 |
Knew disadvantage of short birth interval for mothers (N = 564) * | Anemia | 319 | 37.1 |
Bleeding | 248 | 28.8 |
| Death | 145 | 16.9 |
| Don’t know | 93 | 10.8 |
| No problem | 55 | 6.4 |
Knew modern methods of family planning to delay pregnancy | Yes | 471 | 83.5 |
No | 93 | 16.5 |
Knew appropriate time to begin ANC | Yes | 367 | 65.1 |
| No | 197 | 34.9 |
Knew expected number of ANC during pregnancy at health facilities | Yes | 459 | 81.4 |
No | 105 | 18.6 |
Knew need of preparation for delivery | Yes | 543 | 96.3 |
| No | 21 | 3.7 |
Overall knowledge on obstetric complication during ANC, delivery and PNC | Yes | 94 | 16.7 |
No | 470 | 83.3 |
Obstetric complication that could occur during pregnancy * | High blood pressure | 321 | 28.7 |
Blurred vision or convulsion | 217 | 19.4 |
| Absence or less movement of fetus | 165 | 14.7 |
| Swelling of hands, legs and face | 198 | 17.7 |
| Bleeding or watery gush of fluid discharge through vagina | 219 | 19.6 |
Obstetric complication that could occur during delivery * | Prolonged labor | 205 | 18.1 |
Excessive vaginal bleeding | 309 | 27.3 |
| Delay in placental expulsion | 164 | 14.5 |
| Severe abdominal pain | 134 | 11.9 |
| Rupture uterus | 77 | 6.8 |
| Fetus in abnormal position | 89 | 7.9 |
| Cord prolapsed | 81 | 7.2 |
| Mal presentation | 71 | 6.3 |
Obstetric complication that could occur during PNC * | High fever | 250 | 50.6 |
Foul smell discharge | 244 | 49.4 |
Overall knowledge on newborn danger signs | Yes | 71 | 12.6 |
No | 493 | 87.4 |
Know newborn danger signs* | Not able to breastfeed | 382 | 27.1 |
| Fever | 298 | 21.2 |
| Fast breathing | 184 | 13.1 |
| Difficulty of breathing | 141 | 10.0 |
| Lethargic or unconscious | 67 | 4.8 |
| Hypothermia | 31 | 2.2 |
| Convulsion | 87 | 6.2 |
| Umbilical infection | 70 | 5.0 |
| Jaundice | 37 | 2.6 |
| Vomiting | 110 | 7.8 |
Note: * analysis was done using multiple responses |
As shown in the Table 4 below, 65.1% of women knew the appropriate time to begin the first ANC service from health facilities. About 81.4% women had also knowledge on the expected number of ANC visits during pregnancy at health facilities. This study found that 96.3% respondents had knowledge for skilled birth preparation from the recognised health facility but only 3.7% of them did not have knowledge (Table 4).
Only few, 16.7%, respondents had overall knowledge about maternal complications that could occur during pregnancy, delivery, and postnatal periods but the rest majority, 83.3%, respondents did not have overall maternal complications knowledge along the CoC. Maternal complications that could occurred during pregnancy known by respondents were high blood pressure, convulsions, absence or no movement of fetus, swelling of hands, legs and face, bleeding or watery gush or fluid discharge through vagina. Maternal complications that could occurred during delivery listed by respondents were prolonged labor, excessive vaginal bleeding, delay in placenta expulsion, severe abdominal pain, fetus in abnormal position, cord prolapse and malpresentation. The complications that could occurred during postnatal period known by respondents were high grade fever and foul smell discharges. The analysis further showed that only 12.6% of respondents had overall knowledge about neonatal danger signs but the rest majority, 87.4%, respondents did not have overall knowledge of neonatal complications (Table 4).
MNH CoC service utilisation
ANC services utilisation
This study indicated that 95% women were attended 1st ANC services in the recent pregnancy. from the total ANC attendants, only 62.1% respondents started within 1–4 months and 37.9% respondents started ANC visits later than four months of their pregnancy. This study indicated that 62.6% of respondents were attended four or more ANC visits from recognised health facilities preceding nine months of the present study but 37.4% of them did not receive the expected number of ANC during their pregnancy (Table 5).
Table 5
ANC service utilisation of women who had given birth in the last 9 months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Category | Frequency | Percent |
---|
Attended ANC for the current child | Yes | 536 | 95.0 |
| No | 28 | 5.0 |
Reasons not attended ANC (N = 28)* | Not aware where to go | 7 | 17.1 |
| It was not necessary | 10 | 24.4 |
| Busy for family care | 5 | 12.2 |
| Facility was too far | 7 | 17.1 |
| Perceived poor quality of maternity services | 2 | 4.9 |
| Was healthy | 10 | 24.4 |
Started 1st ANC at (N = 536) | 1–4 months | 336 | 62.6 |
| 5 months | 200 | 37.4 |
| 6–9 months | 82 | 15.3 |
Received 4th and more ANC (N = 536) | Yes | 353 | 65.9 |
| No | 183 | 34.1 |
Places of ANC services | Hospital | 86 | 15.2 |
| Health Center | 406 | 72.0 |
| Health posts | 38 | 6.7 |
| Private clinic | 6 | 1.1 |
| Not received at all | 28 | 5.0 |
Received pregnancy complication counseling (N = 536) | Yes | 485 | 90.5 |
No | 51 | 9.5 |
Got birth preparedness plan counseling (N = 536) | Yes | 486 | 90.7 |
No | 50 | 9.3 |
Advised about diet and nutrition (N = 536) | Yes | 508 | 94.8 |
| No | 28 | 5.2 |
Counseled for IPPFP (N = 536) | Yes | 484 | 90.3 |
| No | 52 | 9.7 |
Counseled advantage of facility delivery and PNC services (N = 536) | Yes | 514 | 95.9 |
No | 22 | 4.1 |
Advised effect of malaria during pregnancy and its prevention (N = 536) | Yes | 490 | 91.4 |
No | 46 | 8.6 |
During ANC follow-ups, majority of the study respondents received counselling services. In this finding, 90.5% women received pregnancy complication counselling, 90.7% got birth preparedness planning, 90.3% counseled for post-partum family planning (PPFP), 95.9% counselled on advantage of facility delivery and PNC services and 91.4% advised effects of malaria in pregnancy and its prevention (Table 5).
Women who had given birth in the last nine months were expected to receive iron folic acid for about three months for the prevention of pregnancy related anemia. They also expected to receive tetanus toxoid (TT) vaccination up to five times for the prevention of neonatal tetanus. However only 52.8% women received iron folic acid for three and more months, 30.5% received for one to two months, 13.3% received less than one month and 3.1% of them did not receive at all. Regarding TT, only 17.2% women received five times and expected to be protected, the majority, 80.1%, received one to four times and the rest, 2.7%, not received at all (Fig. 1).
The study indicated that 94.0% women measured their weight, 94.0% women got blood pressure checkup, and 93.4% women got fundal height check-ups for the frequent ANC visits. Similarly, 93.8% women were screed for syphilis, 98.7% were tested for HIV, 83.8% them tested for hepatitis B surface antigen and 97.6% women got urine examinations (Fig. 2).
Skilled delivery service utilisation
The present study reveals that 94.5% women who had given birth in the past nine months prior the study was assisted by skilled birth attendance (SBA) in health centers and hospitals. Regarding to the mode of delivery, about 86.3% study respondents delivered through assisted vaginal delivery, 8.0% through spontaneous delivery and 5.7% through cesarean section. Most, 73.2%, of respondents delivered their baby at health centers, 21.5% at hospital, 2.0% at health posts and 3.5% at home. This study shows that 3.5% women who had given birth in the past nine months were not attended SBA due to sudden onset of labor, comfortable to birth in front of relatives, far distances of health facilities and lack of convenient transport during the start of labor (Table 6).
Table 6
Skilled delivery service utilisation of women who had given birth in the last 9 months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Category | Frequency | Percent |
---|
Skilled birth attendant | Yes | 533 | 94.5 |
| No | 31 | 5.5 |
Places of delivery | Hospital | 120 | 21.3 |
| HC | 413 | 73.2 |
| HP | 11 | 2.0 |
| Home | 20 | 3.5 |
Got ambulance service in the recent delivery | Yes | 263 | 46.6 |
No | 301 | 53.4 |
Got ambulance service during recent delivery (N = 263) | Before birth | 207 | 78.7 |
After birth | 36 | 13.7 |
| Both | 20 | 7.6 |
Reasons not delivered at health facilities (N = 20) * | Sudden onset of labor | 9 | 36.4 |
Comfortable to give birth in front of TBAs and relatives | 1 | 4.5 |
| Far to health facility | 3 | 13.6 |
| Inconvenient transport | 10 | 45.5 |
Mode of delivery for your recent baby | Spontaneous vaginal | 45 | 8.0 |
| Assisted vaginal | 487 | 86.3 |
| Cesarean section | 32 | 5.7 |
Service-related payment during delivery (N = 544) | Yes | 81 | 14.9 |
No | 463 | 85.1 |
Providers greet you respectfully (N = 544) | Yes | 435 | 80.0 |
| No | 109 | 20.0 |
Adequate privacy given to you during the examination by the health worker (N = 544) | Yes | 507 | 93.2 |
No | 37 | 6.8 |
Providers allowed to have a companion with you during your labor and delivery (N = 544) | Yes | 483 | 88.8 |
No | 61 | 11.2 |
Providers encourage taking food or fluid in the process of labor (N = 544) | Yes | 489 | 89.9 |
No | 55 | 10.1 |
Providers allow you to sleep your preferred position during labour (N = 544) | Yes | 416 | 76.5 |
No | 128 | 23.5 |
Providers offer compassionate delivery care (N = 544) | Yes | 519 | 95.4 |
No | 25 | 4.6 |
Want to deliver again in this same facility (N = 544) | Yes | 497 | 91.4 |
No | 47 | 8.6 |
* Multiple analysis was done |
According to the respondents’ response, 14.9% women paid service-related payment during delivery but the rest majority, 85.1%, received the services freely. During delivery attendance about 80.0% of women were got respectful greeting from providers, 93.2% were given adequate privacy during delivery, 88.8% were allowed to have a companion’s care during their labour and delivery, 89.9% were encouraged to take food or fluid in the process of labour, 76.5% women allowed to sleep in their preferred position during labour and 95.4% women were offered compassionate delivery care in the study area by providers. According to the respondents’ response, about 91.4% of them wanted to deliver again at the same facility for their future delivery but only a few, 8.6%, did not want to deliver in the same facility (Table 6).
PNC service utilisation
This study identified that about 87.9% of women who had given birth in the past nine months were attended PNC services. From the total 496 women who utilised PNC, more than half, 54.0%, were attended within 24hrs, 13.1% attended within 25-48hrs, 9.0% within 49-72hrs, 16.0% from 73hrs to 6 days and 9.8% attended greater than 6 weeks. About 52.1%, of the respondents received PNC services from the health centers and the rest, 47.9%, respondents were received services at hospital, health posts and their homes. The present study also shows that 22.2%, 28.6%, 17%, 12%, and 12.3%, of respondents were counselled about the nature of vaginal discharge, breast feeding, neonatal and maternal danger signs, diet and nutrition, and family planning services, respectively. The main reasons to utilise PNC services were due to sickness of women and neonates, check themselves and neonate health condition, child immunisation, get family planning, receive on counselling for breast feeding, test anemia and obtain information on danger signs (Table 7).
Table 7 PNC service utilisation of women who had given birth in the last 9 months in Assosa Zone, North Western Ethiopia (N=564)
Nearly half, 46.8%, health status of mothers and their neonate were assessed by health extension workers (HEWs), 21.8% by midwives, 1.8% by doctors, 2.3% by Women development army (WDA) and the rest not assessed their health status after they left the health facility for those who delivered in the health facilities and those who had given birth at home (Table 7).
As shown in the table 1.77 below, 12.1% of respondents were not utilised PNC services due to considered that the services were not necessary, believed to forty days rule i. e confinement at home, lack of support, too far distances to reach health facilities, lack of transport access, perceived poor quality of services, absence of previous complications, previous negative experiences at facilities, presence of friend influences and lack of facility trust.
After delivery, 25.2% were utilised female steralisation, IUCD, injectables (Dipo), implants and pills. This study indicates that 79.8% of women had partner supports to use PPFP services and the rest did not have partner supports. The partners assisted the women through taking FP themselves, supporting by provision of transport, reminding dates of appointment and used of condoms (Table 7).
Completion of MNH continuum of care services
The flow of services within continuum of care indicates that the proportion of women whose journey from one maternal care services to the next and the points where women drop from the journey of the continuum of care. As shown in the Fig. 3, first ANC, fourth ANC, SBA and PNC services coverages were high and ranges from 62.6–95.0% among women who had given birth in the past nine months in the study area. However, the utilisation of CoC services among women were declined from first ANC through PNC. This indicates that significant proportion of women drop along the journey of the CoC at each step. From the total respondents, significant proportions, 32.4%, did not continue on the journey to attend four or more ANC visits resulting only 62.6% of women received four or more ANC visits. Across the continuum, the smallest dropout, 2.8%, was observed between fourth or more ANC visits and skilled birth attendance. In the present study, cumulatively, 53.7% women accessed the full range of services within MNH CoC (Fig. 3).
Factors affecting completion of MNH continuum of care services
The results show that occupation, partner support, knowledge on expected number of ANC, knowledge on neonatal danger signs, initiation of first ANC visit period, place of ANC, place of PNC, comprehensive counselling and physical examination during ANC and mode of delivery variables were significantly associated with completion of CoC use among women after adjusted with other variables (Table 8).
Table 8
Determinants of complete CoC service utilisation among women who had given birth in the last nine months in Assosa Zone, North Western Ethiopia (N = 564)
Variables | Completion of MNH CoC | COR | AOR | P.value |
---|
Yes | No |
---|
Education | | | | | 0.040 |
Secondary and above | 66 | 23 | 3.42(2.04–5.74) | 1.49(0.44–5.01) | 0.518 |
Primary | 71 | 40 | 2.12(1.37–3.28) | 2.53(1.23–5.20) | 0.011 |
Not formal education | 166 | 198 | 1.00 | 1.00 | |
Occupation | | | | | 0.057 |
Employee | 51 | 10 | 5.00(2.44–10.22) | 12.26(1.87–80.28) | 0.009 |
Others* | 30 | 13 | 2.26(1.14–4.51) | 1.07(0.34–3.34) | 0.909 |
Farmers | 68 | 81 | 0.82(0.55–1.22) | 1.33(0.67–2.65) | 0.419 |
Merchants | 5 | 11 | 0.45(0.15(1.31) | 0.33(0.05–2.13) | 0.246 |
Housewives | 149 | 146 | 1.00 | 1.00 | |
Partner support | | | | | |
Yes | 295 | 227 | 5.52(2.51–12.16) | 4.94(1.43–17.14) | 0.012 |
No | 8 | 34 | 1.00 | 1.00 | |
Know expected number of ANC visits during pregnancy | | | |
Yes | 282 | 177 | 6.37(3.81–10.65) | 13.21(6.29–27.72) | < 0.001 |
No | 21 | 84 | 1.00 | 1.00 | |
ANC 1st visit started | | | | | |
with 1–4 months | 241 | 92 | 5.96(4.06–8.74) | 8.31(4.70-14.69) | < 0.001 |
More than 4 months | 62 | 141 | 1.00 | 1.00 | |
Place of ANC | | | | | 0.002 |
Hospital | 57 | 29 | 10.90(4.99–23.83) | 7.19(2.07–24.99) | 0.002 |
Health center | 235 | 171 | 7.62(3.89–14.92) | 5.07(1.88–13.66) | 0.001 |
Health post, private clinic and home | 11 | 61 | 1.00 | 1.00 | |
Place PNC | | | | | < 0.001 |
Hospital | 41 | 16 | 3.84(1.74–8.47) | 0.98(0.29–3.33) | 0.976 |
Health center | 197 | 97 | 3.05(1.69–5.51) | 6.91(2.61–18.29) | < 0.001 |
Health post | 43 | 47 | 1.37(0.70–2.71) | 2.92(0.96–8.92) | 0.060 |
Home | 22 | 33 | 1.00 | 1.00 | |
Knowledge of neonatal danger signs or complications | | | |
Yes | 32 | 39 | 0.55(0.33–0.92) | 0.21(0.09–0.51) | < 0.001 |
No | 305 | 188 | 1.00 | 1.00 | |
Know modern FP method | | | | | |
Yes | 261 | 210 | 1.51(0.96–2.36) | 1.96(0.93–4.15) | 0.078 |
No | 42 | 51 | 1.00 | 1.00 | |
Received comprehensive counseling and physical examination during ANC follow-ups | | | |
Yes | 235 | 153 | 2.44(1.69–3.52) | 2.04(1.07–3.89) | 0.030 |
No | 68 | 108 | 1.00 | 1.00 | |
Mode of delivery | | | | | |
C-section | 20 | 12 | 1.47(0.70–3.06) | 9.68(1.75–53.66) | 0.009 |
Vaginal and assisted delivery | 283 | 249 | 1.00 | 1.00 | |
N.B. The assumptions for the application of multivariate logistic regression analysis were fulfilled by using Hosmer and Lemeshow test and the model was adequately fits at (P = 0.629). For explanatory variables having more than two categories, the overall significance of P-value used. Variables whose P-value less than 0.2 in the bivariate logistic regress were entered to multivariate logistic analysis. |
Significantly significant at P < 0.05 |
Education positively influences the completion of CoC services among women who had given birth in the past nine months. Compared to women did not have formal education, those who had primary education were around 2.5 times (AOR = 2.53, 95%CI = 1.23–5.20) more likely to complete CoC services from the recognised health facilities. Occupation status of women determine the completion of MNH continuum of care services from the recognised health facilities. Employment was a strong predictor to the completion of CoC services in the present study. Employed women were 20 times (AOR = 20.19, 95%CI = 3.50-116.53) more likely to complete CoC services than housewives but there was no significant difference between other occupation categories (Table 8).
Partner support is a strong predictor and positively influences for the completion of maternal and neonatal CoC services. In this study, partner supported women were 5 times (AOR = 4.94, 95%CI = 1.43–17.14) more likely to complete CoC services than those who did not have partners support (Table 8).
Knowledge of expected number of ANC visits among women strongly affects the completion of MNH CoC services. The chance of completion of CoC were about 13 times (AOR = 13.21, 95%CI = 6.29–27.72) more likely among women who knew the expected numbers of ANC visits than who did not know it. Surprisingly, the odd of completion of MNH CoC services were decreased by 21% (AOR = 0.21, 95%CI = 0.09–0.51) among women who had knowledge of neonatal danger signs or complications than their counterparts (Table 8).
Initiated ANC services in the first trimester is a strongest factor to the completion of MNH CoC services from ANC through PNC. This study showed that women who started their ANC visit within 1–4 months were 8 times (AOR = 8.31, 95%CI = 4.70-14.69) more likely to complete MNH CoC services than those who stared lately. Counselling and physical examination plays great role for the completion of MNH CoC among women. Women received comprehensive counselling and physical examination during ANC follow-ups were 2 times (AOR = 2.04, 95%CI = 1.07–3.89) more likely to complete MNH CoC services than who were not received. Place of ANC and PNC significantly contributed for the completion of MNH CoC services among women. Women who followed ANC services in the health centers were 7 times (AOR = 7.19, 95%CI = 2.07–24.99) more likely to compete maternal and neonatal CoC services than those women followed at health posts, private clinics and at home. In Addition, women who followed ANC services in the hospitals were 5 times (AOR = 5.07, 95%CI = 1.88–13.66) more likely to compete maternal and neonatal CoC services than those women followed at health posts, private clinics and at home. Regarding to place of PNC, those women who received PNC services in the health centers were 7 times (AOR = 6.9, 95%CI = 2.61–18.29) more likely to maternal and neonatal CoC services than women who received ANC services at home. This study found that the odd of completion of CoC was significantly higher among women who had given birth their neonates though C-section (AOR = 9.68, 95%CI = 1.75–53.66) than who had given birth through assisted and spontaneous vaginal delivery (Table 8).