{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T15:34:55Z","timestamp":1791819295433,"version":"4.3.4"},"reference-count":31,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T00:00:00Z","timestamp":1736467200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Somalia is continuing to recover from three decades of underdevelopment, political instability, civil unrest, and protracted humanitarian crises. However, Somalia has one of the lowest maternal health indicators in the world. For instance, the maternal mortality ratio is 621 per 100,000 live births. Extra efforts are needed to improve maternal health. In this study, we aim to investigate the level of completion and coverage along the maternity continuum of care in Somalia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>The study used data from the Somalia Health and Demographic Survey 2020. We restricted our analysis to ever-married women who had a live birth in the five years preceding the survey (n = 2432). Completion of the continuum of maternity care was the outcome variable for this study. It was constructed into a binary variable with complete coded as one and incomplete coded as 0. We categorized it into three models: ANC4+ as the first model, ANC4+ &amp; SBA as the second model, and ANC4+ &amp; SBA &amp; PNC as the third model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>More than half of the women (53.1%) had their most recent births at \u226419 years old. Of all the mothers (n = 2432), only 235 (9.7%) had at least four or more of the recommended antenatal care (ANC4+), and 68 (2.8%) of them utilized skilled birth attendants. Only 14 (0.6%) women received all three maternal healthcare services (ANC4+, SBA, and PNC within 48 hours). About 78.1% of the mothers did not attend any of the three CoC services.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Maternal health care utilization decreases as they progress from ANC4+ to PNC utilization. The government and partners should design and implement strategies to improve maternal healthcare utilization specific to rural and nomads, less educated, not working, low income, and have less power in decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pgph.0004102","type":"journal-article","created":{"date-parts":[[2025,1,10]],"date-time":"2025-01-10T14:45:45Z","timestamp":1736520345000},"page":"e0004102","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":21,"title":["Level of completion of maternity continuum of care among ever-married women: An analysis of Somalia\u2019s health and demographic survey 2020"],"prefix":"10.1371","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5740-7608","authenticated-orcid":true,"given":"Adam A.","family":"Mohamed","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2379-3325","authenticated-orcid":true,"given":"Ays\u201ae","family":"Ak\u0131n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sare","family":"Mihciokur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarp","family":"\u00dcner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3616-6411","authenticated-orcid":true,"given":"Abdi","family":"Gele","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,1,10]]},"reference":[{"issue":"2","key":"pgph.0004102.ref001","doi-asserted-by":"crossref","first-page":"e004233","DOI":"10.1136\/bmjgh-2020-004233","article-title":"Disparities in pregnancy-related deaths: spatial and Bayesian network analyses of maternal mortality ratio in 54 African countries","volume":"6","author":"S Yaya","year":"2021","journal-title":"BMJ Glob Health"},{"issue":"20","key":"pgph.0004102.ref002","doi-asserted-by":"crossref","first-page":"13146","DOI":"10.3390\/ijerph192013146","article-title":"Maternal mortality in Africa: regional trends (2000\u20132017)","volume":"19","author":"L Onambele","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pgph.0004102.ref003","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1186\/s12884-021-04280-9","article-title":"Early age at first childbirth and skilled birth attendance during delivery among young women in sub-Saharan Africa","volume":"21","author":"E Budu","year":"2021","journal-title":"BMC Preg Childbirth"},{"key":"pgph.0004102.ref004","doi-asserted-by":"crossref","first-page":"102653","DOI":"10.1016\/j.eclinm.2024.102653","article-title":"Global maternal mortality projections by urban\/rural location and education level: a simulation-based analysis","volume":"72","author":"ZJ Ward","year":"2024","journal-title":"EClinicalMedicine"},{"key":"pgph.0004102.ref005","volume-title":"Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA\/Population Division: executive summary","author":"WHO","year":"2023"},{"key":"pgph.0004102.ref006","volume-title":"Health systems strengthening in fragile contexts: a partnership model in South West State, Somalia. 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A retrospective study of 30 cases using a Verbal Autopsy approach","volume":"12","author":"JA Aden","year":"2019","journal-title":"Glob Health Action"},{"issue":"1","key":"pgph.0004102.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12889-022-14960-6","article-title":"Population health trends and disease profile in Somalia 1990\u20132019, and projection to 2030: Will the country achieve sustainable development goals 2 and 3?","volume":"23","author":"J Morrison","year":"2023","journal-title":"BMC Public Health"},{"issue":"2","key":"pgph.0004102.ref010","doi-asserted-by":"crossref","DOI":"10.1177\/21582440241257319","article-title":"Voluntary national reviews on implementation of sustainable development goals: key lessons from East African Member States","volume":"14","author":"SN Chisika","year":"2024","journal-title":"Sage Open"},{"issue":"1","key":"pgph.0004102.ref011","doi-asserted-by":"crossref","first-page":"409","DOI":"10.1186\/s12913-018-3212-9","article-title":"Why do rural women in the most remote and poorest areas of Zambia predominantly attend only one antenatal care visit with a skilled provider? 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