The aim of this study was to assess the level of continuum of maternal, newborn, childand reproductive health coverage using the composite coverage index (CCI) and to identify its determinants, including socioeconomic, community context, individual and family, and health service-related factors, among postpartum women one year after childbirth in Ethiopia.

This study was a secondary analysis of longitudinal data from the second cohort of the performance monitoring for action (PMA) Ethiopia survey, which was conducted from 2021 to 2023. Data were collected at four intervals: a baseline survey, a 6 week postpartum survey, a 6 month postpartum survey and a 1 year postpartum survey to track reproductive, maternal, newborn, and child health indicators.

The study was conducted from the major regions of Ethiopia, namely Amhara, Oromia, Southern Nations, Nationalities and Peoples’ and the city administration of Addis Ababa.

A total of 2297 women enrolled in cohort two of PMA Ethiopia. Of these, 2072 completed the 6 week, 1874 the 6 month and 1858 (along with their 1800 children) the 1 year postpartum follow-up surveys. The final analysis was based on a weighted sample of 1793 participants.

The outcome variable for this study was the continuum of maternal, newborn, child and reproductive health services, assessed using the CCI. We applied quantile regression analyses at the 10th, 25th, 50th, 75th and 90th quantiles of the outcome variable. Statistical significance of predictors was determined based on p values

The findings revealed that the mean CCI was 56.2% (95 % CI 52.5% to 59.8%), indicating the proportion of maternal, newborn, child, and reproductive health services received. Notably, only 4% of women received all 12 maternal, newborn, child, and reproductive health services as part of the continuum of care, while 1.1% did not receive any intervention. The study identified several factors significantly associated with CCI across different quantile levels, including maternal age, maternal education level, household wealth index, first antenatal care visit (ANC1), parity, previous facility delivery, partner encouragement, use of maternity waiting homes, and administrative regions.

Based on the findings of this study, the coverage of continuum of maternal, newborn, child and reproductive health services in Ethiopia remains low. This highlights a substantial gap in Ethiopia’s progress toward the 2030 sustainable development goal target. Ethiopia must significantly accelerate efforts to improve maternal, newborn, child and reproductive health services in order to achieve the set goals. Policymakers and programme implementers should carefully consider the identified determinants when designing policies and programmes aimed at enhancing maternal, newborn, child and reproductive health outcomes.

To assess maternal medical conditions, physical and surgical ailments, contraceptive use and barriers to its use, maternal mental health, neonatal health, breastfeeding practices and available social support in the postpartum period.

A prospective cohort study.

A large tertiary care centre.

12 245 women who delivered after 22 weeks gestation in the year 2022.

Three pre-specified exposures, namely mode of delivery, presence of significant risk factors and preterm delivery within the cohort, were used to identify potential groups of women who would need additional support.

The primary outcome was the number of unscheduled visits by the mother or child and the indications for these visits.

The secondary outcomes in mothers included unhealed wound sites, anaemia, increase in body mass index (BMI) by >3, persistent high blood pressure, pain in the abdomen or pelvis, urinary or bowel problems, musculoskeletal pain, abnormal maternal mental health, breast-related issues and barriers to breastfeeding, contraceptive use and sexual activity.

Only 2% of women and children were lost to follow-up. Nine women and 75 babies died. The majority of infant deaths were related to serious congenital diseases. Unscheduled visits to the health facility were seen in 44% of the cohort, most commonly for upper respiratory infections and fever in the mother and baby. 41 mothers and 741 infants needed admission to hospital. Hospitalisation was more common in those with risk factors or preterm delivery. High blood pressure was seen in 3 to 4% and anaemia in 4% of the cohort. Wound infection was seen in 3 to 4% and urinary incontinence in 2% of women. Wound infection was more common with instrumental delivery. Bowel incontinence was rare. A fourth of the cohort had musculoskeletal pain, especially back pain, which was more common after caesarean delivery. Only 5.5% of the cohort had unsatisfactory mental health, and these women were more likely to have abnormal mental health scores with the NICE Questionnaire at screening. The family APGAR of the cohort was 9/10, and 95% belonged to the middle-income group. 2.6% of neonates had delayed milestones, and this was more common in the group with risk factors and preterm delivery.

Healthcare utilisation was mainly for minor complaints. Re-admissions were rare, as intrapartum and immediate postpartum care were optimal. Women who delivered by caesarean section or delivered a preterm child needed additional support in the postpartum phase. NICE Questionnaire is a quick and easy screening tool to identify unsatisfactory mental health and should be used before discharge, postnatally, even in busy settings. The implementation of formal telephonic support 24 hours a day in birthing facilities should be explored in the future. Holistic postnatal care of mother and child during the immunisation of the baby would be the best opportunity to improve the quality and coverage of care in the postnatal phase.

CTRI/2022/03/041343.