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      Completion of maternity continuum of care among women in the post-partum period: Magnitude and associated factors in the northwest, Ethiopia

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          Abstract

          Background

          Maternity continuum of care is a model of integrated components of maternal health service from pregnancy to the post-partum period to improve maternal, neonatal and child health. In Ethiopia, the magnitude of antenatal care, skilled delivery, and post-natal care have shown improvement. However, there is limited evidence of the woman who attends continuing from antenatal care to post-partum care.

          Objective

          To assess completion of maternity continuum of care and its associated factors among women, in Motta town and Hulet Eji Enese district, Northwest Ethiopia.

          Methods

          A community based cross-sectional study with a stratified cluster sampling technique was conducted among 819 women 6week-6month post-partum period in Motta town and Hulet Eji Enese district. The data were collected from March 12, 2019 to April1, 2019 by face to face interviews, using a pretested structured questionnaire. Binary logistic regression (bi-variable and multivariable) model was done. Adjusted odds ratio with respect to 95% confidence interval was employed in the strength and direction of the association between covariates and outcome variable. Besides, a P value<0.05 was used to declare statistical significance.

          Results

          A total of 819 women with100% response rate participated and Completion of maternity continuum of care was found to be 47% (43.2%-50.2%) in the study. Educational attainment of Secondary school and above (adjusted odds ratio(AOR) = 3.5; 1.9–6.3), urban residence (AOR = 4.6; 95%CI 2.5–8.5), women reach to a health facility within 30minute(AOR = 2.1; 95%CI 1.2–3.7), a woman was the primary decision maker for attending maternity continuum of care(AOR = 3.5;95%CI 1.9–6.3), index pregnancy-related complication(AOR = 2.4;95%CI 1.1–5.3), starting antenatal care within second trimester (AOR = 3.4;95%CI 2.1–5.6) and antenatal care visit 3–4 times(AOR = 2.1;95%CI 1.2–3.8) were statistically significant with completion of maternity continuum of care.

          Conclusions

          The completion of maternity continuum of care is low in the study area. Improving the educational status of women, engaging the rural community, physical accessibility of health facility, woman empowerment for decision making, emphasis on giving care for pregnancy-related complication, and early gestational age antenatal care at least 3 or more visits suggested to increase completion of maternity continuum of care.

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          Most cited references22

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          Success factors for reducing maternal and child mortality

          Reducing maternal and child mortality is a priority in the Millennium Development Goals (MDGs), and will likely remain so after 2015. Evidence exists on the investments, interventions and enabling policies required. Less is understood about why some countries achieve faster progress than other comparable countries. The Success Factors for Women’s and Children’s Health studies sought to address this knowledge gap using statistical and econometric analyses of data from 144 low- and middle-income countries (LMICs) over 20 years; Boolean, qualitative comparative analysis; a literature review; and country-specific reviews in 10 fast-track countries for MDGs 4 and 5a. There is no standard formula – fast-track countries deploy tailored strategies and adapt quickly to change. However, fast-track countries share some effective approaches in addressing three main areas to reduce maternal and child mortality. First, these countries engage multiple sectors to address crucial health determinants. Around half the reduction in child mortality in LMICs since 1990 is the result of health sector investments, the other half is attributed to investments made in sectors outside health. Second, these countries use strategies to mobilize partners across society, using timely, robust evidence for decision-making and accountability and a triple planning approach to consider immediate needs, long-term vision and adaptation to change. Third, the countries establish guiding principles that orient progress, align stakeholder action and achieve results over time. This evidence synthesis contributes to global learning on accelerating improvements in women’s and children’s health towards 2015 and beyond.
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            Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa.

            We assess how countries in regions of the world where maternal mortality is highest-South Asia and Sub-Saharan Africa-are performing with regards to providing women with vital elements of the continuum of care.
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              Levels and determinants of continuum of care for maternal and newborn health in Cambodia-evidence from a population-based survey

              Background Continuum of care throughout pregnancy, birth, and after delivery has become a key program strategy for improving the health of mothers and newborns. Successful program implementation to improve the continuum of care relies on a better understanding of where the gaps are in seeking care along the pathway and what factors contribute to the gaps. Methods Using data from the 2010 Cambodia Demographic and Health Survey, we examine the levels of service use along the continuum of care. Three sequential regression models are fitted to identify factor(s) that affect women from getting skilled birth attendance (SBA) after receiving antenatal care (ANC), and from getting postnatal care (PNC) after having both ANC and SBA. Results Three of every five Cambodian women received all three types of maternal care—antenatal care, skilled birth attendance at birth and postnatal care -for their most recent birth, however with substantial regional variation ranging from 14% to 96%. The results highlight that mother’s age, educational attainment, urban residence, household wealth, lower birth order are associated with women’s use of antenatal care and their continuation to using skilled birth attendant. Health insurance coverage also increases use of antenatal care but not skilled birth attendant. Having four antenatal care visits and receiving better quality of antenatal care affected women’s subsequent use of skilled birth attendant. The odds of having skilled birth attendant increases by 30 to 50% for women who received blood pressure measurement, urine sample taken, and blood sample taken as part of antenatal services. Household wealth status, urine sample taken, and delivery at a health facility were the only three factors significantly associated with the continuation from having skilled birth attendant to receiving postnatal care. Conclusions Cambodia has made remarkable progress in extending the reach of maternal health care in most areas of the country. Future program efforts should focus on the Northeast part of the country where the lowest level of service use was found. Poor women suffered from lower access to continued care and extending the health insurance coverage might be one way to help them out. Quality of antenatal care is connected to women’s use of skilled birth attendant and postnatal care and should be given more focus.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Supervision
                Role: Supervision
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                27 August 2020
                2020
                : 15
                : 8
                : e0237980
                Affiliations
                [1 ] Department of Women’s and Family Health, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                [2 ] Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                [3 ] Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
                University of Cape Coast, GHANA
                Author notes

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

                Author information
                http://orcid.org/0000-0002-2281-7519
                Article
                PONE-D-20-06941
                10.1371/journal.pone.0237980
                7451525
                32853268
                a3e3af18-ac76-4bbf-9d56-e5d37ad1e439
                © 2020 Asratie et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 10 March 2020
                : 6 August 2020
                Page count
                Figures: 1, Tables: 3, Pages: 14
                Funding
                The authors received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Antenatal Care
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Labor and Delivery
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Labor and Delivery
                Earth Sciences
                Geography
                Human Geography
                Urban Geography
                Towns
                Social Sciences
                Human Geography
                Urban Geography
                Towns
                People and Places
                Population Groupings
                Educational Status
                Medicine and Health Sciences
                Health Care
                Health Care Providers
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Neonatal Care
                Medicine and Health Sciences
                Pediatrics
                Neonatology
                Neonatal Care
                Medicine and Health Sciences
                Health Care
                Neonatal Care
                Custom metadata
                All relevant data are within the manuscript and its Supporting Information files.

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