BMJ open · 2026
Pooled prevalence of maternal continuum of care dropout and associated factors among mothers in 41 low-income and middle-income countries: a multi-country cross-sectional study after the Sustainable Development Goals.
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Bitewa Mequanent Dessie, Getachew Milkiyas Solomon, Kassie Tadele Derbew, Getnet Mihret, Lakew Ayenew Molla
Аннотация
OBJECTIVES: This study aimed to assess the pooled proportion of dropout from the maternal continuum of care (CoC) and its associated factors in low-income and middle-income countries (LMICs).
STUDY DESIGN: Cross-sectional study using nationally representative demographic and health survey (DHS) data.
SETTING: 41 LMICs with DHS data available after the establishment of the Sustainable Development Goals from 2016 to 2024 were included. A total of 217 083 (weighted 213 474) women were included. Using Stata V.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from the CoC. The adjusted ORs (AORs) with 95% CIs were calculated, and p<0.05 was statistically significant in the final model.
PARTICIPANTS: Women of reproductive age (15 to 49 years) who had at least one live birth within 2 years preceding the survey.
PRIMARY OUTCOME: Dropout from the CoC was the primary outcome of this study, defined as initiating antenatal care but failing to receive skilled birth attendance and/or postnatal care.
RESULTS: The pooled proportion of CoC dropout was 50% (95% CI 45 to 56%), with significant heterogeneity, which ranges from 19% in Albania to 85% in Ethiopia. Factors associated with higher odds of dropout were multiparity (AOR=1.30, 95% CI 1.26 to 1.34), grand multiparity (AOR=1.70, 95% CI 1.62 to 1.78), delayed first ANC (AOR=2.87, 95% CI 2.79 to 2.95), regions compared with the North Africa/West Asia/Europe region; SSA (AOR=2.65, 95% CI 2.34 to 3.00), Central Asia (AOR=1.78, 95% CI 1.40 to 2.26), South and Southeast Asia (AOR=2.43, 95% CI 2.14 to 2.75), Oceania (AOR=2.41, 95% CI 1.98 to 2.94), Latin America and the Caribbean (AOR=8.47, 95% CI 6.81 to 10.54), distance from health facility (AOR=1.15, 95% CI 1.12 to 1.18), getting permission (AOR=1.27, 95% CI 1.23 to 1.32), pregnancy intention (AOR=0.76, 95% CI 0.73 to 0.78) and rural residence (AOR=1.57, 95% CI 1.51 to 1.64), primary education (AOR=0.83, 95% CI 0.80 to 0.86), secondary education (AOR=0.60, 95% CI 0.58 to 0.62), higher education (AOR=0.43, 95% CI 0.41 to 0.46), middle wealth index (AOR=0.80, 95% CI 0.77 to 0.83), rich wealth index (AOR=0.65, 95% CI 0.63 to 0.68), media exposure (AOR=0.70, 95% CI 0.69 to 0.72), women aged between 20 and 34 (AOR=0.76, 95% CI 0.72 to 0.79) and age ≥35 years (AOR=0.60, 95% CI 0.56 to 0.63) were associated with lower odds of dropout.
CONCLUSIONS: This study found a 50% dropout from CoC in LMICs with considerable heterogeneity. Factors identified as contributing to reducing dropout rates include improving women's education, increasing media exposure, enhancing women's decision-making power, ensuring better access to healthcare facilities, particularly in remote areas, and reducing adolescent pregnancies. To achieve Sustainable Development Goal 3 for maternal and child health by 2030, a coordinated, multi-level strategy is required.
STUDY DESIGN: Cross-sectional study using nationally representative demographic and health survey (DHS) data.
SETTING: 41 LMICs with DHS data available after the establishment of the Sustainable Development Goals from 2016 to 2024 were included. A total of 217 083 (weighted 213 474) women were included. Using Stata V.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from the CoC. The adjusted ORs (AORs) with 95% CIs were calculated, and p<0.05 was statistically significant in the final model.
PARTICIPANTS: Women of reproductive age (15 to 49 years) who had at least one live birth within 2 years preceding the survey.
PRIMARY OUTCOME: Dropout from the CoC was the primary outcome of this study, defined as initiating antenatal care but failing to receive skilled birth attendance and/or postnatal care.
RESULTS: The pooled proportion of CoC dropout was 50% (95% CI 45 to 56%), with significant heterogeneity, which ranges from 19% in Albania to 85% in Ethiopia. Factors associated with higher odds of dropout were multiparity (AOR=1.30, 95% CI 1.26 to 1.34), grand multiparity (AOR=1.70, 95% CI 1.62 to 1.78), delayed first ANC (AOR=2.87, 95% CI 2.79 to 2.95), regions compared with the North Africa/West Asia/Europe region; SSA (AOR=2.65, 95% CI 2.34 to 3.00), Central Asia (AOR=1.78, 95% CI 1.40 to 2.26), South and Southeast Asia (AOR=2.43, 95% CI 2.14 to 2.75), Oceania (AOR=2.41, 95% CI 1.98 to 2.94), Latin America and the Caribbean (AOR=8.47, 95% CI 6.81 to 10.54), distance from health facility (AOR=1.15, 95% CI 1.12 to 1.18), getting permission (AOR=1.27, 95% CI 1.23 to 1.32), pregnancy intention (AOR=0.76, 95% CI 0.73 to 0.78) and rural residence (AOR=1.57, 95% CI 1.51 to 1.64), primary education (AOR=0.83, 95% CI 0.80 to 0.86), secondary education (AOR=0.60, 95% CI 0.58 to 0.62), higher education (AOR=0.43, 95% CI 0.41 to 0.46), middle wealth index (AOR=0.80, 95% CI 0.77 to 0.83), rich wealth index (AOR=0.65, 95% CI 0.63 to 0.68), media exposure (AOR=0.70, 95% CI 0.69 to 0.72), women aged between 20 and 34 (AOR=0.76, 95% CI 0.72 to 0.79) and age ≥35 years (AOR=0.60, 95% CI 0.56 to 0.63) were associated with lower odds of dropout.
CONCLUSIONS: This study found a 50% dropout from CoC in LMICs with considerable heterogeneity. Factors identified as contributing to reducing dropout rates include improving women's education, increasing media exposure, enhancing women's decision-making power, ensuring better access to healthcare facilities, particularly in remote areas, and reducing adolescent pregnancies. To achieve Sustainable Development Goal 3 for maternal and child health by 2030, a coordinated, multi-level strategy is required.