Levels and associated factors of the maternal healthcare continuum in Hadiya zone, Southern Ethiopia: A multilevel analysis

BACKGROUND: The continuity of care throughout pregnancy, birth, and after delivery is an effective strategy to avert maternal and newborn deaths. A low proportion of mothers have achieved the continuum of maternal care in Ethiopia. This study aimed to assess the rate and factors associated with the completion of a continuum of maternal healthcare services in Hadiya Zone, Southern Ethiopia. METHODS: A community-based, cross-sectional study was conducted over two months (from September to October 2021) in 18 kebeles of the Hadiya zone, southern Ethiopia. Multistage cluster sampling was carried out to select the required study subjects, and data were collected using a structured, interviewer-administered questionnaire. A multilevel binary logistic regression model was used to examine the effects of individual and community-level factors on key elements of the care continuum. The measure of fixed effects was expressed as an odds ratio with a 95% confidence interval (CI). RESULTS: In this study, only 11.3% of women completed all components of the care continuum, which included four or more antenatal visits, skilled birth attendance, and postnatal care. The factors that are significantly associated with the completion of maternal care include higher maternal education [AOR = 4.1; 95%CI: 1.3–12.6], urban residence [AOR = 1.8; 95%CI: 1.1–3.0], time of first antenatal care follow-up [AOR = 2.7; 95% CI: 1.6–4.6], knowledgeability regarding postnatal danger signs [AOR = 1.9, 95% CI: 1.1–3.3], being in the highest wealth quintile [AOR = 2.8; 95%CI: 1.2–6.6] and primipara [AOR = 3.6; 95%CI: 1.4–9.4]. CONCLUSION: The rate of continuum of maternal healthcare services utilization was low in the study area. The findings indicated that higher maternal education, urban residence, time of first antenatal care follow-up, knowledgeability regarding postnatal danger signs, being in the highest wealth quintile and primipara were the factors associated with the completion of the continuum of maternal care. As a result of this study’s findings, program planners and ministry of health and non-governmental organizations working on maternal health should prioritize continued and strengthened health education in order to increase the completion level of the continuum of maternal healthcare services.