Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa

Abstract

Objective We assess how countries in regions of the world where maternal mortality is highest - South Asia and Sub-Saharan Africa - are performing with regards to providing women with vital elements of the continuum of care. Methods Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care - at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 hours since birth. Family planning counseling within a year of birth was also included in the descriptive analyses. Results Results indicated that a major drop-out (more than 50%) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (less than 5%) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements. Conclusion Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.

Level of completion along continuum of care for maternal and child health services and factors associated with it among women in Arba Minch Zuria Woreda, Gamo Zone, Southern Ethiopia: a community based cross-sectional study

“…Autonomy in household decisions to seek health care, even if it did not show association with completion of CoC in this study, a number of studies found that it increases the probability of completion along continuum of care for MNH services. For instance, a 20% increase in Pakistan and 45% increase in south Asia and Sub-Saharan African countries was documented in previous studies [22,30]. The other implication to this finding is that working women might have more access to gain money and plan for health care unlike housewives who solely engage in household duties.…”

Dropout from maternity continuum of care and associated factors among women in Debre Markos town, Northwest Ethiopia

“…According to the World Health Organization (WHO), 2015 estimation approximately 303,000 maternal deaths occurred globally, most of the deaths occur during labor, delivery and the immediate postpartum period [2].For subsequent reduction of this problem the new globally adopted agenda between 2016 and 2030 as a part of sustainable development goal aimed to reduce maternal mortality ratio to 70 per 100,000 by addressing all maternal health care services for every woman as a top priority [4]. But women in most countries dropout before completing the full component of maternity continuum of care [3].In many countries, there is a significant dropout among women who had ANC visitbefore getting other subsequent maternal health care services [5,6]. This dropout or failure to access skilled birth attendants and postnatal care results for compromised health and wellbeing of both the mother and newborn [7].…”

Implementation challenges and outcomes of a randomized controlled pilot study of a group prenatal care model in Malawi and Tanzania

“…4–12 Although many women attend at least one PNC visit, less than half complete the four recommended PNC visits or the 6-week postnatal visit. 13 …”