Abstract:
Background: The continuum of care (CoC) has been prioritized to
be of paramount importance in improving maternal newborn and
child health. Effective community based program interventions can
enhance the timely utilization of facility based services, and
improved health outcomes. Methods: A quasi experimental study
with matched comparison groups was conducted in four countries
to determine the levels of the continuity of care for maternal
health. Households in two districts/sub districts in each country
received a package of community based interventions which
included targeted community health worker health promotion for
maternal newborn and child health, and institution of social
accountability mechanisms for effective community engagement.
Two comparison districts/sub districts received ongoing routine
interventions. Women 15-49 years who delivered in the previous
two years were selected and care seeking practices for maternal
newborn and child health were obtained. Results: The study
included 2995 women in Cambodia, 1992, in Guatemala, 2581, in
Kenya, and 1057, in Zambia. More than 85% of the women
reported antenatal care visits, with a significantly higher proportion
of women reporting four or more visits in the intervention sites for
Cambodia (81.2% vs 57.9%, p<0.001) and Kenya (70.5% vs 62%,
p<0.001). Skilled birth attendance was also significantly higher in
the intervention sites for Cambodia (99.1% vs 84.9%, p<0.001).
CoC completion rates were also significantly higher in the
intervention sites for Cambodia (76% vs 42%, p<0.001), and
Kenya (28% vs 21%, p<0.001). Women with higher education,
higher wealth quintile, those from intervention sites (except
Guatemala) had significantly higher odds of CoC completion,
though the results varied between the country contexts.
Conclusions: Concerted efforts for contextually appropriate
integrated health promotion strategies at the household, community
and primary health facility level are essential to enable appropriate
and timely healthcare and effectively mitigate the barriers to care
seeking for maternal and newborn health.
