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

2018 ◽  
Vol 3 (4) ◽  
pp. e000786 ◽  
Author(s):  
Akira Shibanuma ◽  
Francis Yeji ◽  
Sumiyo Okawa ◽  
Emmanuel Mahama ◽  
Kimiyo Kikuchi ◽  
...  
Keyword(s):  
Child Health ◽  
Continuum Of Care ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Cross Sectional ◽  
Newborn And Child Health ◽  
Care Services ◽  
Women And Children ◽  
And Child Health ◽  
The Continuum

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.

scholarly journals The Maternal and Child Health Handbook for Improving the Continuum of Care and Other Maternal and Child Health Indicators in Angola: An Implementation Study Protocol

2021 ◽  
Vol 2 ◽  
Author(s):  
Ai Aoki ◽  
Keiji Mochida ◽  
Michiru Kuramata ◽  
Toru Sadamori ◽  
Helga Reis Freitas ◽  
...  
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Intervention Group ◽  
Health Indicators ◽  
Continuum Of Care ◽  
Health Facilities ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Implementation Status ◽  
And Child Health

Background: Reducing maternal, neonatal, and infant mortality tops the health targets of sustainable development goals. Many lifesaving interventions are being introduced in antenatal, delivery, and postnatal care. However, many low- and middle-income countries (LMICs) have not reached maternal and child health targets. The Maternal and Child Health Handbook (MCH-HB) is recommended as a home-based record to promote a continuum of care from pregnancy to early childhood, and is gaining increasing attention among LMICs. Several countries have adopted it as national health policy. To effectively utilize the MCH-HB in LMICs, implementation needs to be considered. Angola is an LIMC in Sub-Saharan Africa, where maternal and child health indicators are among the poorest. The Angolan Ministry of Health adopted the MCH-HB program in its national health policy and is currently conducting a cluster randomized controlled trial (MCH-HB RCT) to evaluate its impact on the continuum of care. This study aimed to evaluate implementation status, and barriers and facilitators of MCH-HB program implementation in Angola.Methods: To evaluate implementation status comprehensively, the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework will be used. Four components other than effectiveness will be investigated. A cross-sectional survey will be conducted targeting all health facilities and officers in charge of the MCH-HB at the municipality health office in the intervention group after the MCH-HB RCT. Data from the cross-sectional survey, secondary MCH-HB RCT data, and operational MCH-HB RCT records will be analyzed. Health facilities will be classified into good-implementation and poor-implementation groups using RE-AIM indicators. To identify barriers to and facilitators of MCH-HB implementation, semi-structured interviews/focus group discussions will be conducted among health workers at a sub-sample of health facilities and all municipality health officers in charge of MCH-HB in the intervention group. The Consolidated Framework for Implementation Research will be adopted to develop interview items. Thematic analysis will be performed. By comparing good-implementation and poor-implementation health facilities, factors that differ between groups that contribute to successful implementation can be identified.Discussion: This study's findings are expected to inform MCH-HB implementation policy and guidelines in Angola and in other countries that plan to adopt the MCH-HB program.

scholarly journals The Effect of A Demand Side Financing Program on the Continuum of Maternal and Child Health Care in India

2020 ◽  
Author(s):  
Saseendran Pallikadavath ◽  
William Stones ◽  
Sumit Mazumdar ◽  
Ngianga Kandala ◽  
Rahman Mohammad Mahbubur
Keyword(s):  
Child Health ◽  
Maternal And Child Health ◽  
Institutional Delivery ◽  
Continuum Of Care ◽  
Average Treatment Effect ◽  
Demand Side ◽  
Care Services ◽  
Demand Side Financing ◽  
And Child Health ◽  
The Continuum

Abstract Background The Indian Government launched a demand-side financing program, ‘Janani Suraksha Yojana’ (JSY) in 2005 with the aim of reducing maternal and neonatal mortality through increased access to institutional delivery care service. This paper analyses the effects of the JSY on the uptake of maternal and child health (MNCH) care services intending to understand the overall impact of the program on the continuum of care. Methods Using the 2013-14 round of the District-level Household Survey (DLHS) surveyed in high performing states, the average treatment effect on the treated (ATT) was estimated by using the Propensity Score Matching (PSM). Results are reported regarding both ATTs and deviations from the theoretical continuum of care line, which represents 100% uptake, i.e., all women availing all the MNCH services. Results Overall, JSY effects on MNCH components ranged between 0.7% and 12%. As expected, the highest impact of the JSY was on institutional delivery (ATT: 0.12; 95% CI: 0.104-0.131) and the lowest for breastfeeding more than six months (ATT: 0.007; 95% CI: -0.014-0.027). Deviation from the complete continuum of care line ranged from 2.3% to 80.9%. The highest deviation was for three or more Tetanus Toxoid (100%-19.1%=80.9%) injections and the lowest for Polio given at any time (100%-97.7%=2.3%). Conclusions The program had high effects on those MNCH care services, the uptakes of which were already high without the program (low deviations from the continuum of care line), and the program had low effects on those MNCH care services, which had low uptakes in the absence of the program (high deviations from the continuum of care line). The program should also incentivize the utilization of those MNCH care services, which have low uptakes in the absence of the program.

scholarly journals Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ajinkya Kothavale ◽  
Trupti Meher
Keyword(s):  
Child Health ◽  
Neonatal Mortality ◽  
Maternal And Child Health ◽  
Continuum Of Care ◽  
Major Barrier ◽  
Newborn And Child Health ◽  
Factors Associated ◽  
Women In India ◽  
And Child Health ◽  
The Continuum

Abstract Background India, being a developing country, presents a disquiet picture of maternal and neonatal mortality and morbidity. The majority of maternal and neonatal mortality could be avoided if the continuum of care (CoC) is provided in a structured pathway from pregnancy to the postpartum period. Therefore, this article attempted to address the following research questions: What is the level of completion along CoC for MNCH services? At which stage of care do women discontinue taking services? and what are the factors affecting the continuation in receiving maternal, newborn and child health (MNCH) services among women in India? Methods The study utilized the data from the National Family Health Survey (NFHS-4) conducted during 2015–16 in India. The analysis was limited to 107,016 women aged 15–49 who had given a live birth in the last 5 years preceding the survey and whose children had completed 1 year. Four sequential fixed effect logit regression models were fitted to identify the predictors of completion of CoC. Results Nearly 39% of women in India had completed CoC for maternal and child health by receiving all four types of service (antenatal care, institutional delivery, post-natal care and full immunization of their child), with substantial regional variation ranging from 12 to 81%. The highest number of dropouts in CoC were observed at the first stage with a loss of nearly 38%. Further, education, wealth index, and health insurance coverage emerged as significant factors associated with CoC completion. Conclusion The major barrier in achieving CoC for maternal and child health is the low utilization of ANC services in the first stage of the continuum and hence should be addressed for increasing CoC completion rate in the country. The gaps across all the levels of CoC indicate a need for increased focus on the CoC approach in India. A strategy should be developed that will connect all the components of MNCH avoiding dropouts and the MNCH provision should be standardized to provide services to every woman and child.

scholarly journals Health Facility Capacity to Provide Maternal and Newborn Healthcare Services in Unguja

2019 ◽  
Vol 11 (10) ◽  
pp. 120
Author(s):  
Rukia Rajab Bakar ◽  
Rachel N Manongi ◽  
Blandina T. Mmbaga
Keyword(s):  
Child Health ◽  
Staff Training ◽  
Assessment Tool ◽  
Neonatal Care ◽  
Health Facilities ◽  
Sub Saharan Africa ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Services ◽  
And Child Health

Globally, every year 529,000 maternal deaths occur, 99% of which in developing countries with majority being in Sub-Saharan Africa. Maternal, Newborn and Child Health (MNCH) services depend on the accessibility, availability and quality of antenatal care (ANC), delivery and postnatal services. The aim of this study was to assess the health facilities’ capacity and readiness to provide MNCH services in Unguja Island, Zanzibar. A facility-based cross-sectional survey was conducted from May to June 2015 at public health facilities providing MNCH services. Data was collected by using the modified Service Availability and Readiness Assessment tool. Eighteen health facilities were assessed, two-thirds (66.7%, n = 12) of which were offering both maternity and reproductive and child health (RCH) services, 4 (22.2%) RCH services only, and 2 (11.1%) maternity services only. Readiness score for ANC services was 66% with high readiness scores in diagnostics services (89%) and equipment (69%). Overall, 14% offered all seven signal functions. Overall, delivery service readiness score was 48%. Overall readiness for comprehensive emergency obstetric and neonatal care services was 13%. Staff training and guidelines readiness score was 11%, while medicine and commodities score was 9%. The health facilities’ readiness in providing MNCH services remains inadequate in Unguja Island. Readiness in providing services was low for delivery and emergency obstetric and neonatal care services. Basic and advanced delivery services need to be improved in parallel with provision of necessary equipment, medicines and commodities and staff training for better MNCH service delivery.

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