The pooled prevalence and associated factors of dropout from maternal continuum of care among mothers in 41 low- and middle-income countries, after the Sustainable Development Goals: a multilevel analysis

BackgroundThis study aimed to assess the pooled proportion of dropouts from the continuum of maternity care (CoC) and its associated factors in LMICs. MethodsA cross-sectional study was conducted based on the data from the Demographic and Health Surveys of 41 low- and middle-income countries after the Sustainable Development Goals. 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 CoC. The adjusted odds ratios with p-values < 0.05 were statistically significant in the final model. The Intra-class Correlation Coefficient, Proportional Change in Variance, and Median Odds Ratio were used to identify the measures of variation for the random effect. ResultsThe pooled proportion of dropout from CoC was 50% (95% CI: 45% to 56%). Factors associated with higher odds of dropout were multi parity (AOR=1.26, 95% CI: 1.22 to 1.29), grand multi parity (AOR=1.58, 95% CI:1.50 to 1.65), delayed first ANC (AOR=2.87, 95% CI:2.79 to 2.95), WHO regions compared to North Africa/West Asia/Europe region; from SSA (AOR=2.59, 95% CI:2.30 to 2.91), Central Asia (AOR=1.55, 95%CI:1.24 to 1.93), South and Southeast Asia (AOR=2.38, 95% CI: 2.12 to 2.67), Oceania (AOR=2.66, 95% CI:2.20 to 3.23), Latin America and the Caribbean (AOR=9.06 95% CI:7.33 to 11.21), distance from health facility (AOR=1.15, 95% CI:1.12 to 1.19), getting permission (AOR= 1.23, 95% CI:1.19 to 1.28), pregnancy intention (AOR=0.81 95% CI:0.78 to 0.84) and rural residence (AOR=1.52, 95% CI:1.46 to 1.59). While primary education (AOR=0.80, 95% CI:0.77 to 0.83), secondary education (AOR=0.58, 95% CI: 0.55 to 0.60), higher education (AOR=0.44, 95% CI:0.42 to 0.47), middle wealth index (AOR=0.80, 95% CI: 0.78 to 0.83), rich wealth index (AOR=0.67, CI: 0.65 to 0.70), media exposure (AOR=0.73, 95% CI:0.71 to 0.75), women aged between 20 to 34 (AOR=0.80, 95% CI:0.76 to 0.84), and age > 35 years (AOR=0.63, 95% CI:0.59 to 0.67) were associated with lower odds of dropout. ConclusionsImproving womens education, media exposure, womens decision-making power, accessibility of health facilities to remote settings, and decreasing teenage pregnancy were found to be factors to reduce dropouts.