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

Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study James Orwa, Samwel Maina Gatimu, Lucy Nyagah, Hussein Kidanto, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8901007/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract 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. continuum of care maternal and newborn health Skilled birth attendants postnatal care quality antenatal care Introduction Despite a decrease in global maternal mortality ratio (MMR) by more than a third between 2000 and 2020, 287,000 women died due to complications related to pregnancy and childbirth globally in 2020 [ 1 ]. Notably, 95% of these deaths occurred in low- and lower-middle-income countries [ 1 ]. Sub-Saharan Africa had the highest neonatal mortality rate in the world at 27 deaths per 1000 live births, followed by central and southern Asia, with a neonatal mortality rate (NMR) of 21 deaths per 1000 live births [ 2 ]. In the past decade, Kenya and Tanzania have reduced maternal and neonatal mortality. The MMR and NMR reduced from 448 to 342 per 100,000 live births [ 1 , 3 , 4 ] and 22 to 21 deaths per 1,000 live births between 2008 and 2022 in Kenya [ 5 ]. In Tanzania, the MMR and NMR reduced from 530 to 104 deaths per 100,000 live births and 25 to 19 deaths per 1,000 live births between 2016 and 2022 [ 6 ]. These gains have occurred alongside improvements in key service-delivery indicators across the maternal continuum of care. During the same period, key maternal care indicator of antenatal care, health facility delivery and postnatal check-up within two days improved. In Kenya and Tanzania, 97.9% and 89.7% received at least one antenatal care with 66.4% and 65.1% attending at least four ANC visits, 82.3% and 81.2% delivered at a health facility and 72.5% and 50.5% received postpartum services, respectively. These patterns suggest progressive strengthening of linked maternal health services, although gaps remain in ensuring that women complete the full continuum of care. Maternal continuum of care is a framework promoted by the World Health Organization to improve timely use of high-quality reproductive, maternal, newborn, and child healthcare services delivery throughout the lifecycle from pre-conception, pregnancy, delivery, and the postpartum period and across different levels of health systems. Strengthening the continuum is crucial in preventing maternal and neonatal deaths [ 7 ]. Most of these deaths result from preventable causes occurring across the continuum from pregnancy to the immediate postpartum period. During pregnancy, conditions such as preeclampsia/eclampsia and maternal anemia increase risks for both mothers and babies and contribute to prematurity. During labor and delivery, complications including uterine rupture and other intrapartum-related events can be fatal without timely and quality obstetric care. In the immediate postpartum period, postpartum hemorrhage remains a leading cause of maternal death, while newborn deaths are commonly due to infections such as sepsis, tetanus, and pneumonia [ 8 ] [ 2 , 9 ]. Our previous study examined maternal healthcare services in isolation in Tanzania using baseline survey data [ 10 – 12 ], highlighting the need for a more integrated approach across the continuum of care. This study therefore aims to assess the coverage and determinants of completion of the maternal continuum of care in selected regions of Kenya and Tanzania, with a specific focus on the pregnancy, delivery, and immediate postpartum periods. The findings are expected to inform the co-creation of context-relevant interventions to improve the utilization and continuity of maternal health services from pregnancy through the first 48 hours after birth and ultimately contribute to improved maternal health indicators. Methods Study design, populations, sampling and setting The study utilized secondary data from the end-line surveys of two projects—Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) and Improving Access to Reproductive, Maternal and Newborn Health (IMPACT)—implemented in Kilifi (Kaloleni and Rabai sub-counties) and Kisii (Bomachoge and Borabu sub-counties) counties in Kenya and Mwanza region of Tanzania (Illemela, Nyamagana, Buchosa, Sengerema, Ukerewe, and Magu districts), respectively. The Kenyan survey was conducted in November and December 2020 while the Tanzania survey was conducted in March 2021. The surveys used a two-stage cluster sampling approach: the first stage where all the first 30 villages were selected based on the number of households they had and the second stage involved a random selection of households within the selected clusters. There was no further sampling at the household level and all consenting women of reproductive age (15–49 years) were surveyed. Details on design, population, sampling and settings can be found in our previous publications [10, 13]. Data collection and management In both surveys, data were collected electronically using open data kits by trained research assistants fluent in English and other local languages (Swahili, Giriama, Sukuma, and Ukerewe). The data collected were reviewed by the team leaders at the end of the day’s work before uploading them into the cloud server for further analysis. The questionnaire was first designed in English and later back translated into different local languages before converted into electronic data tool. The major sections were on reproductive, maternal, newborn, child and adolescent health. All the selected households were included in the interviews; in case there was no eligible respondent available at the time of data collection, three attempts were made before the households were declared unavailable. The research assistants had the support of village elders and village executive offices in Kenya and Tanzania, respectively. Study variables Dependent variable The main outcome of interest was complete CoC of maternal care which was measured as a composite score of at least four antenatal care (ANC), skilled birth attendance (SBA) and maternal immediate postnatal care (PNC) within 48 hours after delivery. A woman was considered to have completed CoC if she had received at least four antenatal care visits (ANC4+), delivered the recent birth with the assistant of skilled health providers(SBA) and received PNC within 48 hours of delivery (immediate PNC), otherwise not complete if she did not receive at least ANC4+, SBA or PNC. The definition was consistent with prior maternal continuum-of-care studies that measure continuity across pregnancy, delivery, and the immediate postpartum transition [14, 15]. Independent variables The selection of independent variables guided by previous studies on maternal CoC [16-22] and the availability of data from the end-line surveys. The sociodemographic variables included maternal age (15–19, 20–34 and 35–49), women’s education (no formal, primary and secondary and higher), marital status (married, not married), woman decision making for seeking healthcare (woman alone, woman with someone and not involved) and household wealth quintiles (richest, richer, middle, poorer and poorest). The household wealth index, a composite measure of the cumulative living standard of a household, was calculated using principal component analysis based on household characteristics and household assets. Maternal variables included pregnancy intention during the last pregnancy and timing of first ANC. Quality of antenatal care was generated as composite variable consisting of blood pressure measured, blood sample has taken, urine sample was taken, received at least two tetanus injection, iron supplementation, and received drugs for intestinal worms. This dichotomized in adequate (high quality) if the woman received all these services, otherwise the antenatal care was considered inadequate [23]. Statistical analysis The data were pooled from the two surveys, and analyzed descriptively using frequency and percentages for categorical variables and median and inter-quartile range for continuous variables. Overall, country-specific and region-specific prevalence of CoC was calculated including the 95% confidence interval. The study followed the approach of Wenjuan et al. [24] and Gizachew et al. [25] to fit four sequential multivariable logistic regression analyses with robust standard errors to analyze the factors associated with at least 4 antenatal care (ANC4+)(Model I), ANC4+ and SBA (Model II), SBA+PNC (Model III) and CoC (Model IV). Each of the model had different outcomes as defined: Model I was coded 1 if a woman received at least four antenatal care and 0 otherwise. Model II outcome was coded 1 for women who received at least four antenatal care and skilled birth attendance, and 0 for receiving at least four antenatal care visits but not skilled birth attendance. The outcome for Model III was coded as 1 for receiving skilled birth attendance and immediate postnatal care, and 0 for receiving skilled birth attendance but not immediate postnatal care, and finally the outcome for Model IV was coded as 1 for receiving antenatal care, skilled birth attendance, and immediate maternal postnatal care, and 0 otherwise. Ethical considerations The surveys were approved by the Aga Khan University Hospital Institutional Scientific Ethics and Research Committee in both countries. The research permits were obtained from NACOSTI and COSTECH for the projects in Kenya and Tanzania respectively. Further approvals to conduct the study in these regions were obtained from county Ministry of Health in Kenya and regional medical officer in Mwanza. The studies were conducted according to the rules and regulations approved by the research committees and in line with the Helsinki Declaration on Research involving Human Subjects. All participants provide informed consent by signing or using thumb prints on the consent forms before the start of the data collection. Women between the ages 15–17 years provided assent in addition to their parents or guardian consents. Results Respondents’ characteristics The study included a total of 1,354 women who delivered in the two regions before the survey which consisted of 305 and 1,049 from Kenya and Tanzania, respectively. The overall median age in years was 27.0 (IQR: 23.0–33.0) with no significant difference in median ages in the two countries (p-value=0.057). Majority of the women were aged 20–34 years in both countries with teenagers being the minority group. Similarly, majority of the women had primary level of education with higher proportion with primary level of education in Tanzania compared to Kenya. Overall, most women (n=472, 34.9%) were from household in the second wealth quintile, however, by regions, most Kenyan women were from households in the first wealth quintile whilst in Tanzania, majority were in the second wealth quintile (Table 1). In both countries, women were not involved in decision making about their own health as reported by 161 (52.8%) and 425 (40.5%) of the women in Kenya and Tanzania, respectively. The median time to initial antenatal care in weeks in Kenya was higher at 20.0 (IQR:14.0–24.0) as compared to Tanzania at 16.0 (IQR: 12.0–20.0). This translates to 546 (40.8%) of the women initiating antenatal care during the first trimester, 548 (41.0%) during the second trimester and 243 (18.2%) in the third trimester. Higher proportion of women in Tanzania initiated their antenatal during the first trimester as compared to Kenya and only 14.8% (n=155) of them initiated their visits in the third trimesters. However, higher proportion of women reported high-quality antenatal care compared to Tanzania at 81.0% (n=247) and 647 (61.7%), respectively. Similarly, a slightly higher proportion of women in Kenya wanted the most recent pregnancy than women in Tanzania (Table 1). Table 1: Demographic and reproductive characteristics of women who delivered two years before the end line surveys in regions of Kenya and Tanzania, 2020 and 2021. Variable Overall N = 1,354 1 Kenya N = 305 1 Tanzania N = 1,049 1 p-value 2 n (%) n (%) n (%) Maternal age (years), (Median (IQR)) 27.0 (23.0–33.0) 26.0 (22.0–32.0) 27.0 (23.0–33.0) 0.057 Age (years) 0.028 15–19 95 (7.0) 30 (9.8) 65 (6.2) 20–34 1,002 (74.0) 228 (74.8) 774 (73.8) 35–49 257 (19.0) 47 (15.4) 210 (20.0) Marital status 0.005 Currently married 1,039 (76.7) 250 (82.0) 789 (75.2) In a union 106 (7.8) 11 (3.6) 95 (9.1) Not in union 209 (15.4) 44 (14.4) 165 (15.7) Level of education <0.001 No formal 158 (11.7) 52 (17.0) 106 (10.1) Primary 866 (64.0) 162 (53.1) 704 (67.1) Secondary and higher 330 (24.4) 91 (29.8) 239 (22.8) Wealth quintile <0.001 1 387 (28.6) 169 (55.4) 218 (20.8) 2 472 (34.9) 106 (34.8) 366 (34.9) 3 252 (18.6) 10 (3.3) 242 (23.1) 4 169 (12.5) 7 (2.3) 162 (15.4) 5 74 (5.5) 13 (4.3) 61 (5.8) Decision-making on respondent’s health <0.001 Woman alone 322 (23.8) 86 (28.2) 236 (22.5) Woman with partner 446 (32.9) 58 (19.0) 388 (37.0) Not involved 586 (43.3) 161 (52.8) 425 (40.5) Initial ANC (Median (IQR)) 16.0 (12.0–20.0) 20.0 (14.0–24.0) 16.0 (12.0–20.0) <0.001 Initiation of first ANC <0.001 First trimester 546 (40.8) 73 (24.9) 473 (45.3) Second trimester 548 (41.0) 132 (45.1) 416 (39.8) Third trimester 243 (18.2) 88 (30.0) 155 (14.8) Quality of ANC services <0.001 Inadequate 460 (34.0) 58 (19.0) 402 (38.3) Adequate/High-quality 894 (66.0) 247 (81.0) 647 (61.7) Wanted of last pregnancy 0.010 Wanted 716 (52.9) 181 (59.3) 535 (51.0) Unwanted 638 (47.1) 124 (40.7) 514 (49.0) ANC visits <0.001 0–3 326 (24.3) 96 (32.2) 230 (22.0) 4+ 1,018 (75.7) 202 (67.8) 816 (78.0) Skilled birth attendance <0.001 Unskilled 165 (12.2) 61 (20.0) 104 (9.9) Skilled 1,189 (87.8) 244 (80.0) 945 (90.1) Postnatal care 0.110 More than 2 days 354 (37.8) 63 (32.8) 291 (39.1) Within 2 days 583 (62.2) 129 (67.2) 454 (60.9) Maternal continuum of care 421 (31.1) 82 (26.9) 339 (32.3) 0.071 1 Median (IQR) or Frequency (%); 2 Wilcoxon rank sum test; Pearson's Chi-squared test; ANC : Antenatal care; IQR : Interquartile range; Maternal continuum of care Overall, only 31.1% (95% CI:28.6%-33.6%) of women completed the maternal continuum of care, with 26.9% (95% CI:22.0%-32.2%) in Kenya and 32.3% (95% CI:29.5%-35.2%) in Tanzania. The highest completion rate was in Buchosa at 40.1%, and the lowest in Sengerema at 18.2% (Table 2). Most women attended at least four ANC visits (75.7%), with the highest percentage in Ilemela, Tanzania (81.3%) and the lowest in Kilifi, Kenya (67.7%). Most women had skilled birth attendance (87.8%), with the highest percentage in Buchosa, Tanzania (96.8%) and the lowest in Kilifi, Kenya (72.9%). At least, 62.2% of women received postnatal care within two days after delivery, with the highest percentage in Ukerewe, Tanzania (87.8%) and the lowest in Sengerema, Tanzania (41.2%) (Table 2). Kenyan women had higher rates of skilled births and postnatal check-ups compared to Tanzanian women, at 14.1% and 8.0%, respectively. Women with at least four antenatal visits and skilled births were 27.5% in Kenya and 39.2% in Tanzania. Those with both antenatal visits and postnatal check-ups were 0.7% in Kenya and 2.4% in Tanzania (Table 2). Table 2: Coverage of different components of maternal health care utilization and CoC among women in regions of Kenya and Tanzania Total Kenya ( n (%) ) Tanzania ( n (%) ) Variable Overall Kilifi Kisii Buchosa Ilemela Magu Nyamagana Sengerema Ukerewe N = 1,354 N = 192 N = 113 N = 157 N = 422 N = 153 N = 155 N = 99 N = 63 ANC visits 0–3 326 (24.3) 60 (32.3) 36 (32.1) 35 (22.3) 79 (18.7) 33 (21.9) 44 (28.6) 22 (22.2) 17 (27.0) 4+ 1,018 (75.7) 126 (67.7) 76 (67.9) 122 (77.7) 343 (81.3) 118 (78.1) 110 (71.4) 77 (77.8) 46 (73.0) Skilled birth attendance Unskilled 165 (12.2) 52 (27.1) 9 (8.0) 5 (3.2) 36 (8.5) 17 (11.1) 17 (11.0) 15 (15.2) 14 (22.2) Skilled 1,189 (87.8) 140 (72.9) 104 (92.0) 152 (96.8) 386 (91.5) 136 (88.9) 138 (89.0) 84 (84.8) 49 (77.8) Postnatal care >2 days 354 (37.8) 33 (30.6) 30 (35.7) 47 (38.2) 110 (35.6) 58 (52.7) 31 (33.0) 40 (58.8) 5 (12.2) Within 2 days 583 (62.2) 75 (69.4) 54 (64.3) 76 (61.8) 199 (64.4) 52 (47.3) 63 (67.0) 28 (41.2) 36 (87.8) Maternal CoC 421 (31.1) 48 (25.0) 34 (30.1) 63 (40.1) 151 (35.8) 37 (24.2) 45 (29.0) 18 (18.2) 25 (39.7) CoC: Continuum of care Determinants of completion of continuum of care Women not involved, secondary+ level of education, second and third trimester and having received high-quality antenatal care were significantly associated with the maternal continuum of care (Model IV). Women who were not involved in decision-making about their health had a decreased likelihood of completing the continuum of care (aOR: 0.66, 95% CI: 0.47–0.92). Similarly, women who attended their first antenatal care visits during the second or third trimester were less likely to complete the continuum of care. However, there were increased odds of completing the continuum of care among women with at least secondary education (aOR: 1.78, 95% CI: 1.13–2.84) or who have received quality antenatal care services (aOR: 1.50, 95% CI: 1.14–1.97). Other factors not significantly associated at p-value > 0.05 with the maternal continuum of care is presented in Table 3. Table 3: Logistic regression analysis of factors associated with the different components of maternal health care utilization and CoC among women in regions of Kenya and Tanzania. Variable Dependent variable Model I (ANC->ANC4+) Model II (ANC4+-–>SBA) Model III (SBA->PNC) Model IV (CoC) Age (years) 15–19 Ref Ref Ref Ref 20–34 0.66 (0.31–1.23) 0.27**(0.08–0.68) 1.28 (0.74–2.20) 0.80 (0.49–1.34) 35–49 0.82 (0.39–1.68) 0.32**(0.09–0.87) 1.42 (0.76–2.67) 0.91 (0.51–1.62) Own health Alone Ref Ref Ref Ref Joint with the partner 1.16 (0.72–1.85) 1.92**(1.13–3.27) 1.11 (0.75–1.65) 1.28 (0.91–1.81) Not involved 0.82 (0.53–1.25) 0.85 (0.55–1.31) 0.65**(0.12–0.94) 0.66**(0.47–0.92) Marital status Currently married Ref Ref Ref Ref In union 0.72 (0.41–1.31) 0.74 (0.42–1.40) 0.92 (0.52–1.64) 0.74 (0.45–1.17) Not–in union 1.39 (0.86–2.29) 0.88 (0.54–1.46) 0.90 (0.58–1.39) 0.88 (0.60–1.29) Level of education No formal Ref Primary 1.03 (0.62–1.69) 1.64**(1.02–2.57) 1.11 (0.70–1.76) 1.06 (0.71–1.61) Secondary and higher 2.01**(1.09–3.68) 2.89**(1.56–5.47) 1.45 (0.85–2.45) 1.78**(1.13–2.84) Wealth quintile 1 Ref Ref Ref Ref 2 1.18 (0.80–1.75) 0.95 (0.63–1.43) 0.90 (0.63–1.29) 0.94 (0.69–1.29) 3 1.34 (0.83–2.20) 1.21 (0.72–2.09) 0.79 (0.52–1.19) 0.85 (0.59–1.22) 4 1.29 (0.73–2.33) 1.38 (0.73–2.75) 0.76 (0.47–1.24) 0.76 (0.50–1.15) 5 0.73 (0.35–1.57) 4.03*(1.18–25.27) 0.55**(0.30–0.997) 0.59*(0.32–1.05) Initiation of ANC First trimester Ref Ref Ref Ref Second trimester 0.19***(0.12–0.30) 0.61**(0.41–0.91) 0.96 (0.71–1.30) 0.63***(0.49–0.81) Third trimester 0.02***(0.40–0.77) 0.58**(0.36–0.95) 1.07 (0.71–1.61) 0.13***(0.08–0.21) Previous pregnancy wanted Wanted Ref Ref Ref Ref Unwanted 0.56***(0.40–0.77) 1.07 (0.75–1.53) 0.94 (0.71–1.26) 0.78*(0.61–1.01) Quality of ANC Inadequate Ref Ref Ref Ref Adequate/High–quality 0.92 (0.65–1.31) 1.56**(1.08–2.23) 1.33*(0.97–1.81) 1.50***(1.14–1.97) Observations 1337 1337 884 1337 AIC 1017.70 928.11 1187.28 1544.83 Note : *p<0.1; **p<0.05; ***p<0.01; CoC : Continuum of care; ANC : Antenatal care; AIC : Akaike Information Criterion; SBA : Skilled birth attendance; PNC : Postnatal care Discussion The study aimed to determine the coverage and determinants of completion of maternal continuum of care in some regions of Kenya and Tanzania. The study revealed less than half of the women completed the maternal CoC similar pattern to a study from 32 countries in sub-Saharan Africa of 29.4% [ 26 ] and in Ethiopia that found maternal completion rate of 37% [ 27 ] but lower than completion rate among Ghanian women of 8.0% [ 17 ]. Greatest contributor to the low rate of maternal continuum of care was postnatal care within two days after delivery which was stricter as the definition used in other studies. The slight variations in the completion rates could further be associated with the different interventions used in different settings to improve the uptake of the different components of continuum of care. The study found women who had at least secondary education had higher odds of complete continuum of care than those with no formal education training which is in line with other studies [ 28 ]. Similarly, women with at least primary level of education showed high likelihood of continuation of care with the skilled birth attendance after receiving at least four antenatal care which was similar to the study in Ethiopia [ 25 ]. Low literacy levels among participants in this setting may be associated with low health knowledge, on the otherhand, highly educated women may acquire information from many sources including in schools regarding benefits of maternal health care. In addition, illiterate women are most likely economically unstable and, in many cases, depends on their husbands to finance their maternal needs including financial support to attend adequate maternal health care during the continuum of care process. Economic stability had shown strong associations with the uptake of maternal healthcare services in other settings [ 29 ]. On the other hand, women who were not involved in decision making about their health were less likely to have a complete continuum of care as compared to those who participated in the decision-making about their own health. Involving a woman in each stage of the continuum ensure improves maternal nutrition, and better maternal care, and provides a woman with the freedom to choose when and where to seek maternal healthcare when needed [ 30 ]. The finding was in line with the study in Cote d’Ivoire in which women who were involved in decision-making about their health had 18% higher odds of attending at least four antenatal care visits [ 31 ]. Starting antenatal care during the second and third trimesters was associated with a decreased likelihood of completing the continuum of care. Early booking for the antennal care is the entry point for other maternal preventive and curative care services. The findings were in agreement with other previous studies [ 26 ]. Initiating antenatal care services within the first trimester gives a woman an opportunity to receive health promotion and preventive care such as screening for proteinuria, early detection and treatment of sexually transmitted infections, immunization against tetanus, nutrition counselling, supplementation of iron and folic acid, prophylactic treatment of malaria and worms [ 22 ]. Moreover, early ANC initiation facilitates timely linkage to additional maternal services such as counseling on birth preparedness, HIV testing and treatment, monitoring of maternal conditions like hypertension and anemia, and planning for skilled birth attendance and postnatal care, thereby enhancing overall maternal and neonatal health outcomes. Quality antenatal care reduces maternal mortalities and improves the survival of newborns. The study revealed higher quality of care than the 13% found in Mozambique [ 32 ] which could be attributed to different management practices in the two settings. Strength and limitations This is the first study to provide a comprehensive analysis of maternal completion of care in two rural sub-counties of Kenya and the Mwanza region. The findings provide context-specific findings which could aid in co-designing further interventions to improve maternal and newborn health in these regions. The results of the study contributed to the existing knowledge of the role of early antenatal care initiation, women involvement in decision making on their own health in the whole spectrum of the maternal continuum of care. The study included variables that were collected to respond to the project management framework and might not have considered all the variables explaining the maternal continuum of care such as exposure to media, political goodwill and social-cultural determinants among others. Being a cross-sectional study which could not allow the study of a cause-and-effect relationship between the outcomes and exposure variables was another limitation which limits the the analysis to determine causality. The study also included a few numbers of teenagers which might not be representative of the teenage population in the study settings. Future studies involving youths is therefore recommended. Finaly, the situation might have changed due to different interventions, government and stakeholder support provided in these regions and the study might not reflect the current situation of maternal continuum of care in these regions. This calls for new studies to provide current information in line with investments in maternal and newborn health and to provide more information on the quality of the services received. Conclusion The study found less than half of the women completed continuum of care during the previous pregnancy which was majorly contributed to low uptake of maternal postnatal care.. The odds of completing the continuum of care increased with the at least secondary level of education and having received high quality antenatal care services and decreased among women who were not involved in decision making about their own health and those who had delayed initiation of antenatal care visits. To effectively increase the uptake of women completing continuum of care, programs targeting female involvement in decision making concerning their own health, early initiation of antenatal care visits and education empowerment among girls should be encouraged in these settings. In addition, more interventions are necessary to strengthen antenatal care which is the entry point for skilled birth attendance and immediate maternal postnatal care after delivery. Abbreviations AIC: Akaike Information Criterion; ANC: Antenatal care; AQCESS: Access to Quality Care through Extending and Strengthening Health Systems; CoC: Continuum of care; IMPACT: Improving Access to Reproductive, Maternal and Newborn Health in Mwanza; IQR: Interquartile range; MMR: Maternal mortality ratio; PNC: Postnatal care; SBA: Skilled birth attendance; SDGs: Sustainable Development Goals (SDGs); WHO: World Health Organization Declarations Ethics approval and consent to participate The surveys were approved by the Aga Khan University Hospital Institutional Scientific Ethics and Research Committee in both countries. The research permits were obtained from NACOSTI and COSTECH for the projects in Kenya and Tanzania respectively. Further approvals to conduct the study in these regions were obtained from county Ministry of Health in Kenya and regional medical officer in Mwanza. The studies were conducted according to the rules and regulations approved by the research committees and in line with the Helsinki Declaration on Research involving Human Subjects. All participants provide informed consent by signing or using thumb prints on the consent forms before the start of the data collection. Women between the ages 15–17 years provided assent in addition to their parents or guardian consents. Consent for publication Not applicable Availability of data and materials The datasets generated and analyzed for this study are available on request from Prof. Marleen Temmerman through the email address: [email protected] . and based on an official data transfer and user agreement sent to the director of the Centre of Excellence in Women and Child Health East Africa at the Aga-Khan University. Competing interests We affirm that we have no conflict of interest. Funding The endline surveys that collected data used for this study were funded by the Government of Canada and the Aga Khan Foundation Canada (AKFC) as part of AQCESS project which was implemented by the Aga Khan Development Network in partnership with the Government of Kenya. AKFC contributed to the design and data collection of the endline survey. The time to develop the concept, data analysis, and write-up was supported by the Office Of The Director, National Institutes Of Health (OD), the National Institute Of Biomedical Imaging And Bioengineering (NIBIB), the National Institute Of Mental Health (NIMH), and the Fogarty International Center (FIC) of the National Institutes of Health under award number U54TW012089 (Abubakar A and Waljee AK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Author contributions JO conceptualized the study, acquired, analyzed data for the study and wrote the first draft. SMG, LN, and HK writing review and editing of original draft. MT provided overall project supervision. All authors contributed to the article and approved the submitted version Acknowledgement. Acknowledgement We would like to thank all women interviewed, study end line research team in the two countries from the ministry of health and projects teams. We are also grateful to the Government of Canada and AKFC for funding the AQCESS and IMPACT projects and for the Aga Khan Foundation Canada (AKFC) staff for the enormous time spend reviewing the end line study protocol and tools development. Authors’ ORCID James Orwa: 0000-0001-8717-6073 Samwel Maina Gatimu: 0000-0002-8331-4536 Kidanto Hussein: 0000-0001-9167-8068 Marleen: 0000-0001-9966-9000 Lucy Nyaga: 0000-0002-6974-1670 References World Health Organization: Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division : World Health Organization; 2023. Newborn mortality [https://www.who.int/news-room/fact-sheets/detail/newborn-mortality] Kerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE: Continuum of care for maternal, newborn, and child health: from slogan to service delivery . Lancet 2007, 370 (9595):1358-1369. Ministry of Health: Kenya Health Sector Strategic Plan: Transforming Health Systems: Achieving Universal Health Coverage by 2022 . In . Nairobi: Ministry of Health; 2017. Kenya National Bureau of Statistics, ICF: Kenya Demographic and Health Survey 2022 . In . : Nairobi, Kenya, and Rockville, Maryland, USA; 2023. Ministry of Health CD, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland],, Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), ICF: Tanzania Demographic and Health Survey and Malaria Indicator Survey 2022 . In . Dodoma, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, OCGS, and ICF; 2022. Geleto A, Chojenta C, Musa A, Loxton D: Barriers to access and utilization of emergency obstetric care at health facilities in sub-Saharan Africa: a systematic review of literature . Systematic reviews 2018, 7 :1-14. Akinyemi JO, Bamgboye EA, Ayeni O: Trends in neonatal mortality in Nigeria and effects of bio-demographic and maternal characteristics . BMC Pediatr 2015, 15 :36. Arunda M, Emmelin A, Asamoah BO: Effectiveness of antenatal care services in reducing neonatal mortality in Kenya: analysis of national survey data . Glob Health Action 2017, 10 (1):1328796. Orwa J, Mantel M, Mugerwa M, Brownie S, Pallangyo ES, Mwasha L, Isangula K, Subi L, Mrema S, Edwards G et al : Maternal healthcare services use in Mwanza Region, Tanzania: a cross-sectional baseline survey . BMC Pregnancy Childbirth 2019, 19 (1):474. Galgalo DA, Mokaya P, Chauhan S, Kiptulon EK, Wami GA, Várnagy Á, Prémusz V: Utilization of maternal health care services among pastoralist communities in Marsabit County, Kenya: a cross-sectional survey . Reproductive Health 2024, 21 (1):126. Banke-Thomas O, Banke-Thomas A, Ameh CA: Utilisation of maternal health services by adolescent mothers in Kenya: analysis of the demographic health survey 2008–2009 . International journal of adolescent medicine and health 2018, 30 (2):20160042. Orwa J, Gatimu SM, Mantel M, Luchters S, Mugerwa MA, Brownie S, Subi L, Mrema S, Nyaga L, Edwards G: Birth preparedness and complication readiness among women of reproductive age in Kenya and Tanzania: a community-based cross-sectional survey . BMC pregnancy and childbirth 2020, 20 :1-9. Dennis ML, Benova L, Abuya T, Quartagno M, Bellows B, Campbell OM: Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya . Health policy and planning 2019, 34 (2):120-131. Oyedele OK: Multilevel and subnational analysis of the predictors of maternity continuum of care completion in Nigeria: a cross-sectional survey . Scientific Reports 2023, 13 (1):20863. Alem AZ, Shitu K, Alamneh TS: Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis . BMC Pregnancy Childbirth 2022, 22 (1):422. Yeji F, Shibanuma A, Oduro A, Debpuur C, Kikuchi K, Owusu-Agei S, Gyapong M, Okawa S, Ansah E, Asare GQ et al : Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors . PLoS One 2015, 10 (12):e0142849. Sserwanja Q, Nuwabaine L, Gatasi G, Wandabwa JN, Musaba MW: Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020 . BMC Health Serv Res 2022, 22 (1):812. Rwabilimbo AG, Ahmed KY, Page A, Ogbo FA: Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania . Trop Med Health 2020, 48 :38. Joshi C, Torvaldsen S, Hodgson R, Hayen A: Factors associated with the use and quality of antenatal care in Nepal: a population-based study using the demographic and health survey data . BMC Pregnancy Childbirth 2014, 14 :94. Blackstone SR: Evaluating antenatal care in Liberia: evidence from the demographic and health survey . Women Health 2019, 59 (10):1141-1154. World Health Organization: WHO recommendations on antenatal care for a positive pregnancy experience : World Health Organization; 2016. Sserwanja Q, Nuwabaine L, Gatasi G, Wandabwa JN, Musaba MW: Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan demographic health survey 2020 . BMC health services research 2022, 22 (1):812. Wang W, Hong R: Levels and determinants of continuum of care for maternal and newborn health in Cambodia-evidence from a population-based survey . BMC Pregnancy Childbirth 2015, 15 :62. Tiruneh GT, Demissie M, Worku A, Berhane Y: Predictors of maternal and newborn health service utilization across the continuum of care in Ethiopia: A multilevel analysis . PLoS One 2022, 17 (2):e0264612. Alem AZ, Shitu K, Alamneh TS: Coverage and factors associated with completion of continuum of care for maternal health in sub-Saharan Africa: a multicountry analysis . BMC Pregnancy and Childbirth 2022, 22 (1):422. Saito A, Kondo M: Continuum of care for maternal and child health and child undernutrition in Angola . BMC Public Health 2024, 24 (1):680. Chalise B, Chalise M, Bista B, Pandey AR, Thapa S: Correlates of continuum of maternal health services among Nepalese women: Evidence from Nepal Multiple Indicator Cluster Survey . PLoS One 2019, 14 (4):e0215613. Wairoto KG, Joseph NK, Macharia PM, Okiro EA: Determinants of subnational disparities in antenatal care utilisation: a spatial analysis of demographic and health survey data in Kenya . BMC health services research 2020, 20 (1):665. Kabir A, Rashid MM, Hossain K, Khan A, Sikder SS, Gidding HF: Women’s empowerment is associated with maternal nutrition and low birth weight: evidence from Bangladesh Demographic Health Survey . BMC women's health 2020, 20 :1-12. Denise KDO, Marie-Dorothée KM, Marie-Laurette AY, Akoua T, Laure EEM, Williams Y, Dinard K: Factors associated with maternal health service utilization in Cote d’Ivoire: analysis of the 2011 Ivorian Demographic and Health Survey . Sci J Public Health 2019, 7 (4):115-122. Reis-Muleva B, Borges ALV, Duarte LS, Dos Santos CCdS, de Castro Nascimento N: Assessment of the quality of antenatal care in Mozambique . Midwifery 2023, 118 :103598. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 30 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers invited by journal 17 Mar, 2026 Editor assigned by journal 16 Mar, 2026 Editor invited by journal 20 Feb, 2026 Submission checks completed at journal 19 Feb, 2026 First submitted to journal 19 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8901007","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":607665112,"identity":"aa6b183f-0817-457e-a535-6c362c932cfc","order_by":0,"name":"James Orwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzklEQVRIiWNgGAWjYBACxgY4k/kAhHOAeC1sCcRpQQI8BsRpYW4/nfjwB4NNvsHxMx8/zmxjkOO7kUDAYT25m415GNIsN5zJ3Sy5sY3BWJKglobcbdIMDIcNzA7kbpB82MaQuIGglv6323/+AGk5/+bxT6CWesJaZuRuY+ABabmRwwZyWIIBYS1vN0vzGKQZ2N94ZmY545yE4cwzD/BrMezP3fjxR4WNgWR/8uObPWU28nzHCdhi2AAiDeB8CfzKQUCesJJRMApGwSgY8QAAPnNJvplqoL8AAAAASUVORK5CYII=","orcid":"","institution":"Aga Khan University","correspondingAuthor":true,"prefix":"","firstName":"James","middleName":"","lastName":"Orwa","suffix":""},{"id":607665113,"identity":"77243f91-8c76-400e-a985-95d1d534a95e","order_by":1,"name":"Samwel Maina Gatimu","email":"","orcid":"","institution":"Diabetes Foot Foundation of Kenya","correspondingAuthor":false,"prefix":"","firstName":"Samwel","middleName":"Maina","lastName":"Gatimu","suffix":""},{"id":607665114,"identity":"7aebad82-7cd0-49f2-a7c2-ebb34c2e0b2e","order_by":2,"name":"Lucy Nyagah","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Lucy","middleName":"","lastName":"Nyagah","suffix":""},{"id":607665115,"identity":"797b4fcf-bdd1-4991-bbee-7621357397ec","order_by":3,"name":"Hussein Kidanto","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Hussein","middleName":"","lastName":"Kidanto","suffix":""},{"id":607665116,"identity":"44554750-65e8-4fdc-9e5c-ace6fdc421dc","order_by":4,"name":"Marleen Temmerman","email":"","orcid":"","institution":"Aga Khan University","correspondingAuthor":false,"prefix":"","firstName":"Marleen","middleName":"","lastName":"Temmerman","suffix":""}],"badges":[],"createdAt":"2026-02-17 12:24:28","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8901007/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8901007/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":105050965,"identity":"05f784e4-5aaf-4dec-9df1-72365ee9c35a","added_by":"auto","created_at":"2026-03-20 10:19:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2692317,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8901007/v1/fc5e3002-a596-4d9c-83c7-19629f97141b.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDespite a decrease in global maternal mortality ratio (MMR) by more than a third between 2000 and 2020, 287,000 women died due to complications related to pregnancy and childbirth globally in 2020 [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Notably, 95% of these deaths occurred in low- and lower-middle-income countries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Sub-Saharan Africa had the highest neonatal mortality rate in the world at 27 deaths per 1000 live births, followed by central and southern Asia, with a neonatal mortality rate (NMR) of 21 deaths per 1000 live births [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the past decade, Kenya and Tanzania have reduced maternal and neonatal mortality. The MMR and NMR reduced from 448 to 342 per 100,000 live births [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] and 22 to 21 deaths per 1,000 live births between 2008 and 2022 in Kenya [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Tanzania, the MMR and NMR reduced from 530 to 104 deaths per 100,000 live births and 25 to 19 deaths per 1,000 live births between 2016 and 2022 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. These gains have occurred alongside improvements in key service-delivery indicators across the maternal continuum of care. During the same period, key maternal care indicator of antenatal care, health facility delivery and postnatal check-up within two days improved. In Kenya and Tanzania, 97.9% and 89.7% received at least one antenatal care with 66.4% and 65.1% attending at least four ANC visits, 82.3% and 81.2% delivered at a health facility and 72.5% and 50.5% received postpartum services, respectively. These patterns suggest progressive strengthening of linked maternal health services, although gaps remain in ensuring that women complete the full continuum of care.\u003c/p\u003e \u003cp\u003eMaternal continuum of care is a framework promoted by the World Health Organization to improve timely use of high-quality reproductive, maternal, newborn, and child healthcare services delivery throughout the lifecycle from pre-conception, pregnancy, delivery, and the postpartum period and across different levels of health systems. Strengthening the continuum is crucial in preventing maternal and neonatal deaths [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Most of these deaths result from preventable causes occurring across the continuum from pregnancy to the immediate postpartum period. During pregnancy, conditions such as preeclampsia/eclampsia and maternal anemia increase risks for both mothers and babies and contribute to prematurity. During labor and delivery, complications including uterine rupture and other intrapartum-related events can be fatal without timely and quality obstetric care. In the immediate postpartum period, postpartum hemorrhage remains a leading cause of maternal death, while newborn deaths are commonly due to infections such as sepsis, tetanus, and pneumonia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur previous study examined maternal healthcare services in isolation in Tanzania using baseline survey data [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], highlighting the need for a more integrated approach across the continuum of care. This study therefore aims to assess the coverage and determinants of completion of the maternal continuum of care in selected regions of Kenya and Tanzania, with a specific focus on the pregnancy, delivery, and immediate postpartum periods. The findings are expected to inform the co-creation of context-relevant interventions to improve the utilization and continuity of maternal health services from pregnancy through the first 48 hours after birth and ultimately contribute to improved maternal health indicators.\u003c/p\u003e"},{"header":"Methods","content":"\u003ch2\u003eStudy design, populations, sampling and setting\u003c/h2\u003e\n\u003cp\u003eThe study utilized secondary data from the end-line surveys of two projects\u0026mdash;Access to Quality Care through Extending and Strengthening Health Systems (AQCESS) and Improving Access to Reproductive, Maternal and Newborn Health (IMPACT)\u0026mdash;implemented in Kilifi (Kaloleni and Rabai sub-counties) and Kisii (Bomachoge and Borabu sub-counties) counties in Kenya and Mwanza region of Tanzania (Illemela, Nyamagana, Buchosa, Sengerema, Ukerewe, and Magu districts), respectively. The Kenyan survey was conducted in November and December 2020 while the Tanzania survey was conducted in March 2021. The surveys used a two-stage cluster sampling approach: the first stage where all the first 30 villages were selected based on the number of households they had and the second stage involved a random selection of households within the selected clusters. There was no further sampling at the household level and all consenting women of reproductive age (15\u0026ndash;49 years) were surveyed. Details on design, population, sampling and settings can be found in our previous publications [10, 13].\u003c/p\u003e\n\u003ch2\u003eData collection and management\u003c/h2\u003e\n\u003cp\u003eIn both surveys, data were collected electronically using open data kits by trained research assistants fluent in English and other local languages (Swahili, Giriama, Sukuma, and Ukerewe). The data collected were reviewed by the team leaders at the end of the day\u0026rsquo;s work before uploading them into the cloud server for further analysis. The questionnaire was first designed in English and later back translated into different local languages before converted into electronic data tool. The major sections were on reproductive, maternal, newborn, child and adolescent health. All the selected households were included in the interviews; in case there was no eligible respondent available at the time of data collection, three attempts were made before the households were declared unavailable. The research assistants had the support of village elders and village executive offices in Kenya and Tanzania, respectively.\u003c/p\u003e\n\u003ch2\u003eStudy variables\u003c/h2\u003e\n\u003ch3\u003eDependent variable\u003c/h3\u003e\n\u003cp\u003eThe main outcome of interest was complete CoC of maternal care which was measured as a composite score of at least four antenatal care (ANC), skilled birth attendance (SBA) and maternal immediate postnatal care (PNC) within 48 hours after delivery. A woman was considered to have completed CoC if she had received at least four antenatal care visits (ANC4+), delivered the recent birth with the assistant of skilled health providers(SBA) and received PNC within 48 hours of delivery (immediate PNC), otherwise not complete if she did not receive at least ANC4+, SBA or PNC. The definition was consistent with prior maternal continuum-of-care studies that measure continuity across pregnancy, delivery, and the immediate postpartum transition [14, 15]. \u003c/p\u003e\n\u003ch3\u003eIndependent variables\u003c/h3\u003e\n\u003cp\u003eThe selection of independent variables guided by previous studies on maternal CoC [16-22] and the availability of data from the end-line surveys. The sociodemographic variables included maternal age (15\u0026ndash;19, 20\u0026ndash;34 and 35\u0026ndash;49), women\u0026rsquo;s education (no formal, primary and secondary and higher), marital status (married, not married), woman decision making for seeking healthcare (woman alone, woman with someone and not involved) and household wealth quintiles (richest, richer, middle, poorer and poorest). The household wealth index, a composite measure of the cumulative living standard of a household, was calculated using principal component analysis based on household characteristics and household assets. Maternal variables included pregnancy intention during the last pregnancy and timing of first ANC. Quality of antenatal care was generated as composite variable consisting of blood pressure measured, blood sample has taken, urine sample was taken, received at least two tetanus injection, iron supplementation, and received drugs for intestinal worms. This dichotomized in adequate (high quality) if the woman received all these services, otherwise the antenatal care was considered inadequate [23]. \u003c/p\u003e\n\u003ch2\u003eStatistical analysis\u003c/h2\u003e\n\u003cp\u003eThe data were pooled from the two surveys, and analyzed descriptively using frequency and percentages for categorical variables and median and inter-quartile range for continuous variables. Overall, country-specific and region-specific prevalence of CoC was calculated including the 95% confidence interval. The study followed the approach of Wenjuan et al. [24] and Gizachew et al. [25] to fit four sequential multivariable logistic regression analyses with robust standard errors to analyze the factors associated with at least 4 antenatal care (ANC4+)(Model I), ANC4+ and SBA (Model II), SBA+PNC (Model III) and CoC (Model IV). Each of the model had different outcomes as defined: Model I was coded 1 if a woman received at least four antenatal care and 0 otherwise. Model II outcome was coded 1 for women who received at least four antenatal care and skilled birth attendance, and 0 for receiving at least four antenatal care visits but not skilled birth attendance. The outcome for Model III was coded as 1 for receiving skilled birth attendance and immediate postnatal care, and 0 for receiving skilled birth attendance but not immediate postnatal care, and finally the outcome for Model IV was coded as 1 for receiving antenatal care, skilled birth attendance, and immediate maternal postnatal care, and 0 otherwise. \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe surveys were approved by the Aga Khan University Hospital Institutional Scientific Ethics and Research Committee in both countries. The research permits were obtained from NACOSTI and COSTECH for the projects in Kenya and Tanzania respectively. Further approvals to conduct the study in these regions were obtained from county Ministry of Health in Kenya and regional medical officer in Mwanza. The studies were conducted according to the rules and regulations approved by the research committees and in line with the Helsinki Declaration on Research involving Human Subjects. All participants provide informed consent by signing or using thumb prints on the consent forms before the start of the data collection. Women between the ages 15\u0026ndash;17 years provided assent in addition to their parents or guardian consents.\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eRespondents\u0026rsquo; characteristics\u003c/h2\u003e\n\u003cp\u003eThe study included a total of 1,354 women who delivered in the two regions before the survey which consisted of 305 and 1,049 from Kenya and Tanzania, respectively. The overall median age in years was 27.0 (IQR: 23.0\u0026ndash;33.0) with no significant difference in median ages in the two countries (p-value=0.057). Majority of the women were aged 20\u0026ndash;34 years in both countries with teenagers being the minority group. Similarly, majority of the women had primary level of education with higher proportion with primary level of education in Tanzania compared to Kenya. Overall, most women (n=472, 34.9%) were from household in the second wealth quintile, however, by regions, most Kenyan women were from households in the first wealth quintile whilst in Tanzania, majority were in the second wealth quintile (Table 1).\u003c/p\u003e\n\u003cp\u003eIn both countries, women were not involved in decision making about their own health as reported by 161 (52.8%) and 425 (40.5%) of the women in Kenya and Tanzania, respectively. The median time to initial antenatal care in weeks in Kenya was higher at 20.0 (IQR:14.0\u0026ndash;24.0) as compared to Tanzania at 16.0 (IQR: 12.0\u0026ndash;20.0). This translates to 546 (40.8%) of the women initiating antenatal care during the first trimester, 548 (41.0%) during the second trimester and 243 (18.2%) in the third trimester. Higher proportion of women in Tanzania initiated their antenatal during the first trimester as compared to Kenya and only 14.8% (n=155) of them initiated their visits in the third trimesters. However, higher proportion of women reported high-quality antenatal care compared to Tanzania at 81.0% (n=247) and 647 (61.7%), respectively. Similarly, a slightly higher proportion of women in Kenya wanted the most recent pregnancy than women in Tanzania (Table 1).\u003c/p\u003e\n\u003cp\u003eTable 1: \u0026nbsp;Demographic and reproductive characteristics of women who delivered two years before the end line surveys in regions of Kenya and Tanzania, 2020 and 2021.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"98%\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 1,354\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKenya\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 305\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTanzania\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eN = 1,049\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep-value\u003c/strong\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal age (years), (Median (IQR))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e27.0 (23.0\u0026ndash;33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e26.0 (22.0\u0026ndash;32.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e27.0 (23.0\u0026ndash;33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e15\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e95 (7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e30 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e65 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e20\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,002 (74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e228 (74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e774 (73.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e35\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e257 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e47 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e210 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eCurrently married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,039 (76.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e250 (82.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e789 (75.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eIn a union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e106 (7.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e11 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e95 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNot in union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e209 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e44 (14.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e165 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNo formal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e158 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e52 (17.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e106 (10.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e866 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e162 (53.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e704 (67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eSecondary and higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e330 (24.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e91 (29.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e239 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWealth quintile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e387 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e169 (55.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e218 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e472 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e106 (34.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e366 (34.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e252 (18.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e10 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e242 (23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e169 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e7 (2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e162 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e74 (5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e13 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e61 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDecision-making on respondent\u0026rsquo;s health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eWoman alone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e322 (23.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e86 (28.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e236 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eWoman with partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e446 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e58 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e388 (37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eNot involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e586 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e161 (52.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e425 (40.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitial ANC (Median (IQR))\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e16.0 (12.0\u0026ndash;20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e20.0 (14.0\u0026ndash;24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e16.0 (12.0\u0026ndash;20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitiation of first ANC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eFirst trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e546 (40.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e73 (24.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e473 (45.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eSecond trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e548 (41.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e132 (45.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e416 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e243 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e88 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e155 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuality of ANC services\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eInadequate\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e460 (34.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e58 (19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e402 (38.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eAdequate/High-quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e894 (66.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e247 (81.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e647 (61.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWanted of last pregnancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eWanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e716 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e181 (59.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e535 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eUnwanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e638 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e124 (40.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e514 (49.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC visits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e0\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e326 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e96 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e230 (22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e4+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,018 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e202 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e816 (78.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkilled birth attendance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e165 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e61 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e104 (9.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eSkilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e1,189 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e244 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e945 (90.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostnatal care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eMore than 2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e354 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e63 (32.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e291 (39.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003eWithin 2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e583 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e129 (67.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e454 (60.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal continuum of care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 16px;\"\u003e\n \u003cp\u003e421 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 15px;\"\u003e\n \u003cp\u003e82 (26.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 18px;\"\u003e\n \u003cp\u003e339 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.071\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\" style=\"width: 100px;\"\u003e\n \u003cp\u003e\u003csup\u003e1\u0026nbsp;\u003c/sup\u003eMedian (IQR) or Frequency (%); \u003csup\u003e2\u003c/sup\u003e Wilcoxon rank sum test; Pearson\u0026apos;s Chi-squared test; \u003cstrong\u003eANC\u003c/strong\u003e: Antenatal care; \u003cstrong\u003eIQR\u003c/strong\u003e: Interquartile range;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003ch2\u003eMaternal continuum of care\u003c/h2\u003e\n\u003cp\u003eOverall, only 31.1% (95% CI:28.6%-33.6%) of women completed the maternal continuum of care, with 26.9% (95% CI:22.0%-32.2%) in Kenya and 32.3% (95% CI:29.5%-35.2%) in Tanzania. The highest completion rate was in Buchosa at 40.1%, and the lowest in Sengerema at 18.2% (Table 2).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMost women attended at least four ANC visits (75.7%), with the highest percentage in Ilemela, Tanzania (81.3%) and the lowest in Kilifi, Kenya (67.7%). Most women had skilled birth attendance (87.8%), with the highest percentage in Buchosa, Tanzania (96.8%) and the lowest in Kilifi, Kenya (72.9%). At least, 62.2% of women received postnatal care within two days after delivery, with the highest percentage in Ukerewe, Tanzania (87.8%) and the lowest in Sengerema, Tanzania (41.2%) (Table 2).\u003c/p\u003e\n\u003cp\u003eKenyan women had higher rates of skilled births and postnatal check-ups compared to Tanzanian women, at 14.1% and 8.0%, respectively. Women with at least four antenatal visits and skilled births were 27.5% in Kenya and 39.2% in Tanzania. Those with both antenatal visits and postnatal check-ups were 0.7% in Kenya and 2.4% in Tanzania (Table 2).\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eTable 2: Coverage of different components of maternal health care utilization and CoC among women in regions of Kenya and Tanzania\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"2\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKenya (\u003c/strong\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"6\" valign=\"bottom\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTanzania (\u003c/strong\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003cstrong\u003e)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOverall\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKilifi\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eKisii\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBuchosa\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eIlemela\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMagu\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNyamagana\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSengerema\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUkerewe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 1,354\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 192\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 113\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 157\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 422\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 153\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 155\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 99\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN = 63\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eANC visits\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0\u0026ndash;3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e326 (24.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e60 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e36 (32.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e35 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e79 (18.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e33 (21.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e44 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e22 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e17 (27.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e4+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1,018 (75.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e126 (67.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e76 (67.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e122 (77.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e343 (81.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e118 (78.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e110 (71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e77 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e46 (73.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSkilled birth attendance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003eUnskilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e165 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e52 (27.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e9 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e5 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e36 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e17 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e17 (11.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e15 (15.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e14 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003eSkilled\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1,189 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e140 (72.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e104 (92.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e152 (96.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e386 (91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e136 (88.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e138 (89.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e84 (84.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e49 (77.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePostnatal care\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u0026gt;2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e354 (37.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e33 (30.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e30 (35.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e47 (38.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e110 (35.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e58 (52.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e31 (33.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e40 (58.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e5 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003eWithin 2 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e583 (62.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e75 (69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e54 (64.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e76 (61.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e199 (64.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e52 (47.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e63 (67.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e28 (41.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e36 (87.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMaternal CoC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e421 (31.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e48 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e34 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e63 (40.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e151 (35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 9px;\"\u003e\n \u003cp\u003e37 (24.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 11px;\"\u003e\n \u003cp\u003e45 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 10px;\"\u003e\n \u003cp\u003e18 (18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 8px;\"\u003e\n \u003cp\u003e25 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eCoC: Continuum of care\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ch2\u003eDeterminants of completion of continuum of care\u003c/h2\u003e\n\u003cp\u003eWomen not involved, secondary+ level of education, second and third trimester and having received high-quality antenatal care were significantly associated with the maternal continuum of care (Model IV). Women who were not involved in decision-making about their health had a decreased likelihood of completing the continuum of care (aOR: 0.66, 95% CI: 0.47\u0026ndash;0.92). Similarly, women who attended their first antenatal care visits during the second or third trimester were less likely to complete the continuum of care. However, there were increased odds of completing the continuum of care among women with at least secondary education (aOR: 1.78, 95% CI: 1.13\u0026ndash;2.84) or who have received quality antenatal care services (aOR: 1.50, 95% CI: 1.14\u0026ndash;1.97). Other factors not significantly associated at p-value \u0026gt; 0.05 \u0026nbsp;with the maternal continuum of care is presented in Table 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3: Logistic regression analysis of factors associated with the different components of maternal health care utilization and CoC among women in regions of Kenya and Tanzania.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" rowspan=\"2\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" colspan=\"4\" valign=\"bottom\" style=\"width: 73px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel I\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(ANC-\u0026gt;ANC4+)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel II\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(ANC4+-\u0026ndash;\u0026gt;SBA)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel III\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(SBA-\u0026gt;PNC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel IV\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e(CoC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e15\u0026ndash;19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e20\u0026ndash;34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.66 (0.31\u0026ndash;1.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.27**(0.08\u0026ndash;0.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.28 (0.74\u0026ndash;2.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.80 (0.49\u0026ndash;1.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e35\u0026ndash;49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.82 (0.39\u0026ndash;1.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.32**(0.09\u0026ndash;0.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.42 (0.76\u0026ndash;2.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.91 (0.51\u0026ndash;1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOwn health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eAlone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eJoint with the partner\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.16 (0.72\u0026ndash;1.85)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.92**(1.13\u0026ndash;3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.11 (0.75\u0026ndash;1.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.28 (0.91\u0026ndash;1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eNot involved\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.82 (0.53\u0026ndash;1.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.85 (0.55\u0026ndash;1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.65**(0.12\u0026ndash;0.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.66**(0.47\u0026ndash;0.92)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eCurrently married\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eIn union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.72 (0.41\u0026ndash;1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.74 (0.42\u0026ndash;1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.92 (0.52\u0026ndash;1.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.74 (0.45\u0026ndash;1.17)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eNot\u0026ndash;in union\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.39 (0.86\u0026ndash;2.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.88 (0.54\u0026ndash;1.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.90 (0.58\u0026ndash;1.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.88 (0.60\u0026ndash;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eNo formal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.03 (0.62\u0026ndash;1.69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.64**(1.02\u0026ndash;2.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.11 (0.70\u0026ndash;1.76)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.06 (0.71\u0026ndash;1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSecondary and higher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2.01**(1.09\u0026ndash;3.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e2.89**(1.56\u0026ndash;5.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.45 (0.85\u0026ndash;2.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.78**(1.13\u0026ndash;2.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWealth quintile\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.18 (0.80\u0026ndash;1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.95 (0.63\u0026ndash;1.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.90 (0.63\u0026ndash;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.94 (0.69\u0026ndash;1.29)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.34 (0.83\u0026ndash;2.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.21 (0.72\u0026ndash;2.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.79 (0.52\u0026ndash;1.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.85 (0.59\u0026ndash;1.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.29 (0.73\u0026ndash;2.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.38 (0.73\u0026ndash;2.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.76 (0.47\u0026ndash;1.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.76 (0.50\u0026ndash;1.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.73 (0.35\u0026ndash;1.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e4.03*(1.18\u0026ndash;25.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.55**(0.30\u0026ndash;0.997)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.59*(0.32\u0026ndash;1.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInitiation of ANC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eFirst trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eSecond trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.19***(0.12\u0026ndash;0.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.61**(0.41\u0026ndash;0.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.96 (0.71\u0026ndash;1.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.63***(0.49\u0026ndash;0.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eThird trimester\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.02***(0.40\u0026ndash;0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.58**(0.36\u0026ndash;0.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.07 (0.71\u0026ndash;1.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.13***(0.08\u0026ndash;0.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious pregnancy wanted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eWanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eUnwanted\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.56***(0.40\u0026ndash;0.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.07 (0.75\u0026ndash;1.53)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.94 (0.71\u0026ndash;1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e0.78*(0.61\u0026ndash;1.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQuality of ANC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eInadequate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eAdequate/High\u0026ndash;quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e0.92 (0.65\u0026ndash;1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1.56**(1.08\u0026ndash;2.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.33*(0.97\u0026ndash;1.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1.50***(1.14\u0026ndash;1.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eObservations\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e884\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1337\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 26px;\"\u003e\n \u003cp\u003eAIC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e1017.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 19px;\"\u003e\n \u003cp\u003e928.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1187.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd nowrap=\"\" valign=\"bottom\" style=\"width: 17px;\"\u003e\n \u003cp\u003e1544.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote\u003c/strong\u003e: *p\u0026lt;0.1; **p\u0026lt;0.05; ***p\u0026lt;0.01; \u003cstrong\u003eCoC\u003c/strong\u003e: Continuum of care; \u003cstrong\u003eANC\u003c/strong\u003e: Antenatal care; \u003cstrong\u003eAIC\u003c/strong\u003e: Akaike Information Criterion; \u003cstrong\u003eSBA\u003c/strong\u003e: Skilled birth attendance; \u003cstrong\u003ePNC\u003c/strong\u003e: Postnatal care\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study aimed to determine the coverage and determinants of completion of maternal continuum of care in some regions of Kenya and Tanzania. The study revealed less than half of the women completed the maternal CoC similar pattern to a study from 32 countries in sub-Saharan Africa of 29.4% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and in Ethiopia that found maternal completion rate of 37% [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] but lower than completion rate among Ghanian women of 8.0% [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Greatest contributor to the low rate of maternal continuum of care was postnatal care within two days after delivery which was stricter as the definition used in other studies. The slight variations in the completion rates could further be associated with the different interventions used in different settings to improve the uptake of the different components of continuum of care.\u003c/p\u003e \u003cp\u003eThe study found women who had at least secondary education had higher odds of complete continuum of care than those with no formal education training which is in line with other studies [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Similarly, women with at least primary level of education showed high likelihood of continuation of care with the skilled birth attendance after receiving at least four antenatal care which was similar to the study in Ethiopia [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Low literacy levels among participants in this setting may be associated with low health knowledge, on the otherhand, highly educated women may acquire information from many sources including in schools regarding benefits of maternal health care. In addition, illiterate women are most likely economically unstable and, in many cases, depends on their husbands to finance their maternal needs including financial support to attend adequate maternal health care during the continuum of care process. Economic stability had shown strong associations with the uptake of maternal healthcare services in other settings [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, women who were not involved in decision making about their health were less likely to have a complete continuum of care as compared to those who participated in the decision-making about their own health. Involving a woman in each stage of the continuum ensure improves maternal nutrition, and better maternal care, and provides a woman with the freedom to choose when and where to seek maternal healthcare when needed [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. The finding was in line with the study in Cote d\u0026rsquo;Ivoire in which women who were involved in decision-making about their health had 18% higher odds of attending at least four antenatal care visits [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStarting antenatal care during the second and third trimesters was associated with a decreased likelihood of completing the continuum of care. Early booking for the antennal care is the entry point for other maternal preventive and curative care services. The findings were in agreement with other previous studies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Initiating antenatal care services within the first trimester gives a woman an opportunity to receive health promotion and preventive care such as screening for proteinuria, early detection and treatment of sexually transmitted infections, immunization against tetanus, nutrition counselling, supplementation of iron and folic acid, prophylactic treatment of malaria and worms [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Moreover, early ANC initiation facilitates timely linkage to additional maternal services such as counseling on birth preparedness, HIV testing and treatment, monitoring of maternal conditions like hypertension and anemia, and planning for skilled birth attendance and postnatal care, thereby enhancing overall maternal and neonatal health outcomes. Quality antenatal care reduces maternal mortalities and improves the survival of newborns. The study revealed higher quality of care than the 13% found in Mozambique [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] which could be attributed to different management practices in the two settings.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrength and limitations\u003c/h2\u003e \u003cp\u003eThis is the first study to provide a comprehensive analysis of maternal completion of care in two rural sub-counties of Kenya and the Mwanza region. The findings provide context-specific findings which could aid in co-designing further interventions to improve maternal and newborn health in these regions. The results of the study contributed to the existing knowledge of the role of early antenatal care initiation, women involvement in decision making on their own health in the whole spectrum of the maternal continuum of care.\u003c/p\u003e \u003cp\u003eThe study included variables that were collected to respond to the project management framework and might not have considered all the variables explaining the maternal continuum of care such as exposure to media, political goodwill and social-cultural determinants among others. Being a cross-sectional study which could not allow the study of a cause-and-effect relationship between the outcomes and exposure variables was another limitation which limits the the analysis to determine causality. The study also included a few numbers of teenagers which might not be representative of the teenage population in the study settings. Future studies involving youths is therefore recommended.\u003c/p\u003e \u003cp\u003eFinaly, the situation might have changed due to different interventions, government and stakeholder support provided in these regions and the study might not reflect the current situation of maternal continuum of care in these regions. This calls for new studies to provide current information in line with investments in maternal and newborn health and to provide more information on the quality of the services received.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe study found less than half of the women completed continuum of care during the previous pregnancy which was majorly contributed to low uptake of maternal postnatal care.. The odds of completing the continuum of care increased with the at least secondary level of education and having received high quality antenatal care services and decreased among women who were not involved in decision making about their own health and those who had delayed initiation of antenatal care visits. To effectively increase the uptake of women completing continuum of care, programs targeting female involvement in decision making concerning their own health, early initiation of antenatal care visits and education empowerment among girls should be encouraged in these settings. In addition, more interventions are necessary to strengthen antenatal care which is the entry point for skilled birth attendance and immediate maternal postnatal care after delivery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIC: Akaike Information Criterion; ANC: Antenatal care; AQCESS: Access to Quality Care through Extending and Strengthening Health Systems; CoC: Continuum of care; IMPACT: Improving Access to Reproductive, Maternal and Newborn Health in Mwanza; IQR: Interquartile range; MMR: Maternal mortality ratio; PNC: Postnatal care; SBA: Skilled birth attendance; SDGs: Sustainable Development Goals (SDGs); WHO: World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThe surveys were approved by the Aga Khan University Hospital Institutional Scientific Ethics and Research Committee in both countries. The research permits were obtained from NACOSTI and COSTECH for the projects in Kenya and Tanzania respectively. Further approvals to conduct the study in these regions were obtained from county Ministry of Health in Kenya and regional medical officer in Mwanza. The studies were conducted according to the rules and regulations approved by the research committees and in line with the Helsinki Declaration on Research involving Human Subjects. All participants provide informed consent by signing or using thumb prints on the consent forms before the start of the data collection. Women between the ages 15\u0026ndash;17 years provided assent in addition to their parents or guardian consents.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and analyzed for this study are available on request from Prof. Marleen Temmerman through the email address: [email protected]. and based on an official data transfer and user agreement sent to the director of the Centre of Excellence in Women and Child Health East Africa at the Aga-Khan University. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eWe affirm that we have no conflict of interest.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe endline surveys that collected data used for this study were funded by the Government of Canada and the Aga Khan Foundation Canada (AKFC) as part of AQCESS project which was implemented by the Aga Khan Development Network in partnership with the Government of Kenya. AKFC contributed to the design and data collection of the endline survey. The time to develop the concept, data analysis, and write-up was supported by the Office Of The Director, National Institutes Of Health (OD), the National Institute Of Biomedical Imaging And Bioengineering (NIBIB), the National Institute Of Mental Health (NIMH), and the Fogarty International Center (FIC) of the National Institutes of Health under award number U54TW012089 (Abubakar A and Waljee AK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthor contributions\u003c/h2\u003e\n\u003cp\u003eJO conceptualized the study, acquired, analyzed data for the study and wrote the first draft. SMG, LN, and HK writing review and editing of original draft. MT provided overall project supervision. All authors contributed to the article and approved the submitted version\u0026nbsp;Acknowledgement.\u003c/p\u003e\n\u003ch2\u003eAcknowledgement\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eWe would like to thank all women interviewed, study end line research team in the two countries from the ministry of health and projects teams. We are also grateful to the Government of Canada and AKFC for funding the AQCESS and IMPACT projects and for the Aga Khan Foundation Canada (AKFC) staff for the enormous time spend reviewing the end line study protocol and tools development.\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; ORCID\u003c/h2\u003e\n\u003cp\u003eJames Orwa: 0000-0001-8717-6073\u003c/p\u003e\n\u003cp\u003eSamwel Maina Gatimu: 0000-0002-8331-4536\u003c/p\u003e\n\u003cp\u003eKidanto Hussein: 0000-0001-9167-8068\u003c/p\u003e\n\u003cp\u003eMarleen: 0000-0001-9966-9000\u003c/p\u003e\n\u003cp\u003eLucy Nyaga: 0000-0002-6974-1670\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization: \u003cstrong\u003eTrends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division\u003c/strong\u003e: World Health Organization; 2023.\u003c/li\u003e\n\u003cli\u003e\u003cstrong\u003eNewborn mortality \u003c/strong\u003e[https://www.who.int/news-room/fact-sheets/detail/newborn-mortality]\u003c/li\u003e\n\u003cli\u003eKerber KJ, de Graft-Johnson JE, Bhutta ZA, Okong P, Starrs A, Lawn JE: \u003cstrong\u003eContinuum of care for maternal, newborn, and child health: from slogan to service delivery\u003c/strong\u003e. \u003cem\u003eLancet \u003c/em\u003e2007, \u003cstrong\u003e370\u003c/strong\u003e(9595):1358-1369.\u003c/li\u003e\n\u003cli\u003eMinistry of Health: \u003cstrong\u003eKenya Health Sector Strategic Plan: Transforming Health Systems: Achieving Universal Health Coverage by 2022\u003c/strong\u003e. 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ALV, Duarte LS, Dos Santos CCdS, de Castro Nascimento N: \u003cstrong\u003eAssessment of the quality of antenatal care in Mozambique\u003c/strong\u003e. \u003cem\u003eMidwifery \u003c/em\u003e2023, \u003cstrong\u003e118\u003c/strong\u003e:103598. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"continuum of care, maternal and newborn health, Skilled birth attendants, postnatal care, quality antenatal care","lastPublishedDoi":"10.21203/rs.3.rs-8901007/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8901007/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eDespite 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.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eThe 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.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eA 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\u0026ndash;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\u0026ndash;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.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eThere 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\u0026rsquo; 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.\u003c/p\u003e","manuscriptTitle":"Completion of the maternal continuum of care in Kenya and Tanzania: role of quality antenatal care and other factors in a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-20 10:18:56","doi":"10.21203/rs.3.rs-8901007/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"240873967517068865748564990309172598682","date":"2026-03-30T12:15:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"194923372782538580419347428599565434783","date":"2026-03-24T19:17:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-17T14:06:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-16T11:41:23+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T17:31:52+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-19T15:27:51+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pregnancy and Childbirth","date":"2026-02-19T12:53:13+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pregnancy-and-childbirth","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"prch","sideBox":"Learn more about [BMC Pregnancy and Childbirth](http://bmcpregnancychildbirth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/prch/default.aspx","title":"BMC Pregnancy and Childbirth","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c79e329-4a16-4dc5-95b9-1607ccb5e1ad","owner":[],"postedDate":"March 20th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-20T10:18:56+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-20 10:18:56","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8901007","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8901007","identity":"rs-8901007","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}