The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman-child pairs in Ghana

Abstract

IntroductionThe continuum of care has recently received attention in maternal, newborn and child health. It can be an effective policy framework to ensure that every woman and child receives timely and appropriate services throughout the continuum. However, a commonly used measurement does not evaluate if a pair of woman and child complies with the continuum of care. This study assessed the continuum of care based on two measurements: continuous visits to health facilities (measurement 1) and receiving key components of services (measurement 2). It also explored individual-level and area-level factors associated with the continuum of care achievement and then investigated how the continuum of care differed across areas.MethodsIn this cross-sectional study in Ghana in 2013, the continuum of care achievement and other characteristics of 1401 pairs of randomly selected women and children were collected. Multilevel logistic regression was used to estimate the factors associated with the continuum of care and its divergence across 22 areas.ResultsThroughout the pregnancy, delivery and post-delivery stages, 7.9% of women and children achieved the continuum of care through continuous visits to health facilities (measurement 1). Meanwhile, 10.3% achieved the continuum of care by receiving all key components of maternal, newborn and child health services (measurement 2). Only 1.8% of them achieved it under both measurements. Women and children from wealthier households were more likely to achieve the continuum of care under both measurements. Women’s education and complications were associated with higher continuum of care services-based achievement. Variance of a random intercept was larger in the continuum of care services-based model than the visit-based model.ConclusionsMost women and children failed to achieve the continuum of care in maternal, newborn and child health. Those who consistently visited health facilities did not necessarily receive key components of services.

Trends and correlates of maternal, newborn and child health services utilization in primary healthcare facilities: an explorative ecological study using DHIMSII data from one district in the Volta region of Ghana

“…Global efforts towards attainment of universal health coverage has been largely progressive, albeit the pace in low-and middle-income countries (LMICs) is comparatively slow [3]. Studies on continuum of care (CoC) for MNCH services abound in Ghana [7][8][9][10][11][12] but there are no known ecological studies on the topic area using the DHIMSII data set from a predominantly rural district in the Volta Region of Ghana. The existing gap in the literature thus makes this study relevant and timely.…”

Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: evidence from two cross-sectional household surveys in Shaanxi Province

“…However, this study found that the utilisation rates of CMHS have increased after China's 2009 healthcare reform but still remains low. Studies in other LMICs have shown that the rate of CMHS utilisation is low because of shortages in 5.0% of maternal women completed at least four antenatal visits, hospital delivery and at least once postnatal visits continuously in Ratanakiri, Cambodia [12]; 41% of maternal women completed at least one antenatal visit, hospital delivery and at least one postnatal visit continuously in Nepal [23]; 7.9% of women completed the continuum of care through continuous visits to health facilities in Ghana [43]. The post-reform survey data in this study showed only 20.56% of urban women and 19.26% of rural women made CMHS.…”

Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility-based survey

“…Most maternal deaths could be averted if women accessed maternal health care equitably [6] In the provision of maternal health services, the notion of "continuum of care (CoC)" has been recommended as a fundamental approach [7,8] to ensure women receive essential services. There is a growing need to assess coverage of maternal services based on the frequency and the package of services accessed [9,10]. This is intended to demonstrate the range of services provided as women attend maternal health clinics.…”

“…This is intended to demonstrate the range of services provided as women attend maternal health clinics. Maternal health care assessment includes the number of antenatal care (ANC) visits, facility-based deliveries (FD), skilled birth attendance and postnatal care (PNC) visits [9]. To ensure CoC, when measuring the coverage of maternal services, the estimates should be based on the entire package of services received continuously from the pregnancy to post-delivery stages and not separate individual interventions [11].…”