Key questions What is already known?
Key questions What is already known? Women and children do not necessarily receive all recommended care along the continuum of care from pregnancy to post-delivery. What are the new findings? Geographical disparity existed in the coverage of the continuum of care in Ghana. What do the new findings imply? Health administrators should ensure that women and children receive all the key components of services on their visit to health facilities.
Continuum of care should be measured at the individual level and compared subnationally to reduce inequality in provision of care across subnational areas. Introduction Saving lives from maternal and neonatal complications remains a major health challenge in low-income and middle-income countries. In these countries, the maternal mortality ratio was 20 times higher and the neonatal mortality rate was 7 times higher than those in high-income countries in CoC can be an effective policy framework to improve the coverage of MNCH services for women and children.
CoC at the time dimension refers to a situation where a woman and her child receive MNCH services from prepregnancy to childhood. In contrast, CoC at the time dimension is a policy goal that every woman and child should achieve. Thus, it can be an indicator that measures the coverage of MNCH services. CoC at the time dimension addresses the importance of linkages among the packages of MNCH service delivery at different reproductive stages.
Women and children can potentially receive timely and necessary MNCH care through these packages and reduce risks of maternal and infant mortality and morbidity. Thus, CoC could be more affected by services provided by a health facility when it is measured as receiving key components of services, rather than simply counting the number of visits. Such health facility factors may explain part of availability of MNCH services and efficiency in managing health workers and services at health facilities.
For example, the coverage of delivery attended by SBA ranged from The objectives of this study were threefold. CoC measured by counting visits and CoC measured by key components of services that were received.
Second, this study compared the factors affecting CoC based on the two different CoC measurements. Finally, this study examined to what extent CoC achievement was different across areas, using the two measurements described above. Methods Study design and area Under a cross-sectional design, this study measured MNCH service-seeking behaviours of women and their children at the pregnancy, delivery and post-delivery stages in Ghana. It also measured their background characteristics and complications using face-to-face interviews with women in health demographic surveillance sites under three Health Research Centres HRC in Ghana, namely Dodowa, 39 Kintampo 40 and Navrongo.
Participants and selection criteria The targeted women in this study were aged between 15 and 49 years who experienced their latest pregnancy as a live birth or stillbirth between January and April Inclusion criteria were women who lived in study site on the date of the data collection. If the women delivered twice or more during the above period, the latest pregnancy data were used.
A total of women were selected based on the two-stage random sampling method. The primary sampling unit involved communities under a zone or subdistrict area , depending on HRC. The study site has 22 areas in three HRCs. Women were randomly selected under probability proportional to the sample size. The first measurement is the proportion of women and children who received MNCH services at the pregnancy, delivery and post-delivery stages.
Under this measurement, a pair woman and child achieved the CoC when the woman received ANC four times or more, delivered at a health facility and received both maternal and child PNC within 48 hours and around 2 and 6 weeks post-delivery. According to our observations in the study site, women and children visited health facilities and received such MNCH services while few received them at the community level.
The components of MNCH services were measured in this study as follows. As services received during ANC, three components of the services were measured: For delivery, two components of the services were measured: For PNC, three components of the services were measured: These components of services were selected based on the guidelines and policy documents for ANC, delivery care and PNC, 3 45—47 related literature 48—54 and comments from health administrators at the study site.
This study collected the socioeconomic characteristics of women and their households that were likely to affect their MNCH service-seeking behaviour based on previous research.
Socioeconomic status was also estimated using factor analysis based on the following variables: Factors during the latest pregnancy of women were also measured. These factors included intended pregnancy, birth preparedness, health insurance, support from household members and complications and danger signs. Data collection This study collected data using a structured questionnaire that was written in English.
Interviewers who could speak at least one local language in a survey area were hired and received training in July on the objectives, design and ethical consideration of this study, as well as the contents of the questionnaire.
Pretesting was undertaken in each HRC in July , and the contents of the questionnaire were confirmed. Face-to-face interviews with women were undertaken from July to September in local languages that women could listen to and speak.
The data items used to construct the socioeconomic status were extracted from the health demographic surveillance database at each HRC. Then, descriptive analysis was performed to present the background characteristics of women and children in the sample and the coverage of CoC.
A multilevel logistic regression with a random intercept at the area level was performed to identify the factors associated with the achievement of CoC and the variance of the achievement across areas. Variance inflation factor was used to check the multicollinearity, although no variable exceeded 4 as a threshold.
To evaluate to what extent differences in the level of CoC were caused by specific factors at the area level, this study used different sets of explanatory variables in the regression model. In addition to the full model socioeconomic characteristics and factors relating to the latest pregnancy as explanatory variables , the null model excluding all explanatory variables and the model excluding factors relating to the latest pregnancy were tested. Then, intraclass correlation coefficient ICC was used to compare the proportion of variance caused by the random intercept at the area level among different models.
Ethical consideration All respondents voluntarily participated and were given details of the study before the survey. Written informed consent was obtained, and confidentiality was assured for all participants.
Results Characteristics of women and their households Table 1 shows the socioeconomic characteristics of women and their households. Of participants recruited, 99 women were excluded as their background information was partly missing or they were found not to meet the inclusion criteria. A sample of women was used in this study.
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The costs and benefits of delivering a set of integrated reproductive, maternal, newborn, and child health RMNCH interventions across the continuum of care in countries with high child and maternal mortality in order to 1 demonstrate that high returns can come from strengthening investments in the delivery of high-impact interventions; and 2 underscore the importance of an accurate assessment of those returns, including the full range of costs involved in delivering integrated care across the continuum and the full range of benefits that flow from the interventions. The development of models focused more strongly on the morbidity elements of maternal and child health, and the evolution of that morbidity over time, remains an important topic for future research.