This study employs structural equation modelling to explore the inter-relationships among optimal antenatal care (ANC), health facility delivery and early postnatal care (EPNC) in Ethiopia. By identifying both direct and indirect influencing factors, the study offers valuable insights to support integrated maternal health strategies and guide informed decision-making by policymakers and women alike.

The secondary analysis of the Ethiopian Demographic and Health Survey 2016 was performed to investigate inter-relationships between optimal ANC, health facility delivery and postnatal care (PNC) among women in Ethiopia. Data were analysed with R software V.4.3.2. The study used binary logistic regression to examine differences in optimal ANC, health facility delivery and EPNC, focusing on variables with a p value of 0.1 or less. Selected variables were incorporated into a generalised structural equation model (GSEM) using the LAVAAN package to explore both direct and indirect effects. The GSEM method assessed the impact of exogenous variables on endogenous variables, all binary, using a logistic link and binomial family. Missing data were handled with the multiple imputation by chained equations package, and sampling weights were applied to ensure national and regional representativeness.

The source population comprised all women of reproductive age (15–49 years) who gave birth in the 5 years preceding the survey. From 16 650 interviewed households (98% response rate), we identified 7590 eligible women with recent births. Finally, we included 2415 women who had attended four or more ANC visits.

Media exposure significantly boosts the likelihood of using ANC (OR=1.8, 95% CI (1.04 to 3.23), p=0.04), health facility delivery (OR=1.7, 95% CI (1.23 to 2.45), p=0.05) and PNC (OR=2.0, 95% CI (1.6 to 4.01), p=0.01). Urban residence and secondary education also enhance ANC (OR=1.2, 95% CI (1.01 to 2.88), p=0.022; OR=1.3, 95% CI (1.20 to 3.01), p=0.018), health facility delivery (OR=1.1, 95% CI (1.01 to 3.24), p=0.035; OR=1.5, 95% CI (1.22 to 3.45), p=0.03) and PNC (OR=1.6, 95% CI (1.01 to 4.32), p=0.03). ANC directly affects health facility delivery (OR=1.4, 95% CI (1.28 to 3.09), p=0.01) and PNC (OR=1.6, 95% CI (1.01 to 3.80), p=0.03). Additionally, women aged 20–34 years and those from male-headed households positively impact health facility delivery (OR=1.5, 95% CI (1.20 to 4.80), p=0.01; OR=1.3, 95% CI (1.07 to 3.45), p=0.014) and PNC (OR=1.4, 95% CI (1.10 to 2.90), p=0.01; OR=1.2, 95% CI (1.07 to 3.08), p=0.025).

Optimal ANC is vital for encouraging health facility delivery and EPNC. To enhance maternal and neonatal health, policies should integrate these services. Key predictors include being aged 20–34, having secondary and higher education, media exposure, male-headed households and living in urban areas. Improving education and media exposure can boost maternal healthcare service use.

This study aimed to assess functional disability and associated factors among people with severe mental illness attending public hospitals in Harar town, Eastern Ethiopia.

An institution-based cross-sectional study was conducted in public hospitals found in Harar town, Eastern Ethiopia, from 1 April to 10 May 2023.

A total of 342 patients with severe mental illness attending public hospitals in Harar town, Eastern Ethiopia, were included.

The main outcome of this study was functional disability, which was measured using a 12-item version of the WHO Disability Assessment Schedule.

In this study, the mean (±) score of functional disability among patients with severe mental illness was 31.8 (±9.6) (95% CI: 30.7 to 32.8). The multiple linear regression model revealed that unemployment (β: 1.93; 95% CI: 0.28 to 3.59), total illness duration (5–10 years and above 10 years) (β: 3.71; 95% CI: 1.95 to 5.48 and β: 4.51; 95% CI: 2.41 to 6.62, respectively), age at illness onset (β: –0.37; 95% CI: –0.45 to –0.28), having drug side effects (β: 3.05; 95% CI: 1.46 to 4.63), medication non-adherence (β: 6.15; 95% CI: 4.56 to 7.73) and having high perceived stigma (β: 2.27; 95% CI: 0.72 to 3.82) were significantly associated with functional disability.

Patients with severe mental illness had a high mean functional disability score. Unemployment, age at onset of mental illness, total duration of illness, medication side effects, medication non-adherence and higher perceived stigma were factors that were associated with functional disability. Given the mean functional disability score observed among respondents, a multipronged intervention strategy that prioritises early detection and management of severe mental illness, particularly targeting individuals at risk, is recommended to mitigate disability and enhance quality of life.