Determinants of continued maternal care seeking during pregnancy, birth and postnatal and associated neonatal survival outcomes in Kenya and Uganda: analysis of cross-sectional, demographic and health surveys data

Abstract

ObjectivesTo examine how maternal and sociodemographic factors determine continued care-seeking behaviour from pregnancy to postnatal period in Kenya and Uganda and to determine associated neonatal survival outcomes.DesignA population-based analysis of cross-sectional data using multinomial and binary logistic regressions.SettingCountrywide, Kenya and Uganda.ParticipantsMost recent live births of 24 502 mothers within 1–59 months prior to the 2014–2016 Demographic and Health Surveys.OutcomesCare-seeking continuum and neonatal mortality.ResultsOverall, 57% of the mothers had four or more antenatal care (ANC) contacts, of which 73% and 41% had facility births and postnatal care (PNC), respectively. Maternal/paternal education versus no education was associated with continued care seeking in majority of care-seeking classes; relative risk ratios (RRRs) ranged from 2.1 to 8.0 (95% CI 1.1 to 16.3). Similarly, exposure to mass media was generally associated with continued care seekin; RRRs ranged from 1.8 to 3.2 (95% CI 1.2 to 5.4). Care-seeking tendency reduced if a husband made major maternal care-seeking decisions. Transportation problems and living in rural versus urban were largely associated with lower continued care use; RRR ranged from 0.4 to 0.7 (95% CI 0.3 to 0.9). The two lowest care-seeking categories with no ANC and no PNC indicated the highest odds for neonatal mortality (adjusted OR 4.2, 95% CI 1.6 to 10.9). 23% neonatal deaths were attributable to inadequate maternal care attendance.ConclusionStrategies such as mobile health specifically for promoting continued maternal care use up to postnatal could be integrated in the existing structures. Another strategy would be to develop and employ a brief standard questionnaire to determine a mother’s continued care-seeking level during the first ANC visit and to use the information to close the care-seeking gaps. Strengthening the community health workers system to be an integral part of promoting continued care seeking could enhance care seeking as a stand-alone strategy or as a component of aforementioned suggested strategies.

Prevalence of completion of maternity continuum of care and its associated factors in Ethiopia: a systematic review and meta-analysis

“…Those women who had completed secondary and above educational status were 3.5 times more likely to complete the maternity CoC than those who did not have formal education. The finding is consistent with studies conducted in Pakistan, Uganda and Kenya 27 28. The possible explanation might be those women who are able to read and write have awareness regarding the benefit of antenatal follow-up, giving birth at a health facility and postnatal follow-up such as early detection and management of diseases, prevention of infection and bleeding after delivery.…”

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

“…These bottlenecks require addressing so that the woman who have been left behind can benefit from programs and initiatives put into place. The high ownership of mobile phones in East Africa can be leveraged to create mobile health program simultaneously with community health workers (CHWs) to facilitate follow-ups and minimize socioeconomic barriers [ 91 ] among the poor. Determining the degree of follow-up needed based on ANC user characteristics during the first ANC visit can also be used to increase return visits and ANC uptake.…”

“…Women from poor households often have lower educational attainment which negatively affects utilization [92] as observed in the hotspot districts. In the short run, health promotion and outreach campaigns among pregnant will be useful [91,93] at the villagelevel [93] or through mass media [94] in the hotspots. This could neutralize harmful traditions and cultural beliefs, misinformation from family or traditional healers, or cases where pregnant women are misled to delay ANC visits [84,95].…”

Spatial variation and inequities in antenatal care coverage in Kenya, Uganda and mainland Tanzania using model-based geostatistics: a socioeconomic and geographical accessibility lens

“…These bottlenecks require addressing so that the woman who have been left behind can bene t from programs and initiatives put into place. The high ownership of mobile phones in East Africa can be leveraged to create mobile health program simultaneously with community health workers (CHWs) to facilitate follow-ups and minimize socioeconomic barriers (93) among the poor. Determining the degree of follow-up needed based on ANC user characteristics during the rst ANC visit can also be used to increase return visits and ANC uptake.…”

“…Women from poor households often have lower educational attainment which negatively affects utilization (94) as observed in the hotspot districts. In the short run, health promotion and outreach campaigns among pregnant will be useful (93,95) at the village-level (95) or through mass media (96) in the hotspots. This could neutralize harmful traditions and cultural beliefs, misinformation from family or traditional healers, or cases where pregnant women are misled to delay ANC visits (86, 97).…”