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

Abstract

Introduction: The 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.

Methods: In 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.

Results: Throughout 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.

Conclusions: Most 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.

Keywords: child health; community-based survey; cross-sectional survey; health services research; maternal health.

Figure 1

MNCH services received. (A) During ANC. (B) During delivery. (C) During PNC. Paired t-test was conducted for testing the difference in proportions between the reference variable and each of the other variables in each figure. *Significant at 5% level; **significant at 1% level; ***significant at 0.1% level. ANC, antenatal care; CoC, continuum of care; MNCH, maternal, newborn and child health; PNC, postnatal care; Ref., reference variable.

Figure 2

Continuum of care (CoC) acheivement by measurement and area. (A) The percentage of women who achieved visit-based CoC exceeded 20% in one area out of 22 (area no. 15). Six areas did not have women who achieved visit-based CoC (area no. 7, 10, 11, 12, 17 and 21). (B) The percentage of women who achieved services-based CoC was approximately 30% in four areas (area no. 2, 6, 21 and 22). Seven areas had no women who achieved services-based CoC (area no. 7, 8, 10, 11, 17, 19 and 20).