Background Early medical checkups during and after delivery are key strategies to detect, prevent and treat maternal health concerns. Knowledge of interrelationships between early Antenatal Care (ANC), skilled delivery and early postnatal care (EPNC) is essential for focused and well-targeted interventions. This paper investigated the interconnectedness between maternal health services in Uganda. Objective This study examines the predictors of interrelationships between early antenatal care, health facility delivery and early postnatal care. Methods We used a sample of 10,152 women of reproductive ages (15–49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. A generalized Structural Equation Model and STATA 13.0 software were used. Results Early ANC was a mediating factor for health facility delivery (aOR=1.04; 95% CI=1.01-1.14) and EPNC (aOR=1.1; 95% CI=1.05-1.26). Increased odds of early ANC utilization was directly associated with: Adult women aged 35-49 (aOR=1.18; 95% CI=1.10-1.35), having completed primary seven (aOR=1.68; 95% CI=1.56-1.84); distance to a health facility (aOR=1.35; 95% CI=1.23-1.73) and costs (aOR=1.85; 95% CI=1.31-2.12) not being a problem, available community workers (aOR=1.06; 95% CI=1.04-1.17), pregnancy complications (aOR=2.04; 95% CI=1.85-2.26) and desire for pregnancy (aOR=1.15; 95% CI=1.07-1.36). Through early ANC utilization, being married (aOR=1.16; (=1.04*1.10)), no distance issues ((aOR=1.40; (=1.04*1.35)) and complications (aOR=2.12; (=1.04*2.04)) indirectly influenced utilization of health facility delivery. Women aged 20-34 (aOR=1.01; (=0.92*1.1)), completing primary seven (aOR=1.85; (=1.69*1.1)) and no cost problems (aOR=2.04; (=1.85*1.1)) indirectly influenced EPNC. Conclusion Early antenatal care was a mediating factor for health facility delivery and EPNC; and hence, there is need for more focus on factors for increased early antenatal care utilization. Women with higher education and those with no cost problems were more likely to have early ANC utilization, skilled delivery and EPNC; therefore there is need to design and implement policies targeting social and economically disadvantaged women.

Background Maternal health care and treatment services have a bearing on maternal mortality. Direct and Indirect factors affecting Maternal health outcomes therefore require understanding to enable well targeted interventions. This study, therefore, assessed the interrelationships between early antenatal care, health facility delivery and early postnatal care.Methods We investigated Maternal Health services using utilizing Antenatal care (ANC) within three months of pregnancy, Health facility delivery and utilizing postnatal care (PNC) within 48 hours after childbirth. The 2016 Uganda Demographic and Health Survey data was used. During analysis, a Generalized Structural Equation Model using logistic link and binomial family option was used. The interrelated (Endogenous) outcomes were timely ANC, health facility delivery and timely PNC.Results Timely ANC (aOR=1.04; 95% CI=0.95-1.14) and(aOR=1.1; 95% CI=1.00-1.26) was directly related to increased odds of health facility delivery and timely PNC respectively. Factors that increased the odds of timely ANC as a mediating factor for health facility delivery and timely PNC were women age 35-39 (aOR=1.18; 95% CI=0.99-1.24) compared to women age 15-19, completing primary seven (aOR=1.68; 95% CI=1.58-1.81) compared to some primary, available health workers (aOR=1.06; 95% CI=0.97-1.18), complications (aOR=2.04; 95% CI=1.89-2.26) and desire for pregnancy(aOR=1.15; 95% CI=1.03-1.36). Factors that reduced the odds of timely ANC were being married (aOR=0.93; 95% CI=0.89-1.20), distance and cost of service being problematic (aOR=0.97; 95% CI=0.85-1.1) (aOR=0.5; 95% CI=0.37-0.82) respectively. Factors that significantly influenced health facility delivery through timely ANC were; unmarried (OR=1.03; (=1.04*0.99)), distance being problematic ((aOR=1.0; (=1.04*0.97)) and complications (aOR=2.02; (=1.04*1.94)). Factors that significantly influenced timely PNC through timely ANC were; women age 35-39 (aOR=1.3; (=1.18*1.1)) compared to 15-19, completing primary seven (aOR=1.68; (=1.68*1.1))compared to some primary and service cost being problematic (aOR=0.55; (=0.5*1.1)). Surprisingly, health facility delivery was not statistically significant as a mediator for timely PNC.Conclusion Attending antenatal care within first trimester was a mediating factor for health facility delivery and early postnatal care. Interventions in maternal health should focus on factors that increase antenatal care first trimester attendance in resource limited settings. Furthermore, Government should reduce on costs of attaining all maternal health services and emphasize girl education completion.

No abstract

BackgroundMaternal health equality is an ultimate goal for a better world. Early maternal healthcare service utilization is hindered by numerous social and economical barriers, along with widespread inequalities in utilization of existing services. To better understand variations existing in Uganda, we assessed differences in early antenatal care, health facility delivery and early postnatal care among women in selected sub regions. The differences were decomposed into components attributed to variation in women's characteristics and the effects of coefficients.MethodsWe used a sample of 1,521 women of reproductive ages (15-49), who delivered a child five years prior to the 2016 Uganda Demographic and Health Survey. Non-linear Oaxaca’ Blinder Multivariate Decomposition method and STATA 13.0 software were used.ResultsSignificant differences in early ANC, health facility delivery and EPNC among women in Eastern and Western sub regions were attributed to both variation in women’s characteristics and effects of coefficients. Overall gap in early ANC (57.39%), health facility delivery (63.88%) and EPNC (59.06%) was attributed to differences in women's characteristics, whereas differences in effects of coefficients attributed 42.61% variations in early ANC, 36.12% in health facility delivery, and 40.94% in EPNC.Specifically, overall gap in early ANC would reduce if differences in availability of community health workers (31.6%) and media exposure (34.7%) were to disappear. Furthermore, the gap would increase by 68.8% and 12.6% in absence of the variation in effects of maternal education, and wealth differences respectively. Overall gap in health facility delivery would reduce if differences in community health worker availability (24.6%) and media exposure (37.2%) were to disappear, and increase by 54.9% in the absence of variations in effects of maternal education. The overall gap in EPNC would reduce if differences in maternal education (18.5%) and community health worker availability (17.17%) were to disappear and increase by 52.8% and 8.4% in the absence of the variation in effects of maternal education and wealth quintile respectively.ConclusionProgress towards equitable maternal health should focus more on strategies that guarantee even distribution of community health workers, broad dissemination of maternal healthcare information and girl child education completion in Uganda.

No abstract