Abstract:
Background: Maintaining and effectively utilizing maternal continuum of care could save an estimated 860,000
additional mothers and newborn lives each year. In Ethiopia, the number of maternal and neonatal deaths occurred
during pregnancy, childbirth, and the postpartum period was very high. It is indisputable that area-based heterogeneity of zero utilization for a standard maternal continuum of care is critical to improve maternal and child health
interventions. However, none of the previous studies explored the spatial distribution of zero utilization for maternal
continuum of care. Hence, this study was aimed to explore geographical variation and predictors of zero utilization for
a standard maternal continuum of care among women in Ethiopia.
Methods: A total of 4178 women who gave birth five years preceding the 2016 Ethiopian demographic and health
survey were included. ArcGIS version 10.7, SaT Scan version 9.6, and GWR version 4.0 Software was used to handle
mapping, hotspot, ordinary least square, Bernoulli model analysis, and to model spatial relationships. Finally, a statistical decision was made at a p-value< 0.05 and at 95% confidence interval.
Main findings: The proportion of mothers who had zero utilization of a standard maternal continuum of care was
48.8% (95% CI: 47.3–50.4). Hot spot (high risk) regions for zero utilization of maternal continuum of care was detected
in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of Oromia region. Respondents who
had poor wealth index, uneducated mothers, and mothers who declared distance as a big problem could increase
zero utilization of maternal continuum of care by 0.24, 0.27, and 0.1 times.
Conclusion: Five women out of ten could not utilize any components of a standard maternal continuum of care. Hot
spot (high risk) areas was detected in Afder, Warder, Korahe and Gode Zones of Somali region and West Arsi Zone of
Oromia region. Poor wealth index, uneducated mothers, and mothers who declare distance as a big problem were
factors significantly associated with zero utilization of maternal continuum of care. Thus, geographical based intervention could be held to curve the high prevalence of zero utilization of maternal continuum of care.
