Applying an Equity Lens to Maternal Health Care Continuum in Rural Communities of Cambodia, Guatemala, Kenya, and Zambia

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.