{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T04:03:56Z","timestamp":1784174636568,"version":"3.55.0"},"reference-count":59,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T00:00:00Z","timestamp":1784073600000},"content-version":"unspecified","delay-in-days":14,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,6,12]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study aimed to assess the pooled proportion of dropout from the maternal continuum of care (CoC) and its associated factors in low-income and middle-income countries (LMICs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study design<\/jats:title>\n                    <jats:p>Cross-sectional study using nationally representative demographic and health survey (DHS) data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>41 LMICs with DHS data available after the establishment of the Sustainable Development Goals from 2016 to 2024 were included. A total of 217 083 (weighted 213 474) women were included. Using Stata V.17.0, a multilevel binary logistic regression analysis was performed to examine the factors associated with dropout from the CoC. The adjusted ORs (AORs) with 95% CIs were calculated, and p&lt;0.05 was statistically significant in the final model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Women of reproductive age (15 to 49 years) who had at least one live birth within 2 years preceding the survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome<\/jats:title>\n                    <jats:p>Dropout from the CoC was the primary outcome of this study, defined as initiating antenatal care but failing to receive skilled birth attendance and\/or postnatal care.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The pooled proportion of CoC dropout was 50% (95% CI 45 to 56%), with significant heterogeneity, which ranges from 19% in Albania to 85% in Ethiopia. Factors associated with higher odds of dropout were multiparity (AOR=1.30, 95% CI 1.26 to 1.34), grand multiparity (AOR=1.70, 95% CI 1.62 to 1.78), delayed first ANC (AOR=2.87, 95% CI 2.79 to 2.95), regions compared with the North Africa\/West Asia\/Europe region; SSA (AOR=2.65, 95% CI 2.34 to 3.00), Central Asia (AOR=1.78, 95% CI 1.40 to 2.26), South and Southeast Asia (AOR=2.43, 95% CI 2.14 to 2.75), Oceania (AOR=2.41, 95% CI 1.98 to 2.94), Latin America and the Caribbean (AOR=8.47, 95% CI 6.81 to 10.54), distance from health facility (AOR=1.15, 95% CI 1.12 to 1.18), getting permission (AOR=1.27, 95% CI 1.23 to 1.32), pregnancy intention (AOR=0.76, 95% CI 0.73 to 0.78) and rural residence (AOR=1.57, 95% CI 1.51 to 1.64), primary education (AOR=0.83, 95% CI 0.80 to 0.86), secondary education (AOR=0.60, 95% CI 0.58 to 0.62), higher education (AOR=0.43, 95% CI 0.41 to 0.46), middle wealth index (AOR=0.80, 95% CI 0.77 to 0.83), rich wealth index (AOR=0.65, 95% CI 0.63 to 0.68), media exposure (AOR=0.70, 95% CI 0.69 to 0.72), women aged between 20 and 34 (AOR=0.76, 95% CI 0.72 to 0.79) and age \u226535 years (AOR=0.60, 95% CI 0.56 to 0.63) were associated with lower odds of dropout.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study found a 50% dropout from CoC in LMICs with considerable heterogeneity. Factors identified as contributing to reducing dropout rates include improving women\u2019s education, increasing media exposure, enhancing women\u2019s decision-making power, ensuring better access to healthcare facilities, particularly in remote areas, and reducing adolescent pregnancies. To achieve Sustainable Development Goal 3 for maternal and child health by 2030, a coordinated, multi-level strategy is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-111915","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T03:20:13Z","timestamp":1784172013000},"page":"e111915","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pooled prevalence of maternal continuum of care dropout and associated factors among mothers in 41 low-income and middle-income countries: a multi-country cross-sectional study after the Sustainable Development Goals"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7239-5104","authenticated-orcid":false,"given":"Mequanent Dessie","family":"Bitewa","sequence":"first","affiliation":[{"name":"Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7575-7452","authenticated-orcid":false,"given":"Milkiyas Solomon","family":"Getachew","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-6090","authenticated-orcid":false,"given":"Tadele Derbew","family":"Kassie","sequence":"additional","affiliation":[{"name":"Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7553-1429","authenticated-orcid":false,"given":"Mihret","family":"Getnet","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara, Ethiopia"},{"name":"School of Medicine, Department of Human Physiology, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-9891","authenticated-orcid":false,"given":"Ayenew Molla","family":"Lakew","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Amhara, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,15]]},"reference":[{"key":"2026071520200805000_16.7.e111915.1","doi-asserted-by":"crossref","first-page":"1358","DOI":"10.1016\/S0140-6736(07)61578-5","article-title":"Continuum of care for maternal, newborn, and child health: from slogan to service delivery","volume":"370","author":"Kerber","year":"2007","journal-title":"The Lancet"},{"key":"2026071520200805000_16.7.e111915.2","doi-asserted-by":"crossref","unstructured":"Wang W , Hong R . 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