Peer-reviewed article
The coverage of continuum of care in maternal, newborn and child health: a cross-sectional study of woman-child pairs in Ghana
Akira Shibanuma, Francis Yeji, Sumiyo Okawa, Emmanuel Mahama, Kimiyo Kikuchi et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how well pregnant women and children in Ghana received continuous, appropriate health services from pregnancy through the post-delivery period. Researchers surveyed 1,401 woman-child pairs and found that very few—less than 8%—achieved complete, continuous care at health facilities, and only 10% received all the key health services they needed. The study identified that wealthier families, more educated women, and those with pregnancy complications were more likely to complete the continuum of care.
Key points
- Only 7.9% of woman-child pairs achieved continuous visits to health facilities throughout pregnancy, delivery and post-delivery
- 10.3% of pairs received all key components of maternal, newborn and child health services
- Just 1.8% achieved the continuum of care under both continuous visits and receipt of key services
- Women from wealthier households were significantly more likely to achieve the continuum of care
- Geographic variation existed across the 22 areas studied, with larger differences in services-based achievement than visit-based achievement
Limitations
This cross-sectional study cannot establish causation or explain the mechanisms behind why the continuum of care was not achieved. The study measures coverage at a single point in time and does not track changes over time or identify barriers and facilitators to continuous care in detail.
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.