Published in PLOS One on 2026-08-18, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Serbesa Dereje Degaga, Solomon Shiferaw, Girma Taye Aweke
Source: PLOS One • DOI 10.1371/journal.pone.0356392
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The maternal continuum of care (CoC) is a key strategy for reducing maternal and neonatal morbidity and mortality. In this study, CoC completion was defined as receiving at least four antenatal care visits, skilled birth attendance and postnatal care within 48 hours after chilbirth. Despite continued national efforts to improve maternal health service utilization, CoC completion remains low in Ethiopia, particularly in rural areas. This study assessed the level of CoC completion and its associated factors among rural women in East Shoa Zone, Eastern Ethiopia.
A community-based cross-sectional study linked to health facility data was conducted from November 5 to December 5, 2024. Using multistage sampling, 1,038 women who had given birth within the 12 months preceding the interview date were selected. Household data were collected through face-to-face interviews and facility readiness was assessed by direct observation using a SARA-adapted checklist. Multilevel logistic regression was used to identify factors associated with CoC completion. Results were reported as adjusted odds ratios with 95% confidence intervals.
Among 1,038 women invited to participate, 997 completed the interview, yielding a 96.1% response rate. Overall, 23.2% (95% CI: 20.6, 25.9) of women completed the maternal continuum of care. CoC completion was associated with secondary or higher education (AOR = 3.27; 95% CI: 1.37,7.79), early ANC initiation (AOR = 5.16; 95% CI: 3.01,8.83), knowledge of pregnancy danger signs (AOR = 3.89; 95% CI: 1.81,8.37), high facility readiness (AOR = 5.19; 95% CI: 1.48,18.16), travel time of less than one hour (AOR = 1.87; 95% CI: 1.01,3.17), and higher household wealth (AOR = 2.57; 95% CI: 1.41,4.67).
Completion of the maternal continuum of care among rural women in East Shoa Zone was low with substantial dropout across successive stages. Both individual and health-system-level factors influenced CoC completion. Context-specific multilevel interventions should combine demand-side strategies that improve women’s awareness, preparedness, decision-making capacity and early initiation of maternal health care with supply-side measures that strengthen health facility readiness.
Introduction
Globally, maternal mortality remains a major public health concern. Although motherhood is generally a source of joy for families particularly for women, each pregnancy in low-income countries presents significant risks to both women and newborns [1]. Approximately one woman dies every two minutes from pregnancy and childbirth related causes. The burden remains disproportionately concentrated in low and middle-income countries where about 92% of maternal deaths occurred. Sub-Saharan Africa alone accounted for approximately 70% of global maternal deaths. Ethiopia also continues to experience a substantial maternal mortality burden with an estimated maternal mortality ratio of 195 deaths per 100,000 live births in 2023. Although this reflects progress over time, the level remains markedly above the Sustainable Development Goal target of fewer than 70 maternal deaths per 100,000 live births by 2030 [2]. Global strategies recommend continuum of maternal health care as one of the key strategies for reducing maternal and newborn morbidity and mortality in LMICs [3]. Eighty percent (80%) of maternal deaths worldwide could be prevented with the provision of timely and quality healthcare during pregnancy, childbirth, and the postnatal period [4]. Achieving approximately 99% coverage of the complete maternal healthcare continuum also could avert an estimated 41%–72% of neonatal deaths. [5].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider research & evidence desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Serbesa Dereje Degaga, Solomon Shiferaw, Girma Taye Aweke. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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