Embed Size (px)
Citation preview
1
Francis Yeji (Navrongo Health Research Centre)
on behalf of Ghana EMBRACE Implementation Research
Team
Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana:
“Low Completion Rate and Multiple Obstacle Factors”
2
Background
Global
• Most sub-Saharan African countries have difficulties in achieving MDGs 4 & 5
Ghana
• Maternal Mortality Ratio: 380/100,000• Neonatal Mortality Rate: 30/1,000
Key
• Ensuring Continuum of Care (CoC) for mother and newborn is crucial in helping achieve MDGs and beyond
3
CoC in MNCH program
• CoC links key MNCH packages of programs across the pregnancy, delivery, and postpartum stages
• Each CoC stage builds on the success of the previous stage
Focused period of this study
4
Objectives of the study
• Measure the completion of CoC from the pregnancy to six weeks postpartum stages in Ghana
1
• Examine the factors associated with the completion of CoC, and discontinuity of CoC
2
5
MethodsStudy sites Study Design
• Cross sectional survey• 467,000 population in 6 districts • 1,500 women (15-49 yrs) selected by
two stage random sampling• Logistic and multinomial regression
analysis
Study outcomeCompletion of CoC: Antenatal care ≥ 4 times Delivery assisted by skilled attendant Postnatal care < 48 hrs, at 2 wks, and 6 wks
6
Participants Background Characteristics
VariableDodowa
N (%)Kintampo
N (%)Navrongo
N (%)TotalN (%)
Age (mean)Mothers 28.4 30.0 28.0 28.9Partners 34.1 34.6 35.4 34.8
Education (Mothers)None 192 (38.4) 264 (47.8) 150 (30.0) 606 (39.1)Primary 109 (21.8) 105 (19.0) 141 (28.2) 355 (22.9)Middle/JHS/higher 199 (39.8) 183 (33.0) 209 (41.8) 591 (38.1)
Education (Partners)None 86 (19.6) 195 (35.3) 167 (33.9) 448 (30.2)Primary 70 (16.0) 35 (6.3) 93 (18.9) 198 (13.3)Middle/JHS/higher 330 (64.5) 258 (46.8) 233 (47.3) 893 (52.1)
Parity1 145 (29.0) 116 (21.0) 140 (28.0) 401 (25.8)2 – 3 211 (42.2) 231 (41.9) 216 (43.2) 658 (42.4)4 – 5 85 (17.0) 112 (20.3) 110 (22.0) 307 (19.8)6 + 59 (11.8) 93 (16.9) 34 (6.8) 186 (12.0)
Marital status Married 134 (26.8) 366 (66.3) 457 (91.4) 957 (61.7) Cohabiting 297 (59.4) 94 (17.0) 7 (1.4) 398 (25.6) Single/Divorce/Widowed 69 (13.8) 92 (16.7) 36 (7.2) 197 (12.7)
Wanted PregnancyThen 216 (43.2) 369 (66.9) 329 (65.8) 914 (58.9)Later 207 (41.4) 137 (24.8) 150 (30.0) 494 (31.8)Not wanted 77 (15.4) 46 (8.3) 21 (4.2) 144 (9.3)
7
Gaps identifies in MNCH services
ANC4+ SBA PNC<48hr PNC at 2wks PNC at 6 wks0
20
40
60
80
10092
89
3944
95
85
63
19
49
97
84
77
23
71
93
86
76
25
52
91
Navrongo Kintampo Dodowa All
Perc
enta
ge
Gap is here
8
CoC completion rate
Navrongo Kintampo Dodowa All0
5
10
15 14
3
78
Location (HDSS Site)
Perc
enta
ge
9
Factors associated with CoC completionVariable Number (N=1497) aOR (95%CI)
Location (HDSS Site)
Navrongo 497 1
Kintampo 500 0.35 (0.13 - 0.95)*Dodowa 500 0.76 (0.30 - 1.93)
Marital StatusMarried 910 1Cohabiting 395 0.45 (0.22 - 0.95)*Single/Divorced/Widowed 192 0.66 (0.28 - 1.60)
Mother's religionChristian 790 1Islam 209 0.57 (0.18 - 1.77)Traditional 352 2.20 (1.05 - 4.60)*Other 146 0.83 (0.22 - 3.11)
Wanted Pregnancy (Timing)
Yes then 875 1
Yes but later 481 1.69 (1.04 - 2.75)**
Not at all 141 0.82 (0.27 - 2.47)
Note: *p< 0.05**p< 0.01, ***p< 0.001 . Adjusted for ageand education
10
Variable Number (N=1417) aOR (95%CI)
Partner's Education
None 433 1
Primary 194 0.64 (0.30 - 1.37)
Middle 419 0.99 (0.51 - 1.90)
Secondary 221 1.01 (0.47 - 2.16)
Tertiary and above 103 2.71 (1.11 - 6.57)*
Transportation to Delivery place
On foot 744 1
Bicycle/Tricycle/Motorcycle 124 1.58 (0.86 - 2.90)
Car(Public/Private)/Ambulance 607 1.97 (1.07 - 3.62)*
Local Beliefs on child sicknesses
All can be treated 495 1
Some cannot be treated 584 0.34 (0.21 - 0.61)***
(Continued.)
Factors associated with discontinuity of CoC
Variable
Discontinued at ANC
Discontinued at Delivery
Discontinued at PNC
RR RR RR
Location (HDSS Site)Navrongo 1 1 1Kintampo 4.28** 15.89*** 1.99Dodowa 2.8 7.63** 1.32
Marital StatusMarried 1 1 1Cohabitating 2.95** 1.74 1.56Single/Divorced/Widowed 3.41* 1.6 1.57
Partner’s educationNone 1 1 1Primary 1.14 1.29 1.66Middle 0.53 0.82 1.05Secondary 0.7 0.89 1.12Tertiary and above 0.13** 0.24* 0.43
Wealth QuintilesHighest 1 1 1Fourth 2.41 3.28 1.78Middle 2.61 3.59** 1.08Second 2.46 6.17*** 1.25Lowest 2.63 7.07*** 1.34
Woman beliefs about child illness All illness can be treated 1 1 1 Some illness can't be treated 3.25*** 2.66*** 2.57***
12
Discussions
• Only 8% received MNCH services continuously. The major gap was PNC within 48hrs1
• CoC completion rates and the associated factors varies across geographical locations2
• The contribution of CHFP/CHPS may be the major factor accounting for the differences 3
13
Conclusions & Policy Implications
• Findings call for attention to interventions within local context aimed at improving coverage of PNC within 48hrs to increase CoC completion rate
14
Acknowledgement• The Chiefs, health workers, and people of the communities
• The Ghana Health Service (GHS)– Headquarters– Research and Development Division– Navrongo, Kintampo, and Dodowa Health Research Centers
• The District Health Management Teams (DHMTs)– Shai-Osudoku , Ningo-Prampram , Kintampo North and South, Kassena Nankana
East and West
• Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo
• Japan International Cooperation Agency (JICA) Human Development Department
• JICA Research Institute
• System Science Consultants Inc., Japan
• Japanese Organization for International Cooperation in Family Planning (JOICFP)
• Special thanks: The Ministry of Foreign Affairs in Japan, and The Ministry of Health in Ghana
