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Background. The maternity continuum of care is the continuity of maternal healthcare services that a woman uses, which includes antenatal care (ANC 4+), skill birth attendant (SBA), and postnatal care (PNC) within 48 hours of delivery. It is one of the essential strategies for reducing maternal and newborn mortality. This study aimed to assess the factors associated with the completion of a continuum of maternal healthcare services among mothers who gave birth in the past five years. Methods. A community-based cross-sectional study was conducted from May 01 to June 29, 2019, among 565 randomly selected mothers who gave birth in five years before the study in primary healthcare project implementation districts of north Gondar zone, Amhara National Regional State, Ethiopia. Bivariable and multivariable logistic regression analysis were computed, and in the multivariable logistic regression analysis, adjusted odds ratio (AOR) with 95% confidence interval (CI) and a p value of less than 0.05 were used to identify the associated factors with completion of the continuum of maternal healthcare services. Results. The study revealed that the overall completion of the continuum of maternal healthcare services was 21.60% (95% CI: 18.20, 24.90). Women who were able to read and write (AOR: 2.70, 95% CI: 1.22, 6.04), using car/motorcycle as a means of transportation to get the health facility (AOR: 5.59, 95% CI: 2.29, 9.50), travel time less than an hour to get the health facility (AOR: 4.98, 95% CI: 2.97, 8.38), being satisfied with the service delivery (AOR: 1.89, 95% CI: 1.15, 3.11), and getting health education on maternal healthcare services in the last 6 months (AOR: 2.77, 95% CI: 1.52, 5.05) were factors associated with the completion of the continuum of maternal healthcare services. Conclusions. The completion of the continuum of maternal healthcare services was relatively low, indicating that women were not getting the likely health benefit from the present health services. Therefore, interventions should focus on increasing women’s awareness, improving the availability of services at nearby health facilities, and improving service delivery by considering women’s preferences and needs to increase their satisfaction are essential to increase the completion of maternal healthcare services.
A community-based cross-sectional study design was conducted in Gondar Zuria and Dabat districts, Northwest Ethiopia, from May 01 to June 29, 2019, to assess the completion of the continuum of maternal care. These two districts are among the six districts of primary healthcare project implementation areas in north Gondar zone, Amhara National Regional State, Ethiopia. Gondar Zuria and Dabat districts consist of 32 and 38 kebeles (the smallest administrative unit in Ethiopia), respectively. The Dabat district has four health centers and twenty-nine health posts and has administratively divided into three urban and twenty-nine rural kebeles, and it is a residence of 155,093 population. Of these, 80,648 are females. While Gondar Zuria district has five urban and thirty-three rural kebeles with 242,892 inhabitants, 116,386 males and 126,506 females. There are 37,222 and 57,322 women in the childbearing age group (15-49) in Dabat and Gondar Zuria districts, respectively. Moreover, 15,423 and 24,113 women gave birth in Dabat and Gondar Zuria districts within the past five years prior to the study, respectively. All mothers who gave birth in the past five years before the time of data collection in the districts were the source population. Mothers with most recent births in the last five years preceding this study from each selected kebeles in both districts were included in the study. However, mothers who gave birth in another district and came to the study area and mothers critically ill and unable to respond to the interview were excluded from the study. The required sample was calculated by single population proportion formula (n = (Zα/2)2 × P(1 − P)/(d)2) with the assumptions of the proportion of continuum of care for maternal healthcare services was 50% (to get the maximum sample), a 95% confidence level, 5% marginal error (d), and adding 5% nonresponse rate, and 1.5 design effect which gives a total sample of 583. Initially, eight kebeles from the Dabat district and ten kebeles in the Gondar Zuria district (30% of the total kebele) were selected using the lottery method. Then, the proportional allocation was applied for each selected kebeles based on the number of the mother who gave birth for the last five years before the data collection period (information obtained from the community health information system) in each kebele. Finally, the study participants were selected using simple random sampling techniques (lottery method) from the Community Health Information System (CHIS) register. Then having the name and house number, interview of the mother was conducted home to home. For those mothers who gave birth more than once in the past five years, mothers with the most recent births fulfilling the inclusion criteria were interviewed. The dependent variable of the study was the continuum of maternal healthcare services. Whereas, the independent variables were socio-demographic variables of women (age, educational status, religion and ethnicity, husbands’ education status, occupational status), maternal healthcare services (antenatal care, delivery place, and postnatal care), and physical access to maternal health services and other related services. The outcome variable continuum of maternal healthcare services was analyzed by the proportion of women who received maternal healthcare services at the pregnancy, delivery, and postdelivery stages. They are measured following Jacobs et al., definition [25]. Accordingly, when a woman receives ANC four times or more, delivers at home or in a health facility by a trained health professional, and receives maternal PNC within 48 hours after delivery by an appropriate provider, it is considered as complete the continuum of maternal healthcare services. Data were collected using a structured interviewer-administered questionnaire, which was initially prepared in English and translated to the local language (Amharic) by language expertise, and then translated back to English by language expertise to ensure its consistency and accuracy. Fifteen diploma nurse data collectors and three public health officer field supervisors were employed for the data collection process. One day training was provided on the techniques of interviewing, handling ethical issues, maintaining confidentiality and privacy two days before the pretest, and five days before the final data collection. The tool was pretested on 5% of the sample (29 women who gave birth in the last five years) in Koladeba district (nearby the districts) to ensure the internal validity of the study. The data was cleaned and checked for consistency, coded, and entered into Epi-Data version 3.1 software, and exported to SPSS version 20 software for analysis. Descriptive measures were computed to summarize the socio-demographic characteristics of the participants and the completion of the continuum of maternal healthcare services. Both bivariable and multivariable logistic regression analyses were computed to determine the associated factors. Variables with a p value of less than 0.2 in the bivariable logistic regression analysis were entered into a multivariable logistic regression analysis to control possible confounding factors after checking model fitness. Finally, a p value of less than 0.05 and an adjusted odds ratio (AOR) with 95% confidence level (CI) were used to declare a statistically significant association between the outcome variable and with the completion of the continuum of maternal healthcare services.
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