Factors Associated with Underutilization of Maternity Health Care Cascade in Mozambique: Analysis of the 2015 National Health Survey

Abstract

Maternity health care services utilization determines maternal and neonate outcomes. Evidence about factors associated with composite non-utilization of four or more antenatal consultations and intrapartum health care services is needed in Mozambique. This study uses data from the 2015 nationwide Mozambique’s Malaria, Immunization and HIV Indicators Survey. At selected representative households, women (n = 2629) with child aged up to 3 years answered a standardized structured questionnaire. Adjusted binary logistic regression assessed associations between women-child pairs characteristics and non-utilization of maternity health care. Seventy five percent (95% confidence interval (CI) = 71.8–77.7%) of women missed a health care cascade step during their last pregnancy. Higher education (adjusted odds ratio (AOR) = 0.65; 95% CI = 0.46–0.91), lowest wealth (AOR = 2.1; 95% CI = 1.2–3.7), rural residency (AOR = 1.5; 95% CI = 1.1–2.2), living distant from health facility (AOR = 1.5; 95% CI = 1.1–1.9) and unknown HIV status (AOR = 1.9; 95% CI = 1.4–2.7) were factors associated with non-utilization of the maternity health care cascade. The study highlights that, by 2015, recommended maternity health care cascade utilization did not cover 7 out of 10 pregnant women in Mozambique. Unfavorable sociodemographic and economic factors increase the relative odds for women not being covered by the maternity health care cascade.

Missed Opportunity of Antenatal Care Services Utilization and Associated Factors among Reproductive Age Women in Eastern Hararghe Zone, Eastern Ethiopia: Mixed Methods Study

“…The odds of missing an antenatal care service were reduced when educational status increased. This finding was supported by previous research in Southern Ethiopia [ 43 ], Northwest Ethiopia [ 46 , 47 ], and Western Ethiopia [ 48 ]; a systematic review conducted in Ethiopia [ 49 ]; and EDS carried out in rural Ethiopia [ 35 , 50 ], Kenya [ 51 ], Guinea [ 52 , 53 ], Afghanistan [ 40 ], Angola [ 54 ], East African countries [ 55 ], India [ 56 , 57 ], Nepal [ 58 ], and Nigeria [ 59 ]. Educated women might be empowered to get services [ 60 – 65 ], and education makes women have decision-making skills [ 65 , 66 ].…”

Cost‐Effectiveness and Budget Impact Analysis of the Implementation of Differentiated Service Delivery Models for HIV Treatment in Mozambique: a Modelling Study

“…Clients’ opportunity costs included travel time to the health facility and time spent at the health facility for service provision. The total opportunity cost per conventional care interaction was estimated as a half‐day of wages, based on the country's average wage, considering on average 1 hour of travel time and 3 hours of time spent at the health facility [ 18 , 19 ]. Medication pick‐ups for the 3MMD were estimated to be 1.5 hours, AC interactions and CAG interactions in the community were estimated to be 3.5 and 1 hour, respectively.…”

“…Medication pick‐ups for the 3MMD were estimated to be 1.5 hours, AC interactions and CAG interactions in the community were estimated to be 3.5 and 1 hour, respectively. For FA, we considered half of the opportunity costs of the conventional visit, assuming that clients using this model reduce their visits by half because members of the same household are scheduled to the same day [ 18 , 19 , 20 ]. Opportunity costs were estimated in Mozambique metical and converted to US dollars (US$) using the 2021 annual average exchange rate of 63.25 metical per US$1.…”