The effects of completion of continuum of care in maternal health services on adverse birth outcomes in Northwestern Ethiopia: a prospective follow-up study

Abstract

Background Globally, around 4 million babies die within the first month of birth annually with more than 3 million stillbirths. Of them, 99% of newborn deaths and 98% of stillbirths occur in developing countries. Despite giving priority to maternal health services, adverse birth outcomes are still major public health problems in the study area. Hence, a continuum of care (CoC) is a core key strategy to overcome those challenges. The study conducted on the effectiveness of continuum of care in maternal health services was scarce in developing countries and not done in the study area. We aimed to assess the effectiveness of continuum of care and determinants of adverse birth outcomes. Methods Community and health facility-linked prospective follow-up study designs were employed from March 2020 to January 2021 in Northwestern Ethiopia. A multistage clustered sampling technique was used to recruit 2198 pregnant women. Data were collected by using a semi-structured and pretested questionnaire. Collected data were coded, entered, cleaned, and analyzed by STATA 14. Multilevel logistic regression model was used to identify community and individual-level factors. Finally, propensity score matching was applied to determine the effectiveness of continuum of care. Results The magnitude of adverse birth outcomes was 12.4% (95% CI 12.2–12.7): stillbirth (2.8%; 95% CI 2.7–3.0), neonatal mortality (3.1%; 95% CI 2.9–3.2), and neonatal morbidity (6.8%; 95% CI 6.6–7.0). Risk factors were poor household wealth (AOR = 3.3; 95% CI 1.07–10.23), pregnant-related maternal complications during pregnancy (AOR = 3.29; 95% CI 1.68–6.46), childbirth (AOR = 6.08; 95% CI 2.36–15.48), after childbirth (AOR = 5.24; 95% CI 2.23–12.33), an offensive odor of amniotic fluid (AOR = 3.04; 95% CI 1.37–6.75) and history of stillbirth (AOR = 4.2; 95% CI 1.78–9.93). Whereas, receiving iron-folic acid (AOR = 0.44; 95% CI 0.14–0.98), initiating breastfeeding within 1 h (AOR = 0.22; 95% CI 0.10–0.50) and immunizing newborn (AOR = 0.33; 95% CI 0.12–0.93) were protective factors. As treatment effect, completion of continuum of care via time dimension (β = − 0.03; 95% CI − 0.05, − 0.01) and space dimension (β = − 0.03; 95% CI − 0.04, − 0.01) were significantly reduce perinatal death. Conclusions Adverse birth outcomes were high as compared with national targets. Completion of continuum of care is an effective intervention for reducing perinatal death. Efforts should be made to strengthen the continuum of care in maternal health services, iron supplementation, immunizing and early initiation of breastfeeding.

The effects of adherence to recommended antenatal services on adverse pregnancy outcomes in Northwest Ethiopia: multilevel and propensity score matching (PSM) modeling

“…As a result, the final sample consisted of 823 pregnant women. However, this study was part of extensive research in which 2,402 pregnant women received follow-up care to determine the effects of a continuum of care in maternal health services on adverse birth outcomes ( 24 ), which was used as the final sample size for this study.…”

Effects of continuity of maternal health services on immediate newborn care practices, Northwestern Ethiopia: multilevel and propensity score matching (PSM) modeling

“…As a result, the maximum sample size calculated for this study was 719 newborns. Even though this study was part of large research work, the sample size was calculated for another objective found to be 2402 pregnant women [ 18 ]. After 11 months of follow-up and excluding abortion cases, the final sample size considered for this study was 2065 babies.…”

The continuum of care for maternal health in Africa: A systematic review and meta-analysis

“…Sub-Saharan Africa alone accounted for approximately 70% of maternal deaths (202,000) [ 5 ]. Maintaining care from pregnancy to childbirth and during the postnatal period significantly reduces the unacceptably high rates of maternal and child mortality and morbidity [ 1 , 4 , 6 – 10 ]. This service offers a substantial opportunity to provide fully integrated care delivery, ensuring routine monitoring and a consistent opportunity for critical intervention throughout pregnancy, the crucial months post-delivery, and the entire postnatal period [ 10 – 13 ].…”