Factors associated with dropouts along the continuum of maternal care among adolescent girls in sub-Saharan Africa: A multilevel analysis of Demographic and Health Surveys from 15 countries.

Background: Adolescent girls in sub-Saharan Africa (SSA) are at higher risk of maternal death as they tend to underuse maternal health services during pregnancy. Aim: This study aimed to identify the factors associated with dropouts along the continuum of maternal care (CoC) among adolescent girls. Setting: The analysis included 15 countries in SSA with high maternal mortality. Methods: We conducted a secondary data analysis using Demographic and Health Surveys data from 15 countries across SSA. All adolescent girls aged 15-19 years who reported a live birth in the 5 years preceding data each collection were included in the study. A multilevel logistic regression models were fitted to the data to identify the factors associated with dropouts. Results: Only 27.3% received all components of the CoC. Dropouts were highest between one and four antenatal care (ANC) visits (42.0%) and between childbirth and 48-h postnatal care (PNC) (37.4%). The odds of dropout between ANC1 and ANC4 visits were higher for adolescents living in rural areas, without formal education, from poor households and with poor ANC content (adjusted odds ratio: 1.68; 95% confidence interval: 1.51-1.86). Regarding 48-h PNC, the distance between home and health facility, the educational attainment and the content of ANC were associated with dropouts. Conclusion: Beside well-known socio-demographic factors, the study shows that poor quality of ANC services was a key driver of dropouts. Contribution: This study, which strengthens the body of evidence on maternal health among adolescent girls in SSA, could help in designing more efficient interventions.