Factors Associated with the Completion of the Continuum of Maternal, Neonatal and Child Care in 11 Sub-Saharan African Countries: A Multilevel Analysis of Demographic and Health Survey Data

Introduction: The utilization of the continuum of maternal, neonatal and child care is recognized as a key strategy for reducing this burden. However, most studies on the continuum of care have focused on pregnancy, childbirth and postpartum care, without considering childhood immunization as part of the continuum of care, and countries with high maternal mortality are not often considered. The aim of this study was to identify the factors explaining the completion of the continuum of maternal, neonatal and infant care in 11 sub-Saharan African countries with high maternal mortality. Population and methods: Using data from recent demographic and health surveys in 11 sub-Saharan African countries with high maternal mortality, we carried out a secondary analysis including 42401 mother-child pairs. Using Stata software version 16.1, we performed a descriptive analysis of all variables, followed by a multilevel regression analysis to identify individual and contextual factors associated with the completion of the continuum of maternal, neonatal and infant care. Results: The level of completion of the continuum of care was 9.56%. The factors that were positively associated with the completion of the continuum of care were: age (OR = 1.47 [1.01 - 2.13] for women aged 35 - 49 years), education level (OR = 1.59 [1.05 - 2.41] for secondary/higher education), household wealth index (OR = 1.37 [1.12 - 1.66] for high wealth), media exposure (OR = 1.43 [1.12 - 1.84]), autonomy in healthcare decision-making (OR = 1.48 [1.17 - 1.87]), and cesarean section delivery (OR = 1.60 [1.38 - 1.86]). The intraclass correlation coefficient, proportional change in variance and median odds ratio were 15.11%, 30.95% and 2.08%, respectively. Conclusion: The level of completion of the continuum of maternal, neonatal and child care remains low in sub-Saharan African countries. The use and completion of the continuum of maternal, neonatal and child care services are imperative for reducing the burden of avoidable mortality in the mother-child pairs.