Background
Methods
Data source
Study sample
Variables measurement and conceptual framework
Data analysis
Ethical considerations
Results
Study participant characteristics
Variable, %(95% CI) | 2007 DHS (n = 7092) | 2013 DHS (n = 9239) | 2016 MIS (n = 4290) |
---|---|---|---|
Mean age (SD) | 29.2 (9.6) | 29.2 (9.8) | 28.7 (9.4) |
Mean age at first birth (SD) | 18.6 (3.7) | 18.2 (3.4) | No data |
Age | |||
15–19 | 18.9 (18.0–19.8) | 20.7 (19.9–21.6) | 20.9 (19.7–22.1) |
20–24 | 19.5 (18.6–20.5) | 17.1 (16.4–17.9) | 18.6 (17.5–19.8) |
25–29 | 16.4 (15.5–17.3) | 17.2 (16.4–17.9) | 15.8 (14.8–17.0) |
30–34 | 14.1 (13.4–15.0) | 13.5 (12.8–14.2) | 15.8 (14.7–17.0) |
35–39 | 13.1 (12.3–13.9) | 13.0 (12.3–13.7) | 12.5 (11.6–13.5) |
40–44 | 9.5 (8.8–10.2) | 9.8 (9.2–10.4) | 9.4 (8.6–10.4) |
45–49 | 8.5 (7.9–9.2) | 8.7 (8.2–9.3) | 6.9 (6.2–7.7) |
Region | |||
Morovia | 26.2 (25.2–27.2) | – | 21.3 (20.1–22.5) |
North Western | 10.8 (10.1–11.5) | 16.9 (16.1–17.6) | 12.2 (11.2–13.2) |
South Central | 15.1 (14.3–16.0) | 29.9 (28.9–30.8) | 17.0 (15.9–18.1) |
South Eastern A | 11.3 (10.6–12.1) | 14.8 (14.1–15.5) | 14.9 (13.9–16.0) |
South Eastern B | 17.5 (16.7–18.4) | 15.5 (14.8–16.2) | 17.4 (16.3–18.5) |
North Central | 19.0 (18.2–20.0) | 23.0 (22.2–23.9) | 17.3 (16.2–18.5) |
Place of residence | |||
Urban | 45.0 (43.9–46.2) | 40.3 (39.3–41.3) | 54.3 (52.8–55.8) |
Rural | 55.0 (53.8–56.1) | 59.7 (58.7–60.7) | 45.7 (44.2–47.2) |
Level of education | |||
No education | 41.8 (40.6–42.9) | 39.8 (38.8–40.8) | 35.5 (34.1–36.9) |
Primary | 35.0 (33.9–36.1) | 34.6 (33.6–35.6) | 27.6 (26.3–29.0) |
Secondary | 21.6 (20.6–22.6) | 23.4 (22.6–24.3) | 32.8 (31.4–34.2) |
Higher | 1.7 (1.4–2.0) | 2.2 (1.9–2.5) | 4.1 (3.5–4.7) |
Religion | |||
Christian | 87.1 (86.3–87.9) | 85.2 (84.4–85.9) | 87.9 (86.9–88.8) |
Muslim | 9.9 (9.2–10.6) | 11.9 (11.2–12.6) | 10.4 (9.5–11.4) |
Traditional | 0.4 (0.3–0.6) | 0.4 (0.3–0.5) | 0.4 (0.2–0.6) |
Nil | 2.6 (2.3–3.0) | 0.3 (0.2–0.4) | 1.3 (1.0–1.7) |
Sex of household head | |||
Male | 64.8 (63.7–65.9) | 63.8 (62.8–64.7) | 66.2 (64.7–67.6) |
Female | 35.2 (34.1–36.3) | 36.2 (35.3–37.2) | 33.8 (32.4–35.3) |
Frequency of reading newspaper or magazine | No data | ||
Not at all | 77.2 (76.2–78.2) | 84.6 (83.9–85.4) | |
Less than once a week | 7.9 (7.2–8.5) | 9.4 (8.8–10.0) | |
At least once a week | 10.7 (10.0–11.4) | 5.9 (5.5—6.4) | |
Almost every day | 4.3 (3.8–4.8) | – | |
Frequency of listening to radio | No data | ||
Not at all | 40.0 (38.8–41.1) | 33.5 (32.6–34.5) | |
Less than once a week | 11.2 (10.4–11.9) | 31.4 (30.5–32.4) | |
At least once a week | 22.2 (21.3–23.2) | 35.1 (34.1–36.1) | |
Almost every day | 26.7 (25.6–27.7) | – | |
Frequency of watching television | No data | ||
Not at all | 61.6 (60.4–62.7) | 73.5 (72.6–74.4) | |
Less than once a week | 10.2 (9.5–10.9) | 14.9 (14.2–15.7) | |
At least once a week | 17.1 (16.2–18.0) | 11.5 (10.9–12.2) | |
Almost every day | 11.2 (10.4–11.9) | – | |
Wealth index | |||
Poorest | 19.0 (18.1–19.9) | 28.0 (27.1–28.9) | 23.5 (22.2–24.8) |
Poorer | 19.5 (18.6–20.4) | 24.7 (23.8–25.6) | 18.7 (17.6–19.9) |
Middle | 19.7 (18.8–20.6) | 21.6 (20.8–22.5) | 22.6 (21.4–23.9) |
Richer | 22.1 (21.1–23.0) | 14.1 (13.4–14.9) | 18.3 (17.1–19.4) |
Richest | 19.8 (18.9–20.7) | 11.6 (10.9–12.2) | 16.9 (15.9–18.1) |
Children ever born | |||
1–4 | 65.6 (64.4–66.8) | 62.0 (60.9–63.1) | 62.1 (60.5–63.8) |
> 4 | 34.4 (33.2–35.6) | 38.0 (36.9–39.1) | 37.9 (36.2–39.5) |
Changes in maternal services utilization
Factors associated with facility-based delivery
Variable | Crude OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value |
---|---|---|---|---|
Year | ||||
2007 | 1.00 | 1.00 | ||
2013 | 1.86 (1.51–2.29) | < 0.001* | 2.21 (1.30–3.75) | 0.003* |
2016 | 4.14 (3.14–5.46) | < 0.001* | 3.01 (3.83–11.67) | 0.001 |
Age at first birth | 1.01 (0.99–1.03) | 0.096 | Ns | |
Age | ||||
15–19 | 1.00 | 1.00 | ||
20–24 | 0.86 (0.73–1.01) | 0.053 | 0.81 (0.67–0.99) | 0.045* |
25–29 | 0.77 (0.65–0.91) | 0.002* | 0.79 (0.63–0.98) | 0.034* |
30–34 | 0.72 (0.61–0.84) | < 0.001* | 0.85 (0.68–1.07) | 0.175 |
35–39 | 0.73 (0.61–0.86) | < 0.001* | 0.92 (0.70–1.21) | 0.567 |
40–44 | 0.58 (0.48–0.71) | < 0.001* | 0.91 (0.66–1.26) | 0.577 |
45–49 | 0.50 (0.37–0.67) | < 0.001* | 1.08 (0.71–1.64) | 0.725 |
Region | ||||
Morovia | 1.00 | 1.00 | ||
North Western | 0.68 (0.53–0.87) | 0.002* | 0.76 (0.56–1.05) | 0.094 |
South Central | 0.48 (0.37–0.62) | < 0.001* | 1.20 (0.87–1.66) | 0.255 |
South Eastern A | 0.76 (0.55–1.04) | 0.084 | 1.21 (0.84–1.73) | 0.303 |
South Eastern B | 0.50 (0.39–0.65) | < 0.001* | 0.94 (0.68–1.30) | 0.720 |
North Central | 0.33 (0.23–0.48) | < 0.001* | 1.65 (1.04–2.61) | 0.034* |
Place of residence | ||||
Urban | 1.00 | 1.00 | ||
Rural | 0.32 (0.27–0.39) | < 0.001* | 0.45 (0.31–0.65) | < 0.001* |
Level of education | ||||
No education | 1.00 | 1.00 | ||
Primary | 1.41 (1.26–1.59) | < 0.001* | 1.11 (0.96–1.27) | 0.150 |
Secondary | 3.35 (2.88–3.89) | < 0.001* | 1.45 (1.20–1.76) | < 0.001* |
Higher | 11.32 (6.85–18.69) | < 0.001* | 3.72 (1.82–7.61) | < 0.001* |
Religion | ||||
Christian | 1.00 | 1.00 | ||
Muslim | 0.97 (0.78–1.21) | 0.774 | 1.06 (0.78–1.44) | 0.697 |
Traditional | 0.85 (0.45–1.60) | 0.614 | 1.54 (0.63–3.82) | 0.345 |
Nil | 0.41 (0.28–0.59) | < 0.001* | 0.55 (0.35–0.85) | 0.007* |
Sex of household head | ||||
Male | 1.00 | 1.00 | ||
Female | 1.40 (1.25–1.56) | < 0.001* | 1.20 (1.07–1.36) | 0.003* |
Frequency of reading newspaper or magazine | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.57 (2.00–3.31) | < 0.001* | 1.01 (0.77–1.31) | 0.951 |
At least once a week | 2.93 (2.28–3.78) | < 0.001* | 1.17 (0.85–1.60) | 0.335 |
Almost every day | 4.76 (2.64–8.60) | < 0.001* | 0.99 (0.49–1.99) | 0.979 |
Frequency of listening to radio | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.18 (1.85–2.57) | < 0.001* | 1.24 (1.04–1.48) | 0.016* |
At least once a week | 2.09 (1.78–2.46) | < 0.001* | 1.12 (0.95–1.32) | 0.165 |
Almost every day | 2. (2.31–3.67) | < 0.001* | 1.61 (1.24–2.10) | < 0.001* |
Frequency of watching television | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.02 (1.67–2.43) | < 0.001* | 0.96 (0.79–1.17) | 0.684 |
At least once a week | 2.22 (1.77–2.79) | < 0.001* | 1.06 (0.83–1.35) | 0.626 |
Almost every day | 3.16 (2.29–4.35) | < 0.001* | 1.31 (0.92–1.87) | 0.133 |
Wealth index | ||||
Poorest | 1.00 | 1.00 | ||
Poorer | 1.40 (1.18–1.66) | < 0.001* | 1.12 (0.81–1.53) | 0.501 |
Middle | 1.91 (1.58–2.32) | < 0.001* | 1.52 (1.02–2.26) | 0.039* |
Richer | 3.16 (2.54–3.91) | < 0.001* | 2.48 (1.60–3.85) | < 0.001* |
Richest | 5.35 (4.09–7.00) | < 0.001* | 2.72 (1.66–4.46) | < 0.001* |
Children ever born | ||||
1–4 | 1.00 | 1.00 | ||
> 4 | 0.65 (0.58–0.71) | < 0.001* | 0.85 (0.71–1.01) | 0.080 |
Antenatal care visits | ||||
< 4 | 1.00 | 1.00 | ||
4 and above | 3.62 (3.16–4.14) | < 0.001* | 2.90 (2.52–3.36) | < 0.001* |
Year*Residence | ||||
2007*Urban | 1.00 | 1.00 | ||
2013*Rural | 2.17 (1.44–3.25) | < 0.001* | 1.64 (1.01–2.67) | 0.047* |
2016*Rural | 2.95 (1.74–4.99) | < 0.001* | ||
Year*wealth index | ||||
2007*Poorest | 1.00 | 1.00 | ||
2013*Poorer | 0.98 (0.68–1.41) | 0.914 | 1.09 (0.75–1.59) | 0.643 |
2013*Middle | 0.77 (0.49–1.23) | 0.276 | 0.94 (0.59–1.49) | 0.784 |
2013*Richer | 0.54 (0.32–0.90) | 0.018* | 0.82 (0.47–1.43) | 0.481 |
2013*Richest | 0.58 (0.29–1.16) | 0.121 | 1.18 (0.56–2.49) | 0.658 |
2016*Poorer | 1.48 (0.85–2.55) | 0.164 | ||
2016*Middle | 0.77 (0.41–1.43) | 0.401 | ||
2016*Richer | 0.37 (0.19–0.71) | 0.003* | ||
2016*Richest | 0.27 (0.13–0.56) | < 0.001* |
Determinants of antenatal care visits
Variable | Crude OR (95% CI) | P-value | Adjusted OR (95% CI) | P-value |
---|---|---|---|---|
Year | ||||
2007 | 1.00 | – | 1.00 | – |
2013 | 1.30 (1.07–1.59) | 0.010* | 0.86 (0.53–1.39) | 0.537 |
2016 | 1.51 (1.16–1.95) | 0.002* | – | – |
Age at first birth | 1.01 (0.99–1.03) | 0.415 | Ns | – |
Age | ||||
15–19 | 1.00 | Ns | ||
20–24 | 1.06 (0.88–1.28) | 0.532 | Ns | |
25–29 | 1.05 (0.87–1.27) | 0.590 | Ns | |
30–34 | 0.95 (0.79–1.17) | 0.676 | Ns | |
35–39 | 1.16 (0.94–1.42) | 0.173 | Ns | |
40–44 | 0.85 (0.67–1.08) | 0.196 | Ns | |
45–49 | 0.78 (0.55–1.12) | 0.179 | Ns | |
Region | ||||
Morovia | 1.00 | 1.00 | ||
North Western | 0.73 (0.56–0.96) | 0.023 | 0.95 (0.69–1.31) | 0.765 |
South Central | 0.54 (0.41–0.73) | < 0.001* | 1.34 (0.97–1.86) | 0.080 |
South Eastern A | 0.41 (0.31–0.54) | < 0.001* | 0.61 (0.43–0.86) | 0.005* |
South Eastern B | 0.51 (0.39–0.66) | < 0.001* | 1.06 (0.77–1.47) | 0.717 |
North Central | 0.41 (0.28–0.58) | < 0.001* | 1.18 (0.76–1.82) | 0.456 |
Place of residence | ||||
Urban | 1.00 | 1.00 | ||
Rural | 0.41 (0.35–0.49) | < 0.001* | 0.51 (0.36–0.72) | < 0.001* |
Level of education | ||||
No education | 1.00 | 1.00 | ||
Primary | 1.33 (1.17–1.50) | < 0.001* | 1.28 (1.11–1.48) | 0.001* |
Secondary | 2.49 (2.10–2.95) | < 0.001* | 1.63 (1.27–2.09) | < 0.001* |
Higher | 7.01 (3.58–13.71) | < 0.001* | 4.33 (1.50–12.55) | 0.007* |
Religion | ||||
Christian | 1.00 | 1.00 | ||
Muslim | 1.76 (1.34–2.32) | < 0.001* | 1.90 (1.38–2.61) | < 0.001* |
Traditional | 0.68 (0.32–1.42) | 0.301 | 1.21 (0.57–2.59) | 0.617 |
Nil | 0.57 (0.39–0.81) | 0.002* | 0.78 (0.52–1.16) | 0.217 |
Sex of household head | ||||
Male | 1.00 | 1.00 | ||
Female | 1.24 (1.08–1.41) | 0.002* | 1.13 (0.98–1.30) | 0.091 |
Frequency of reading newspaper or magazine | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.38 (1.72–3.30) | < 0.001* | 1.04 (0.74–1.48) | 0.812 |
At least once a week | 2.30 (1.67–3.18) | < 0.001* | 0.99 (0.69–1.45) | 0.990 |
Almost every day | 7.10 (1.50–33.65) | < 0.001* | 1.37 (0.27–6.94) | 0.700 |
Frequency of listening to radio | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.03 (1.67–2.46) | < 0.001* | 1.33 (1.09–1.62) | 0.005* |
At least once a week | 1.70 (1.44–2.02) | < 0.001* | 1.09 (0.90–1.31) | 0.366 |
Almost every day | 2.92 (2.23–3.83) | < 0.001* | 1.64 (1.18–2.27) | 0.003* |
Frequency of watching television | ||||
Not at all | 1.00 | 1.00 | ||
Less than once a week | 2.26 (1.79–2.85) | < 0.001* | 1.32 (1.04–1.67) | 0.024 |
At least once a week | 1.95 (1.55–2.46) | < 0.001* | 1.04 (0.81–1.32) | 0.769 |
Almost every day | 3.07 (1.99–4.74) | < 0.001* | 1.10 (0.68–1.79) | 0.696 |
Wealth index | ||||
Poorest | 1.00 | 1.00 | ||
Poorer | 1.38 (1.16–1.64) | < 0.001* | 1.11 (0.81–1.53) | 0.514 |
Middle | 2.25 (1.86–2.72) | < 0.001* | 1.54 (1.11–1.85) | 0.010* |
Richer | 3.11 (2.51–3.85) | < 0.001* | 2.06 (1.36–3.12) | 0.001* |
Richest | 5.18 (3.85–6.95) | < 0.001* | 3.04 (1.75–5.29) | < 0.001* |
Children ever born | ||||
1–4 | 1.00 | 1.00 | ||
> 4 | 0.77 (0.69–0.87) | < 0.001* | 1.02 (0.89–1.17) | 0.758 |
Year*Residence | ||||
2007*Urban | 1.00 | 1.00 | ||
2013*Rural | 2.03 (1.4–2.95) | < 0.001* | 1.83 (1.21–2.75) | 0.004* |
2016*Rural | 2.39 (1.47–3.87) | < 0.001* | ||
Year*wealth index | ||||
2007*Urban | 1.00 | |||
2013*Poorer | 1.11 (0.76–1.63) | 0.579 | 1.13 (0.76–1.68) | 0.560 |
2013*Middle | 0.99 (0.65–1.52) | 0.969 | 1.19 (0.77–1.85) | 0.421 |
2013*Richer | 0.80 (0.50–1.29) | 0.368 | 1.15 (0.67–1.98) | 0.613 |
2013*Richest | 0.47 (0.23–0.94) | 0.033* | 0.79 (0.36–1.72) | 0.554 |
2016*Poorer | 1.51 (0.85–2.67) | 0.162 | 1.47 (0.85–2.55) | 0.164 |
2016*Middle | 1.16 (0.63–2.16) | 0.628 | 0.76 (0.41–1.42) | 0.401 |
2016*Richer | 0.48 (0.26–0.89) | 0.019* | 0.36 (0.19–0.71) | 0.003* |
2016*Richest | 0.40 (0.18–0.85) | 0.018* | 0.26 (0.12–0.56) | 0.000* |