Exploring factors associated with maternal health care utilization in Chad

Abstract

Background: Maternal mortality is still one of the top health priorities in many lowand middle-income countries (LMICs). 99% of maternal deaths occur in LMICs, and Chad is one of the countries with the highest burden. Maternal health services, including antenatal, delivery and postnatal care, are proven to be effective for lowering the level of maternal morbidity and mortality, but their usage levels are often suboptimal in LMICs. In this regard, this study aims to explore factors associated with the utilization of maternal health care (MHC) services among Chadian women. Methods: A composite measure of MHC utilization, encompassing antenatal, delivery, and postnatal stages, has been adaptively constructed to better reflect the level of access to MHC in Chad. This outcome variable has 4-level categories (lowest, mid-low, mid-high, and highest), which incorporates the levels of utilization of prenatal, delivery and postnatal care. Using the data drawn from 2014–2015 Chad Demographic and Health Survey, a multivariate ordered logistic regression was fitted to identify factors affecting the utilization of MHC in Chad. Results: Only a very marginalized portion (7%) of women reported utilizing all the 3 MHC services. Factors found to have significant associations with MHC utilization were mothers' education, husbands/partners' education and occupation, marriage type, access to media, current use of contraceptives, household wealth level, regions, and place of residence. Conclusion: Our study suggests that it is imperative to promote overall levels of MHC service utilization in Chad to address the country's very high maternal burden. Efforts for promoting community-level maternal health activities that involve both women and men might help. In a longer-term, future maternal health programs would need to involve more proactively women from lower socioeconomic status and less developed areas tackling withincountry health inequalities, while the government strives to improve the country's overall socioeconomic status and health infrastructure.