Background
Methods
Study site and sampling
Conceptual framework
Data and measures
Outcome variables
Independent variables
Data analysis
Structural equations
Model evaluation
Ethical consideration
Results
Geographical profile and inequality in MNCH care utilization
Characteristics |
N = 137,505 | Adequate antenatal care | Adequate delivery care | Adequate postnatal care | Adequate immunization |
---|---|---|---|---|---|
All | 100 | 8.8 | 54.8 | 35.2 | 31.7 |
Country, year | *** | *** | *** | *** | |
DR Congo, 2013/14 | 13.6 | 4.8 | 78.3 | 20.2 | 20.5 |
Gambia, 2013 | 5.8 | 10.2 | 62.7 | 57.4 | 55.0 |
Liberia, 2013 | 4.8 | 30.3 | 55.1 | 55.2 | 31.4 |
Mali, 2012/13 | 7.7 | 4.7 | 39.2 | 27.5 | 18.7 |
Namibia, 2013 | 3.5 | 8.4 | 87.4 | 55.5 | 46.3 |
Nigeria, 2013 | 23.5 | 7.1 | 34.4 | 23.7 | 15.3 |
Rwanda, 2010 | 6.7 | 3.3 | 69.0 | 10.5 | 63.2 |
Senegal, 2013 | 4.6 | 22.6 | 58.2 | 54.2 | 40.1 |
Sierra Leone, 2013 | 9.0 | 14.2 | 54.0 | 54.2 | 49.4 |
Tanzania, 2010 | 6.0 | 2.7 | 50.0 | 17.5 | 35.9 |
Togo, 2013/14 | 4.9 | 7.6 | 45.0 | 50.1 | 38.7 |
Zambia, 2013/14 | 9.9 | 7.5 | 64.1 | 53.1 | 29.2 |
Marital status | *** | *** | *** | *** | |
Married | 88.2 | 8.5 | 52.8 | 33.5 | 31.1 |
Formerly married | 5.6 | 10.0 | 61.7 | 38.4 | 33.2 |
Unmarried | 6.2 | 12.5 | 76.8 | 56.6 | 38.1 |
Age group | *** | *** | *** | *** | |
≤ 20 | 10.7 | 9.3 | 52.2 | 40.0 | 22.4 |
21–25 | 23.4 | 8.4 | 56.2 | 33.7 | 29.6 |
26–30 | 28.1 | 8.8 | 55.9 | 33.4 | 33.1 |
31–35 | 18.7 | 9.2 | 56.0 | 36.1 | 34.8 |
36–40 | 12.6 | 8.7 | 52.8 | 35.5 | 33.9 |
≥ 41 | 6.5 | 8.9 | 49.6 | 36.9 | 34.9 |
Birth order | *** | *** | *** | *** | |
1st | 20.5 | 10.3 | 65.6 | 37.1 | 35.1 |
2nd | 19.9 | 9.9 | 62.4 | 38.5 | 34.5 |
3rd–4th | 27.5 | 9.1 | 52.7 | 34.4 | 31.0 |
> 4th | 32.1 | 6.9 | 44.5 | 32.4 | 27.9 |
Family size | *** | *** | *** | ||
≤ 6 | 21.3 | 10.3 | 60.2 | 37.4 | 31.9 |
> 6 | 78.7 | 8.4 | 53.3 | 34.6 | 31.6 |
Number of under-5, M
| *** | *** | *** | *** | |
≤ 2 | 70.1 | 9.7 | 57.9 | 38.2 | 33.0 |
> 2 | 29.9 | 6.7 | 47.7 | 27.9 | 28.3 |
Residence | *** | *** | *** | *** | |
Urban | 32.1 | 14.1 | 77.2 | 49.4 | 38.8 |
Rural | 67.9 | 6.3 | 44.2 | 28.5 | 28.3 |
Mother’s education | *** | *** | *** | *** | |
No education | 41.4 | 7.0 | 35.8 | 29.0 | 26.1 |
Primary | 32.8 | 7.0 | 59.3 | 31.4 | 33.8 |
Secondary & higher | 25.8 | 14.1 | 79.5 | 49.9 | 37.9 |
Wealth index | *** | *** | *** | *** | |
Poorest | 22.7 | 4.7 | 34.8 | 24.0 | 24.1 |
Poor | 22.2 | 5.9 | 41.7 | 28.6 | 26.7 |
Middle | 20.3 | 8.3 | 52.5 | 34.8 | 30.9 |
Rich | 18.7 | 10.7 | 70.2 | 42.8 | 36.4 |
Richest | 16.1 | 17.1 | 86.1 | 51.8 | 44.7 |
Media exposure | *** | *** | *** | *** | |
Not exposed | 31.2 | 5.2 | 41.9 | 24.5 | 21.0 |
Any one | 32.7 | 7.8 | 49.7 | 33.2 | 34.0 |
Any two | 26.6 | 11.4 | 65.7 | 43.9 | 36.7 |
All three | 9.5 | 17.0 | 84.3 | 53.1 | 44.5 |
Mother’s employment | *** | *** | *** | *** | |
Unemployed | 28.4 | 8.5 | 54.9 | 36.1 | 27.8 |
Professional | 2.1 | 17.9 | 89.6 | 56.0 | 44.8 |
Middle level jobs | 23.2 | 10.6 | 57.3 | 37.7 | 28.0 |
Agriculture | 34.4 | 5.7 | 49.4 | 27.8 | 35.0 |
Other | 11.9 | 11.3 | 59.1 | 43.0 | 35.9 |
Father’s employment | *** | *** | *** | *** | |
Unemployed | 9.2 | 5.5 | 42.0 | 28.9 | 20.6 |
Professional | 8.0 | 12.8 | 70.1 | 42.6 | 34.3 |
Middle level jobs | 12.1 | 10.5 | 58.0 | 37.0 | 29.5 |
Agriculture | 42.8 | 5.6 | 43.6 | 26.4 | 29.7 |
Other | 27.9 | 11.9 | 64.6 | 42.0 | 36.3 |
Father’s education | *** | *** | *** | *** | |
No education | 36.7 | 6.9 | 34.9 | 29.6 | 27.2 |
Primary | 26.5 | 5.9 | 53.8 | 27.0 | 33.8 |
Secondary | 30.1 | 10.4 | 69.4 | 40.0 | 31.7 |
Higher | 6.8 | 18.7 | 78.6 | 51.7 | 39.1 |
Baby’s size | *** | *** | *** | *** | |
Very large | 14.1 | 11.4 | 57.8 | 37.8 | 32.3 |
> Average | 26.8 | 9.3 | 57.8 | 36.5 | 33.5 |
Average | 43.3 | 8.1 | 54.6 | 34.9 | 31.8 |
< Average | 10.8 | 8.1 | 52.7 | 33.7 | 30.3 |
Very small | 5.0 | 9.8 | 50.4 | 35.6 | 28.2 |
Baby’s sex | ** | ||||
Male | 50.5 | 8.9 | 55.3 | 35.2 | 31.7 |
Female | 49.5 | 8.8 | 54.3 | 35.1 | 31.7 |
Baby’s age, years | *** | *** | *** | *** | |
< 1 | 21.2 | 12.2 | 57.8 | 50.1 | 9.0 |
1 | 20.3 | 12.3 | 56.9 | 50.4 | 44.2 |
2 | 19.4 | 10.0 | 56.2 | 38.6 | 43.3 |
3 | 19.8 | 6.2 | 53.4 | 24.0 | 39.3 |
4 | 19.3 | 4.3 | 52.5 | 17.2 | 36.6 |
Model evaluation
Determinants of MNCH care utilization measurement indicators
Code | Variable | Std. est.a
| Std. err. |
p-value |
---|---|---|---|---|
VACCINAT | ADEQUATE IMMUNIZATION | |||
Polio0 | Polio 0 | 0.52b
| - | - |
BCG | BCG | 0.79 | 0.002 | <0.001 |
DPT1 | DPT 1 | 0.90 | 0.002 | <0.001 |
Polio1 | Polio 1 | 0.72 | 0.001 | <0.001 |
DPT2 | DPT 2 | 0.93 | 0.002 | <0.001 |
Polio2 | Polio 2 | 0.74 | 0.002 | <0.001 |
DPT3 | DPT 3 | 0.83 | 0.002 | <0.001 |
Polio3 | Polio 3 | 0.57 | 0.002 | <0.001 |
measle | Measles | 0.69 | 0.002 | <0.001 |
POSTNAT | ADEQUATE POSTNATAL CARE | |||
POSTCHEC | PNC after delivery | 0.99b
| - | - |
POSTIME | PNC in 24 h after delivery | 0.66 | 0.001 | <0.001 |
DISCHEC | Checked before discharge | 0.98 | 0.001 | <0.001 |
BABYPOST | Newborn care after birth | 0.31 | 0.002 | <0.001 |
BABYTIME | Newborn care in 24 h after birth | 0.29 | 0.001 | <0.001 |
BABYPROF | Skilled newborn care after birth | 0.34 | 0.002 | <0.001 |
DELIVERY | ADEQUATE DELIVERY CARE | |||
FACDELIV | Delivered at the facility | 0.97b
| - | - |
PROFDELV | Skilled birth attendance | 0.87 | 0.001 | <0.001 |
CSECTION | Caesarean section | 0.18 | 0.001 | <0.001 |
ANTENAT | ADEQUATE ANTENATAL CARE | |||
ANC | ANC contact | 0.96b
| - | - |
ANC4 | ≥4 ANC visits | 0.46 | 0.002 | <0.001 |
ANCTRI | First trimester visit | 0.28 | 0.002 | <0.001 |
ANCPROF | Skilled ANC | 0.79 | 0.001 | <0.001 |
ANCFAC | Health facility-based ANC | 0.88 | 0.001 | <0.001 |
ANCSERV | Essential ANC services | 0.33 | 0.001 | <0.001 |
PERSONAL | INDIVIDUAL & FAMILY CHARACTERISTICS | |||
MARITAL | Marital status | 0.07 | 0.001 | <0.001 |
AGEGRP | Age group | 0.40 | 0.009 | <0.001 |
BORD | Birth order | 1.63 | 0.03 | <0.001 |
HHNO | Family size | −0.03 | 0.002 | <0.001 |
UNDER5NO | No. of under-5 children | 0.09 | 0.002 | <0.001 |
COMMUN | COMMUNITY’S CHARACTERISTICS | |||
COUNTRY | Country | 1.00 | 0.007 | <0.001 |
REGION | Province | 0.96 | 0.08 | <0.001 |
STRATA | Residence | 0.95 | 0.42 | <0.001 |
SES | SOCIOECONOMIC STATUS | |||
EDUCAT | Mother’s education | 0.77 | 0.002 | <0.001 |
WEALTH | Wealth index | 0.61 | 0.004 | <0.001 |
MEDIA | Media exposure | 0.55 | 0.003 | <0.001 |
WOMJOB | Mother’s employment | −0.07 | 0.004 | <0.001 |
MANJOB | Father’s employment | 0.01 | 0.004 | 0.008 |
MANEDUC | Father’s education | 0.68 | 0.003 | <0.001 |
BABY | BABY’S CHARACTERISTICS | |||
BABYSIZE | Size at birth | 0.01 | 0.003 | <0.001 |
BABYSEX | Sex | −0.000 | 0.001 | 0.522 |
AGEYRS | Age in years | −0.95 | 0.003 | <0.001 |
AGEMTHS | Age in months | −1.03 | 0.04 | <0.001 |
Continuum of care for MNCH measurement variables
Structural model analysis
Paths | Parameter | Std. Coeff. | Std. Error |
t-value |
---|---|---|---|---|
PERSONAL → ANTENAT |
β
1
| −0.004 | 0 · 002 | −2.33* |
COMMUN → ANTENAT |
β
2
| 0.08 | 0.003 | 27.29*** |
SES → ANTENAT |
Β
3
| 0.36 | 0 · 004 | 99.11*** |
PERSONAL → DELIVERY |
Β
4
| −0.03 | 0.001 | −20.61*** |
COMMUN → DELIVERY |
Β
5
| −0.05 | 0.003 | −22.04*** |
SES → DELIVERY |
Β
6
| 0.35 | 0.003 | 112.39*** |
ANTENAT → DELIVERY
|
Β
7
| 0.32 | 0.003 | 101.68*** |
PERSONAL → POSTNAT |
Β
8
| 0.001 | 0.001 | 0.91 |
COMMUN → POSTNAT |
Β
9
| 0.07 | 0.002 | 35.47*** |
SES → POSTNAT |
Β
10
| 0.02 | 0.003 | 6.83*** |
BABY → POSTNAT |
Β
11
| 0.02 | 0.002 | 10.32*** |
ANTENAT → POSTNAT
|
Β
12
| −0.001 | 0.003 | −0.46 |
DELIVERY → POSTNAT
|
Β
13
| 0.78 | 0.003 | 274.19*** |
PERSONAL → VACCINAT |
Β
14
| −0.01 | 0.001 | −8.01*** |
COMMUN → VACCINAT |
Β
15
| 0.13 | 0.003 | 50.92*** |
SES → VACCINAT |
Β
16
| 0.10 | 0.004 | 28.27*** |
BABY → VACCINAT |
Β
17
| −0.23 | 0.003 | −84.82*** |
ANTENAT → VACCINAT
|
Β
18
| 0.36 | 0.004 | 94.91*** |
DELIVERY → VACCINAT
|
β
19
| 0.15 | 0.005 | 30.54*** |
POSTNAT → VACCINAT
|
Β
20
| −0.02 | 0.005 | −4.64*** |