Continuum of maternal healthcare utilization in conflict-affected Tigray, Ethiopia

Continuum of maternal healthcare is a continuity of care that a woman receives during pregnancy, childbirth, and the postpartum period from skilled providers. In the Tigray region, the maternal health services are badly damaged and disrupted by the war, resulting in an unacceptably high increment in the maternal mortality rate (840 per 100,000 live births) during the war in 2021. Despite this, little is known about the status of continuum of maternal healthcare in the conflict affected Tigray. Thus, this study aimed to assess the status of the continuum of maternal healthcare among mothers in the conflict-affected Tigray, Ethiopia. A community-based cross-sectional study with a multistage cluster sampling technique was conducted among 2340 mothers in 24 randomly selected districts from January to February 2024. A structured and pretested questionnaire was used to collect data. Binary logistic regression model to determine the factors associated with the utilization of the continuum of maternal healthcare. To handle confounders, bivariate and multivariable logistic regression analyses were conducted. Statistical significance was set at a p -value of < 0.05. Our findings showed that only 3.1% (95% CI, 2.5%-3.9%) of mothers had utilized the continuum of maternity care. There was a significant disparity in the utilization of the continuum of maternal healthcare among residents; it was significantly lower among rural residents (1.7%) compared to urban residents (6.9%) ( P = 0.001). Booking antenatal care visits early (AOR = 3.68, 95% CI: 2.10– 6.61), urban residence (AOR = 2.36, 95% CI: 1.22– 4.59), and being multipara (AOR = 0.52, 95% CI: 0.29–0.95) were significantly associated with the utilization of the continuum of maternal healthcare. Our study showed that the utilization of the continuum of maternal healthcare was low. Factors associated with the continuum of maternal healthcare utilization were urban residence, early booking of antenatal care visits, and parity of mothers. Hence, special attention should be given to multipara mothers as well as mothers residing in the rural districts. In addition, healthcare providers should promote early antenatal care booking to enhance the utilization of continuum of maternal healthcare.