Associations in the continuum of care for maternal, newborn and child health

• Main Authors: Patrick Opiyo Owili, 帕崔克
• Other Authors: Yiing-Jenq Chou
• Format: Others
• Language: en_US
• Published: 2016
• Online Access: http://ndltd.ncl.edu.tw/handle/22208282612302913756

博士 === 國立陽明大學 === 國際衛生碩士學位學程 === 104 === Background: Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn, and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). Features of the health care delivery system may not be the only expounding factors of adequate utilization of antenatal care (ANC) among women. Other social factors such as the family structure and its environment contribute towards pregnant women’s utilization of ANC. The continuum of care for MNCH that recognizes a tight inter-relationship between maternal, newborn and child health at different time periods and location is key towards reducing inequity in health. An understanding of how women in different family structure types and social groups use basic maternal health services is important towards developing and implementing maternal health care policy in the post-Millennium Development Goal era; especially in the sub-Saharan Africa where maternal mortality still remain high. Moreover, understanding the complex relationships in the continuum of care for maternal health is essential in designing and implementing a system of continuity of care towards better maternal and newborn health outcome. We also explored the distributions in the utilization MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH. Methods: Using Demographic and Health Surveys data of 13 countries in SSA, structural equation modeling approach was employed to analyze the complex relationships in continuum of care for MNCH model. The Logistic regression and Full Information Maximum Likelihood estimation procedure, which account for the Missing at Random (MAR) and Missing Completely at Random (MCAR) assumptions, was adopted using Stata 13.0 and LISREL 8.80, respectively. The distribution of MNCH care utilization was presented before the estimated association in the continuum of care for MNCH model. Results: In Kenya, family structure was associated with utilization of ANC. Also, use of antenatal care in Kenya had a positive relationship with use of delivery care (β = 0.06; OR = 1.06; 95% CI: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; OR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related with all the elements in the continuum of care for maternal health, while barriers to delivery care and personal characteristics were only associated with use of delivery care (β = 0.34; OR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; OR = 1.03; 95% CI: 1.01-1.05), respectively. Furthermore, in SSA, some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilization in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from ‘adequate antenatal care’ to ‘adequate delivery care’ (β = 0.32) and to ‘adequate child’s immunization’ (β = 0.36); from ‘adequate delivery care’ to ‘adequate postnatal care’ (β = 0.78) and to ‘adequate child’s immunization’ (β = 0.15) were positively associated and statistically significant at p < 0.001. Only the path relationship from ‘adequate postnatal care’ to ‘adequate child’s immunization’ (β = -0.02) was negatively associated and significant at p < 0.001. Conclusions: In conclusion, utilization of each level of MNCH care is related to the next level of care, that is – antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child’s immunization program. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child’s immunization program could serve towards improving maternal and infant health outcomes and equity.