Determinants of Continuum of Care for Maternal, Newborn and Infant Health in Six Regions of Ethiopia.
| dc.contributor.advisor | Eshetu Girma | |
| dc.contributor.author | Shikur Mohammed | |
| dc.date.accessioned | 2025-08-07T06:40:13Z | |
| dc.date.available | 2025-08-07T06:40:13Z | |
| dc.date.issued | 2024-06 | |
| dc.description.abstract | Background: Ethiopia continues to have unacceptable high rates of maternal and childhood mortalities, mainly due to preventable causes related to pregnancy, childbirth, and inadequate infant care practices. The continuum of care has become as a fundamental program strategy for improving maternal and child health and lowering maternal and child mortality rates. Unlike previous studies, we used a wider scope of continuum of care in our study, focusing on pregnancy, childbirth, postnatal (newborn care), and infants under one year old, whereas previous studies focused on pregnancy, childbirth, and postnatal care within 48 hours. Successful program implementation to improve the continuum of care requires a better understanding of where gaps exist in seeking and practicing care during pregnancy, delivery, post-delivery, and childhood, as well as the factors that contribute to these gaps. Therefore, the specific objectives of this study were to: 1) assess influence of quality antenatal care (ANC) on the continuum of maternal use of skilled delivery service following any ANC visit;2) determine the level of home-based optimal newborn care and associated factors, and 3)determine the level of completion of the continuum of age-appropriate infant feeding practices and associated barriers in six Ethiopian regions. Methods: We used data from Performance Monitoring for Action (PMA) Ethiopia panel survey (2019-2021). In the first and second study objectives, respectively, a total of 1,511 postnatal women and 860 mothers of neonates were included to generate estimates. A rate ratio, or an odds ratio, with 95% CI was used to measure the association between exposure and outcome variables. Generalized estimating equation Poisson and logistic regression models were used to account for clustering nature of data and potential confounders, using Stata vers.16 software. A sequential explanatory mixed methods design (independent quantitative study followed by qualitative study) was used to determine the level of continuum of age-appropriate infant feeding practices and associated barriers. In the quantitative (QUAN) analysis, a total of 1755 mothers of infants were included to generate estimates. Then, a qualitative (QUAL) study was conducted with14 mothers to explore their age-appropriate infant feeding practices, using an in-depth interview guide and analyzed, using a thematic approach. Results from both QUAN and QUAL data were integrated, described under the identified thematic areas, and interpreted concurrently. Results: This study showed that women who received better quality ANC services had 20% higher chance to continue to use skilled birth attendant, compared to women who received low quality ANC service (adjusted IRR = 1.20, 95% CI = 1.11, 1.31). The level of home-based optimal newborn care practice was 8.7%, with 95% uncertainty interval ranged from 6 to 11%. The study also showed that the chance of home-based optimal newborn care practice decreased by 69%among rural resident mothers, compared to urban resident mothers (adjusted OR = 0.31, 95%CI=0.15, 0.61). This study showed 13.96% (95% CI: 12.4 to 15.6%) of mothers practiced a complete continuum of age-appropriate infant feeding. Results from both quantitative and qualitative data showed that mothers’ complete continuum of age-appropriate infant feeding practice was influenced by their level of income, knowledge, and attitude towards optimal infant feeding, as well as by important others, including husbands, grandmothers, and health workers. Conclusion: From this study we conclude that continuity of maternal use of skilled birth attendant was influenced by the quality of ANC services they received during pregnancy. Also, only less than 15% mothers practiced optimal newborn care and age-appropriate infant feeding. Mothers home-based optimal newborn care practices were influenced by their area of residence. Similarly, mothers optimal infant feeding practices were influenced by their area of residence, level of knowledge and attitude towards infant feeding, income or access to food, and health workers or family members. Findings from this study implies that maternal use of skilled birth attendant can be improved by providing quality ANC service during subsequent ANC visits. Similarly, to improve optimal newborn care and infant feeding practices, collaborative efforts are needed to strengthen mothers’ education on the health benefits of optimal maternal, newborn and infant care and design and promote strategies to improve household access and affordability to health services and diverse food. | |
| dc.identifier.uri | https://etd.aau.edu.et/handle/123456789/6175 | |
| dc.language.iso | en_US | |
| dc.publisher | Addis Ababa University | |
| dc.subject | Antenatal care components | |
| dc.subject | Skilled birth attendant | |
| dc.subject | Place of delivery | |
| dc.subject | Home-based newborn care | |
| dc.subject | Essential newborn care | |
| dc.subject | Age-appropriate infant feeding | |
| dc.subject | Exclusive breastfeeding | |
| dc.subject | Complementary feeding | |
| dc.subject | Ethiopia | |
| dc.title | Determinants of Continuum of Care for Maternal, Newborn and Infant Health in Six Regions of Ethiopia. | |
| dc.type | Dissertation |