Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study

Introduction: Despite global decline in the maternal mortality, the decline in sub-Saharan African is still stagnating compared to other regions. Kenya and Tanzania had progressed in reducing maternal mortalities through different interventions including investing in interventions to improve the coverage of continuum of care, however, there is limited region-specific information on the subject. The study aimed to assess the coverage and determinants of maternal continuum of care among women who delivered in the last two years before surveys conducted in regions of Kenya and Tanzania. Methods: The study used data from end line survey of AQCESS and IMPACT project conducted in Kenya and Tanzania, respectively between 2020 and 2021. Cluster sampling approach with the village and household considered as the highest and lowest levels respectively was used to select women who delivered two years before the surveys. Maternal continuum of care is defined as attending at least four antenatal care, skilled birth attendance and receiving postpartum check-up within 48 hours. Socio-economic and reproductive variables were collected. Data were explored descriptively to assess coverage and multivariable logistic regression with robust standard errors was used to identify factors associated with CoC. Results: A total of 305 and 1049 women were included in Kenya and Tanzania surveys, respectively. The median age in years was 27.0 (IQR: 23.0–33.0). Women who attended at least four antenatal care visits were 75.5%, whilst 87.8% and 62.2% had skilled birth attendants and received postnatal check-up within 48 hours after delivery, respectively. The overall CoC was 31.1% (95% CI:28.6%-33.6%), with 26.9% (95% CI:22.0%-32.2%) in Kenya and 32.3% (95% CI:29.5%-35.2%) in Tanzania. Women with at least secondary level of education were 78% likely to complete Coc (aOR: 1.78; 95%CI: 1.13–2.84) than those with primary level of education. Similarly, women who received high quality antenatal care had 50% chances of completing CoC. However, not involving a woman in decision making about her own health and delayed initiation of antenatal care visits were associated with reduced odds of completing CoC. Conclusion: There were less than 50% coverage of complete CoC in the settings because of low coverage of postpartum check-up within 48 hours after delivery which varied between the regions. Having at least secondary level of education and receiving high quality antenatal care were associated with increased odds of completing CoC. Investment in girls’ education and strengthening the existing health systems to improve quality of antenatal care, which is the entry point into preventive and curative care services should be promoted to improve access to postpartum check-up and increase the coverage of completing CoC.