Background
Methods
Data source and study design
Country | Year of survey | Weighted N | Weighted % | Continuum of care |
---|---|---|---|---|
1. Angola | 2015-16 | 641 | 4.2 | 1.2 [0.4–3.6] |
2. Benin | 2017-18 | 1712 | 11.2 | 2.5 [1.8–3.6] |
3. Burundi | 2016-17 | 1149 | 7.5 | 2.4 [1.5–3.8] |
4. Cameroon | 2018 | 651 | 4.2 | 0.9 [0.4–2.0] |
5. Ethiopia | 2016 | 1104 | 7.2 | 3.4 [2.1–5.4] |
6. Gambia | 2019-20 | 566 | 3.7 | 3.8 [2.3–6.2] |
7. Guinea | 2018 | 513 | 3.3 | 0.6 [0.2–2.5] |
8. Liberia | 2019-20 | 228 | 1.5 | 5.3 [3.3–8.3] |
9. Mali | 2018 | 1293 | 8.4 | 3.2 [2.3–4.5] |
10. Malawi | 2015-16 | 838 | 5.5 | 8.8 [6.4–12.1] |
11. Nigeria | 2018 | 1737 | 11.3 | 1.1 [0.7–1.8] |
12. Rwanda | 2019-20 | 613 | 4.0 | 8.9 [6.9–11.5] |
13. Sierra Leone | 2019 | 650 | 4.2 | 6.0 [4.0–8.7] |
14. Tanzania | 2015-16 | 1572 | 10.2 | 1.1 [0.7–2.0] |
15. Uganda | 2016 | 683 | 4.4 | 4.9 [3.3–7.2] |
16. South Africa | 2016 | 103 | 0.7 | 7.7 [2.8–19.1] |
17. Zambia | 2018 | 1306 | 8.5 | 5.2 [4.0–6.7] |
All countries
|
2015–2020
|
15,359
|
100.0
|
3.4 [3.0–3.7]
|
Variables
Outcome variable
Explanatory variables
Variable | Weighted N (%) | Continuum of care % [95% CI] | P-value | cOR [95% CI] |
---|---|---|---|---|
Women’s age (years)
| 0.212 | |||
15–24 | 4,395 (28.6) | 3.4 [2.8–4.1] | 1.0 | |
25–34 | 7,562 (49.2) | 3.6 [3.1–4.1] | 1.06 [0.83–1.35] | |
35 and above | 3,402 (22.2) | 2.8 [2.2–3.6] | 0.82 [0.60–1.12] | |
Mothers’ level of education
| < 0.001 | |||
No education | 5609 (36.5) | 1.9 [1.5–2.4] | 1.0 | |
Primary | 5666 (36.9) | 3.5 [3.0–4.1] | 1.87*** [1.42–2.47] | |
Secondary or higher | 4084 (26.6) | 5.1 [4.3–6.0] | 2.74*** [2.06–3.64] | |
Current working status
| 0.695 | |||
No | 4852 (31.6) | 3.2 [2.7–3.9] | 1.0 | |
Yes | 10,507 (68.4) | 3.4 [3.0–3.9] | 1.05 [0.83–1.32] | |
Marital status
| 0.411 | |||
Married | 12,624 (82.2) | 3.4 [3.0–3.8] | 1.0 | |
Cohabiting | 2735 (17.8) | 3.0 [2.4–3.9] | 0.89 [0.67–1.18] | |
Partner’s level of education
| < 0.001 | |||
No education | 4796 (31.2) | 1.9 [1.5–2.4] | 1.0 | |
Primary | 5270 (34.3) | 3.1 [2.6–3.7] | 1.67** [1.24–2.27] | |
Secondary or higher | 5293 (34.5) | 4.9 [4.3–5.7] | 2.74*** [2.05–3.66] | |
Health insurance coverage
| < 0.001 | |||
No | 14,146 (92.1) | 3.1 [2.8–3.5] | 1.0 | |
Yes | 1213 (7.9) | 6.2 [4.9–7.9] | 2.08*** [1.57–2.75] | |
Wanted last child when pregnant
| 0.492 | |||
Wanted then | 11,422 (74.4) | 3.5 [3.1–3.9] | 1.0 | |
Wanted later | 3168 (20.6) | 3.0 [2.3–3.8] | 0.86 [0.65–1.13] | |
Wanted no more | 769 (5.0) | 3.1 [2.0–4.8] | 0.89 [0.56–1.43] | |
Person who usually decides on respondents health care
| < 0.001 | |||
Partner alone/someone/others | 6222 (40.5) | 2.4 [1.9–2.8] | 1.0 | |
Respondent/partner | 6789 (44.2) | 3.8 [3.3–4.5] | 1.66*** [1.30–2.12] | |
Respondent alone | 2348 (15.3) | 4.5 [3.6–5.7] | 1.97*** [1.46–2.66] | |
Exposed to watching television
| 0.010 | |||
No | 9293 (60.5) | 3.0 [2.6–3.4] | 1.0 | |
Yes | 6066 (39.5) | 3.9 [3.3–4.6] | 1.32* [1.07–1.64] | |
Exposed to listening to radio
| < 0.001 | |||
No | 6502 (42.3) | 2.5 [2.1–3.0] | 1.0 | |
Yes | 8857 (57.7) | 4.0 [3.5–4.5] | 1.62*** [1.29–2.03] | |
Exposed to reading newspaper or magazine
| < 0.001 | |||
No | 13,136 (85.5) | 2.9 [2.6–3.3] | 1.0 | |
Yes | 2223 (14.5) | 5.8 [4.6–7.2] | 2.03*** [1.55–2.65] | |
Timely antenatal care visits
| < 0.001 | |||
Late antenatal care visit | 9311 (60.6) | 2.4 [2.1–2.9] | 1.0 | |
Early antenatal care visit | 6048 (39.4) | 4.7 [4.1–5.4] | 2.00*** [1.61–2.48] | |
Getting medical help for self: distance to health facility
| < 0.001 | |||
Not a big problem | 9658 (62.9) | 3.9[3.4–4.4] | 1.0 | |
Big problem | 5701 (37.1) | 2.4 [2.0–3.0] | 0.61*** [0.48–0.78] | |
Sex of child
| 0.645 | |||
Male | 7875 (51.3) | 3.3 [2.8–3.8] | 1.0 | |
Female | 7484 (48.7) | 3.4 [2.9–4.0] | 1.05 [0.85–1.31] | |
Birth order
| 0.001 | |||
1 | 2775 (18.1) | 4.4 [3.6–5.4] | 1.0 | |
2–3 | 5656 (36.8) | 3.7 [3.1–4.3] | 0.82 [0.62–1.08] | |
4 or more | 6928 (45.1) | 2.6 [2.2–3.1] | 0.59*** [0.45–0.77] | |
Birth size
| 0.172 | |||
Large | 4889 (31.8) | 3.8 [3.2–4.5] | 1.0 | |
Average | 8325 (54.2) | 3.1 [2.7–3.6] | 0.80 [0.64–1.02] | |
Small | 2145 (14.0) | 3.2 [2.4–4.2] | 0.83 [0.60–1.15] | |
Wealth index
| < 0.001 | |||
Poorest | 3130 (20.4) | 2.6 [2.0–3.3] | 1.0 | |
Poorer | 3212 (20.9) | 2.4 [1.8–3.1] | 0.90 [0.63–1.30] | |
Middle | 3258 (21.2) | 3.1 [2.5–3.8] | 1.18 [0.85–1.63] | |
Richer | 2993 (19.5) | 3.1 [2.4–4.0] | 1.20 [0.83–1.73] | |
Richest | 2766 (18.0) | 5.9 [4.8–7.2] | 2.34*** [1.69–3.25] | |
Sex of household head
| 0.767 | |||
Male | 13,329 (86.8) | 3.4 [3.0–3.8] | 1.0 | |
Female | 2030 (13.2) | 3.2 [2.5–4.2] | 0.96 [0.71–1.28] | |
Place of residence
| 0.003 | |||
Urban | 4907 (31.9) | 4.2 [3.5–5.0] | 1.0 | |
Rural | 10,452 (68.1) | 3.0 [2.6–3.4] | 0.70** [0.56–0.88] | |
Geographical subregions
| < 0.001 | |||
Central | 1292 (8.4) | 1.1 [0.5–2.2] | 1.0 | |
Western | 6699 (43.6) | 2.7 [2.3–3.2] | 2.59* [1.22–5.48] | |
Eastern | 5121 (33.4) | 3.3 [2.8–4.0] | 3.24** [1.53–6.86] | |
Southern | 2247 (14.6) | 6.7 [5.4–8.2] | 6.72*** [3.14–14.38] |
Statistical analyses
Maternal, newborn, and child health and continuum of care indicators | Frequency (N) | Percentage (%) |
---|---|---|
Antenatal care (4 or more visits) | 9728 | 63.3 |
Neonatal tetanus protection | 8180 | 53.3 |
Facility-based delivery | 11,549 | 75.2 |
Skilled birth delivery | 10,854 | 70.7 |
Postnatal care within the first 2days after birth | 7657 | 49.9 |
BCG | 14,101 | 91.8 |
DPT | 12,154 | 79.1 |
Polio | 10,379 | 67.6 |
Measles | 11,943 | 77.7 |
Age appropriate breastfeeding | 10,967 | 71.4 |
Current use of modern contraceptive | 5,139 | 33.5 |
Ethical consideration
Results
Maternal, newborn, and child health and continuum of care in the 17 sub-Saharan African countries
Distribution of continuum of care across the explanatory variables
Mixed effect analysis of factors associated with continuum of care in sub-Saharan Africa
Fixed effects results
Variables | Model O | Model I aOR [95% CI] | Model II aOR [95% CI] | Model III aOR [95% CI] |
---|---|---|---|---|
Fixed effect results
| ||||
Mothers’ level of education
| ||||
No education | 1.00 | 1.00 | ||
Primary | 1.35* [1.00, 1.82] | 1.20 [0.87, 1.65] | ||
Secondary or higher | 1.39 [0.98, 1.97] | 1.20 [0.83, 1.74] | ||
Partner’s level of education
| ||||
No education | 1.00 | 1.00 | ||
Primary | 1.26 [0.92, 1.73] | 1.18 [0.86, 1.64] | ||
Secondary or higher | 1.78*** [1.28, 2.48] | 1.52* [1.07, 2.16] | ||
Health insurance coverage
| ||||
No | 1.00 | 1.00 | ||
Yes | 1.55** [1.15, 2.10] | 1.64** [1.18, 2.30] | ||
Person who usually decides on respondents health care
| ||||
Partner alone/someone/others | 1.00 | 1.00 | ||
Respondent/partner | 1.39* [1.07, 1.80] | 1.33* [1.02, 1.74] | ||
Respondent alone | 1.65** [1.21, 2.25] | 1.38* [1.01, 1.89] | ||
Exposed to watching television
| ||||
No | 1.00 | 1.00 | ||
Yes | 0.79 [0.60, 1.05] | 0.84 [0.61, 1.14] | ||
Exposed to listening to radio
| ||||
No | 1.00 | 1.00 | ||
Yes | 1.36* [1.05, 1.77] | 1.38*[1.06, 1.79] | ||
Exposed to reading newspaper or magazine
| ||||
No | 1.00 | 1.00 | ||
Yes | 1.34 [0.99, 1.83] | 1.31 [0.95, 1.79] | ||
Timely antenatal care visits
| ||||
Late antenatal care visit | 1.00 | 1.00 | ||
Early antenatal care visit | 1.82*** [1.46, 2.28] | 1.88*** [1.50, 2.36] | ||
Getting medical help for self: distance to health facility
| ||||
Not a big problem | 1.00 | 1 | ||
Big problem | 0.70** [0.55, 0.91] | 0.73* [0.57, 0.95] | ||
Birth order
| ||||
1 | 1.00 | 1.00 | ||
2–3 | 0.88 [0.66, 1.18] | 0.87 [0.65, 1.18] | ||
4 or more | 0.79 [0.59, 1.06] | 0.80 [0.59, 1.08] | ||
Wealth index
| ||||
Poorest | 1.00 | 1.00 | ||
Poorer | 0.93 [0.63, 1.37] | 0.85 [0.58, 1.24] | ||
Middle | 1.29 [0.90, 1.84] | 1.09 [0.76, 1.55] | ||
Richer | 1.31 [0.88, 1.95] | 0.97 [0.65, 1.45] | ||
Richest | 2.51*** [1.73, 3.66] | 1.44 [0.94, 2.21] | ||
Place of residence
| ||||
Urban | 1.00 | 1.00 | ||
Rural | 0.96 [0.73, 1.28] | 1.06 [0.78, 1.44] | ||
Geographical subregions
| ||||
Central | 1.00 | 1.00 | ||
Western | 2.64* [1.24, 5.64] | 3.15** [1.45, 6.85] | ||
Eastern | 3.39** [1.57, 7.30] | 3.11** [1.41, 6.85] | ||
Southern | 7.50*** [3.44, 16.34] | 7.02*** [3.23, 15.27] | ||
Random effect results
| ||||
PSU variance (95% CI) | 0.526 [0.334–0.829] | 0.509 [0.322–0.806] | 0.488 [0.310 − 0.768] | 0.507 [0.322–0.799] |
ICC | 0.138 | 0.134 | 0.129 | 0.133 |
Wald chi-square | Reference | 141.41 (< 0.001) | 111.66 (< 0.001) | 209.84 (< 0.001) |
Model fitness
| ||||
Log-likelihood | -2218.3041 | -2115.7183 | -2136.8255 | -2071.6726 |
AIC | 4440.608 | 4263.437 | 4293.651 | 4191.345 |
BIC | 4455.887 | 4385.668 | 4370.045 | 4374.692 |
N | 15,359 | 15,359 | 15,359 | 15,359 |
Number of clusters | 1188 | 1188 | 1188 | 1188 |