Trends in and predictors of maternal health services utilization among adolescent mothers in Uganda; A secondary analysis of Uganda Demographic Health Surveys (UDHS) 2000/01 - 2016

Introduction: This study analyzed the trends in and predictors of maternal services Utilization in Uganda for the period 2000/2001-2016 among adolescent mothers aged 15-19 years. Methodology: We used secondary data extracted from 2000/2001, 2006, 2011, and 2016 Uganda Demographic and Health Surveys, UDHS focusing on ANC, delivery care, and postnatal care utilization. About 376, 348, 352, and 789 adolescent women aged 15-19 were selected based on a national stratified-cluster sample design in each respective year of the survey. Data analysis: Data was analyzed using STATA version 14.0 and the type of analyses involved included; Univariate, Bivariate, and Multivariate logistic regression. Cross tabulations were used to investigate the trends of Antenatal Care, Delivery care, and Postnatal Care utilization according to socio-demographic factors. As regards the in-depth analysis, multivariate logistic regression was used to determine the predictors for Antenatal Care, Delivery care, and Post postnatal care services utilization by adolescent mothers. Results: Overall, the utilization of maternal health services by adolescent women aged 15-19 years in Uganda increased from 2000/01–2016 UDHS. The early timing of the first ANC visit increased from 15% in 2000/01 to 26% in 2016 (+11 percent points, p=0.000). The proportion of adequate utilization of ANC increased from 46% in 2000/01 to 59% in 2016 (+13pp, p=0.000). The proportion of health facility deliveries increased from 50% in 2000/01 81% in 2016 (+31pp, p=0.000). Relatedly, assisted deliveries by skilled providers increased from 50% in 2000/01 80% in 2016 (+30pp, p=0.000). PNC checks for adolescent women before discharge from the health facility increased from 35% in 2006 to 67% in 2016 (+32pp, p=0.000). Two predictor variables were associated with ANC utilization; not living together with a partner (AOR=0.43, 95%CI: 0.23-0.80, p=0.009) was negatively associated with ANC visits. Adolescent women from the northern region (AOR=1.87, 95% CI: 1.02-3.40; p=0.042) and those not living together with their partners (AOR=2.19, 95% CI: 1.15-4.16; p=0.016) were positively associated with ANC timing. Urban adolescent women (AOR=3.34, 95% CI: 1.45-7.49; p=0.005) positively predicted institutional delivery. Being married (AOR=0.38, 95% CI: 0.38-0.91; p=0.019), not living together with a partner (AOR=0.46, 95% CI: 0.24-0.90; p=0.024), and primary (AOR=0.10, 95% CI: 0.013-0.819; p-0.032) negatively predicted PNC check before discharge for adolescent women. Conclusion: Generally, the proportion of maternal health services utilization by adolescent women in Uganda increased over the years. Health facility deliveries varied between two regions, eastern and western. Urban areas predicted a significant association with delivering in a health facility; education and marital status were significant in PNC to check for an adolescent mother before discharge from the health facility