Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors

Francis Yeji, Akira Shibanuma, Abraham Oduro, Cornelius Debpuur, Kimiyo Kikuchi, Seth Owusu-Agei, Margaret Gyapong, Sumiyo Okawa, Evelyn Ansah, Gloria Quansah Asare, Keiko Nanishi, John Williams, Sheila Addei, Charlotte Tawiah, Junko Yasuoka, Yeetey Enuameh, Evelyn Sakeah, Peter Wontuo, Masamine Jimba, Abraham Hodgson, Ghana EMBRACE Implementation Research Project Team, Francis Yeji, Akira Shibanuma, Abraham Oduro, Cornelius Debpuur, Kimiyo Kikuchi, Seth Owusu-Agei, Margaret Gyapong, Sumiyo Okawa, Evelyn Ansah, Gloria Quansah Asare, Keiko Nanishi, John Williams, Sheila Addei, Charlotte Tawiah, Junko Yasuoka, Yeetey Enuameh, Evelyn Sakeah, Peter Wontuo, Masamine Jimba, Abraham Hodgson, Ghana EMBRACE Implementation Research Project Team

Abstract

Background: Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15-49.

Methods: A retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion.

Results: Only 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours postpartum. About 95% of women had a minimum of four antenatal visits and postnatal care at six weeks postpartum. A total of 75% had skilled assisted delivery and 25% received postnatal care within 48 hours. Factors associated with CoC completion at 95% CI were geographical location (OR = 0.35, CI 0.13-0.39), marital status (OR = 0.45; CI 0.22-0.95), education (OR = 2.71; CI 1.11-6.57), transportation (OR = 1.97; CI 1.07-3.62), and beliefs about childhood illnesses (OR = 0.34; CI0.21-0.61).

Conclusion: The continuum of care completion rate is low in the study site. Efforts should focus on increasing postnatal care within 48 hours and overcoming the known obstacles to increasing the continuum of care completion rate.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Map of Ghana showing the…
Fig 1. Map of Ghana showing the location of the three Health Research Centres.
Fig 2. Coverage of MNCH services from…
Fig 2. Coverage of MNCH services from pregnancy through delivery to 6 weeks postpartum in Ghana (n = 1,497).

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