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Peer-reviewedCC BY 4.0PLOS One

Determinants of the continuum of maternal healthcare service utilization in Nigeria: Evidence from the 2024 Nigeria Demographic and Health Survey

  • Gideon Ikemdinachi Nwankwo1
  • Rejoice Uche Obiora2
  • Delight Mawufemor Agbi3
  • Bisola Olubiyi4
  • Daniel Mumba5
  • Herbert Tafadzwa Kazonda6
  • Isaac Isiko7
  • Edson Mwebesa8
  • Charles Natuhamya9
9 affiliations
  1. 1Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
  2. 2College of Health, Lehigh University, Bethlehem, Pennsylvania, United States of America
  3. 3Department of Mathematics, Physics and Computing, School of Science and Aerospace Studies, Moi University, Eldoret, Kenya
  4. 4Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
  5. 5University of Global Health Equity, Kigali, Rwanda
  6. 6Malawi Liverpool Wellcome Programme, Infection and Immunity Research Group, Blantyre, Malawi
  7. 7Department of Economics and Finance, Great Zimbabwe University, Masvingo, Zimbabwe
  8. 8Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, Canada
  9. 9Department of Mathematics, Faculty of Science, Muni University, Arua, Uganda
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Abstract

Background: Maternal mortality remains a major public health challenge, particularly in low- and middle-income countries, with Sub-Saharan Africa bearing a disproportionate burden. Nigeria accounts for over one-quarter of all maternal deaths worldwide. This reflects gaps in access to and continuity of maternal healthcare. The continuum of maternal healthcare, which includes antenatal care (ANC), skilled delivery, and postnatal care (PNC) is critical for improving maternal and neonatal outcomes. This study examines the determinants of continuum of maternal healthcare service utilization in Nigeria. Methods: This study utilized data from 13,596 women (weighted n = 14,183) from the 2024 Nigeria Demographic and Health Survey. Maternal Health Services Utilization (MHSU) was operationalized as a composite outcome (none, partial, adequate) based on ANC attendance, place of delivery, maternal and child PNC. Multilevel multinomial logistic regression models were fitted to assess individual, household, and contextual predictors. Variables significant at p < 0.20 in bivariate analysis were included in multivariable models. Statistical significance was set at p < 0.05. Results: Overall, 44.0% of women did not utilize any services, 44.4% partially utilized services, and only 11.6% achieved adequate utilization. Women with secondary or higher education were significantly more likely to achieve adequate utilization (Relative Risk Ratio (RRR) = 12.10, 95% CI: 8.72, 16.81). Wealth status, media exposure, employment, and health insurance were positively associated with utilization, while higher parity and decision-making barriers reduced utilization. Rural residence was associated with lower utilization (RRR = 0.38, 95% CI: 0.29, 0.49). Distance to health facilities was not significant in the adjusted model. Conclusion: Maternal healthcare service utilization in Nigeria remains suboptimal, with significant inequities driven by socioeconomic status, education, and women’s autonomy. Strengthening the continuum of care requires multisectoral interventions addressing structural and social determinants of health.

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Cite

BibTeXRIS
BibTeX
@article{nwankwo2026determinants,
  title = {{Determinants of the continuum of maternal healthcare service utilization in Nigeria: Evidence from the 2024 Nigeria Demographic and Health Survey}},
  author = {Gideon Ikemdinachi Nwankwo and Rejoice Uche Obiora and Delight Mawufemor Agbi and Bisola Olubiyi and Daniel Mumba and Herbert Tafadzwa Kazonda and Isaac Isiko and Edson Mwebesa and Charles Natuhamya},
  journal = {PLOS One},
  year = {2026},
  month = oct,
  doi = {10.1371/journal.pone.0359946},
  url = {https://doi.org/10.1371/journal.pone.0359946},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Determinants of the continuum of maternal healthcare service utilization in Nigeria: Evidence from the 2024 Nigeria Demographic and Health Survey
AU  - Gideon Ikemdinachi Nwankwo
AU  - Rejoice Uche Obiora
AU  - Delight Mawufemor Agbi
AU  - Bisola Olubiyi
AU  - Daniel Mumba
AU  - Herbert Tafadzwa Kazonda
AU  - Isaac Isiko
AU  - Edson Mwebesa
AU  - Charles Natuhamya
PY  - 2026
DA  - 2026/10/05
JO  - PLOS One
DO  - 10.1371/journal.pone.0359946
UR  - https://doi.org/10.1371/journal.pone.0359946
AB  - Background: Maternal mortality remains a major public health challenge, particularly in low- and middle-income countries, with Sub-Saharan Africa bearing a disproportionate burden. Nigeria accounts for over one-quarter of all maternal deaths worldwide. This reflects gaps in access to and continuity of maternal healthcare. The continuum of maternal healthcare, which includes antenatal care (ANC), skilled delivery, and postnatal care (PNC) is critical for improving maternal and neonatal outcomes. This study examines the determinants of continuum of maternal healthcare service utilization in Nigeria. Methods: This study utilized data from 13,596 women (weighted n = 14,183) from the 2024 Nigeria Demographic and Health Survey. Maternal Health Services Utilization (MHSU) was operationalized as a composite outcome (none, partial, adequate) based on ANC attendance, place of delivery, maternal and child PNC. Multilevel multinomial logistic regression models were fitted to assess individual, household, and contextual predictors. Variables significant at p < 0.20 in bivariate analysis were included in multivariable models. Statistical significance was set at p < 0.05. Results: Overall, 44.0% of women did not utilize any services, 44.4% partially utilized services, and only 11.6% achieved adequate utilization. Women with secondary or higher education were significantly more likely to achieve adequate utilization (Relative Risk Ratio (RRR) = 12.10, 95% CI: 8.72, 16.81). Wealth status, media exposure, employment, and health insurance were positively associated with utilization, while higher parity and decision-making barriers reduced utilization. Rural residence was associated with lower utilization (RRR = 0.38, 95% CI: 0.29, 0.49). Distance to health facilities was not significant in the adjusted model. Conclusion: Maternal healthcare service utilization in Nigeria remains suboptimal, with significant inequities driven by socioeconomic status, education, and women’s autonomy. Strengthening the continuum of care requires multisectoral interventions addressing structural and social determinants of health.
SN  - 1932-6203
ER  -