Exploring the Multilevel Determinants of Suboptimal Maternal and Child Continuum of Care in Indonesia.

Objective: Understanding the multilevel factors associated with completeness of care across the continuum of maternal and child health is needed in order to reduce maternal and child mortality and morbidity in Indonesia. This study aims to assess the multilevel determinants of continuum of care (CoC) and its contextual factors in Indonesia.

Methods: Data from the 2017 Indonesian Demographic and Health Survey were analyzed. A total of 14,398 women aged 15-49 years who had live births 5 years preceding the survey were analyzed for maternal CoC, while data from 9,206 women and their children (aged < 36 months) were analyzed for maternal CoC and vaccination. Maternal CoC include antenatal care visits, safe facility delivery, and postnatal care. Vaccination includes the 10 recommended dosages of vaccination adjusted for age. Multilevel logistic regression was used to analyse variations in maternal CoC at the individual, household and community levels.

Results: Our findings showed that only half of the women in our study had the complete maternal CoC, and only one-third had both the complete CoC and vaccination for their children. The odds of completing CoC and vaccination are lower among women aged < 20 years, have ≥ 4 children, have low socioeconomic status, and live in rural areas or outside Java-Bali. Pregnancy-related factors were also associated with CoC completeness.

Conclusions for practice: Targeted interventions to improve awareness and increase access that go beyond the individual factors should be developed. In addition to awareness campaigns, interventions aimed at reducing disparities across the different regions in Indonesia should be implemented to improve completeness of maternal CoC and vaccination.