Magnitude and Determinants of Maternal and Neonatal Continuum-of-Care Service Utilization in Public Health Facilities of Assosa Zone, Northwest Ethiopia

Abstract Background: The Maternal and Neonatal Health Continuum of care (MNH CoC) is a recommended strategy for reducing maternal and neonatal deaths. Aim: This study aimed to determine the magnitude of MNH CoC utilization and factors influencing it at public health facilities in the Assosa Zone, Ethiopia. Methods: A facility-based cross-sectional study involving 592 women who gave birth in the past nine months was conducted from January to March 2022. Samples were proportionally allocated to health facilities, followed by systematic sampling. Exit interviews were conducted after obtaining consent from each selected woman. Complete CoC level was determined by women who received at least four antenatal care visits to health facilities during pregnancy, delivered by skilled providers, and received postnatal care within 24hours, 48hours, 72hours, and 7days at health facilities or home by health extension workers. Missing one or more of these services was considered discontinuity. Data were analyzed using SPSS version 27 software. Binary logistic regression was used to identify the factors associated with CoC, and a p-value < 0.05 was considered statistically significant. Results: The completion rate of CoC from antenatal to postnatal was 53.7%. Early ANC booking (AOR=8.31, 95%CI=4.70-14.69) and knowledge of expected ANC visits (AOR=13.21, 95%CI=6.29-27.72) significantly increased the likelihood of CoC completion, underscoring timely engagement. Primary education (AOR=2.53,95%CI=1.23-5.20), employment (AOR=12.26,95%CI=1.87-80.28), strong partner support (AOR=4.94,95%CI=1.43-17.14), comprehensive counseling and physical examinations during antenatal periods (AOR=2.04, 95%CI=1.07-3.89), and Cesarean-section delivery (AOR=9.82,95%CI=1.75-53.66) significantly boosted retention of CoC services along the pathways. Conclusions: According to the study findings, nearly 50% of women did not receive comprehensive and interlinked (focused ANC, skilled delivery, and postnatal care) interventions along the continuum pathways. Hence, comprehensive awareness raising, education, counselling, and empowering of women at the household, community, and facility levels are required. [Ethiop. J. Health Dev. 2025; 39(3)] Key words: Maternal and neonatal health, continuum of care, utilization, determinant factors