<![CDATA[Utilization of the Maternal and Child Health (MCH) Handbook plays a crucial role in monitoring the health and development of children under five years of age; however, its uptake remains suboptimal. According to the 2023 Indonesian Health Survey (SKI), MCH Handbook utilization for under-five growth monitoring in North Sumatra Province was only 67.9%, below the national average of 74.4%. This study aimed to analyze the influence of sociodemographic factors and healthcare accessibility on MCH Handbook utilization for under-five child monitoring in North Sumatra Province. A cross-sectional design was employed using secondary data from the 2023 SKI. The study sample comprised 4,164 under-five children who owned or had previously owned an MCH Handbook in North Sumatra. Data were analyzed through univariate frequency distribution, bivariate chi-square testing, and multivariate multiple logistic regression using the backward stepwise (likelihood ratio) method. The multivariate analysis demonstrated that health insurance ownership (AOR = 1.389; 95% CI = 1.215–1.587), maternal education (AOR = 1.326; 95% CI = 1.107–1.588), maternal age (AOR = 1.163; 95% CI = 1.009–1.339), and maternal employment (AOR = 1.161; 95% CI = 1.007–1.338) were significant positive predictors of MCH Handbook utilization, while longer travel time to health facilities (AOR = 0.690; 95% CI = 0.503–0.946) was inversely associated. Area classification was not statistically significant. These findings underscore the need for sustained health education targeting mothers, maintenance of universal health insurance coverage, and strengthening of community-based health services particularly posyandu to optimize MCH Handbook utilization in North Sumatra.]]>
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