Abstract
OBJECTIVE: 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. DESIGN: 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. SETTINGS: 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. PARTICIPANTS: 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. OUTCOME MEASURES: 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 <0.05. Estimates for the regression coefficient, standard errors, p values and CIs were generated across the quantiles. RESULT: 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. CONCLUSION: 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.