Magnitude and determinant of Continuum of care in maternal health services and its impact on maternal and infant health outcome: Review of Literature

Abstract

Introduction: Worldwide, annually millions of women, newborns and children died from preventable causes that could manage by easily and affordable interventions. However, more than 60 million pregnant women were delivered at home without the help of skilled providers. Thus, assuring continuity of care has become a key program strategy for improving the health of mothers and newborns. But, evidence was rare on level and determinants of a continuum of care in maternal health services and how continuity of maternal health service is effective on the reduction of maternal and infant mortality, particularly in developing countries. Therefore, this review gave some clues on this scarce evidences.  

Methodology: The searching strategies were done by searching for published studies only in the form of the English language. Our searching engines were: PubMed, Google Scholar, Cochrane, and Medline. Bibliographies of eligible papers were manually identified from relevant citations. Then, the identified articles were evaluated based on the stated objectives and review full articles that fulfill inclusion criteria.

Result: The review result reveals that the magnitude of a continuum of care in maternal health services was low. Such that in South Asia (25%), Sub-Saharan African (14%), Cambodia (60%) and Ghana (8%) of women were received a full range of key components of maternal health services. Hence, the determinant factors that hinder the completion of a continuum of care were categorized as individual factors, socio-economic factors, family factors, and community factors. Some of those factors were the richest women [AOR= 14.2; 95%CI: 6.97 - 28.83]; urban resident [AOR=0.42; 95%CI: 0.27 - 0.65]; greater autonomy [AOR=1.45; 95%CI: 1.21 - 1.71]; women in the highest household wealth index [AOR=2.7; 95%CI: 1.8 – 3.9], higher household wealth index [AOR=1.9; 95%CI: 1.4 – 2.7], middle household wealth index[AOR=1.4; 95%CI: 1 – 1.9] and lower household wealth index [AOR=1.4; 95%CI: 1 – 1.8]. Completion of a continuum of care was clinically and statistically significant on the reduction of maternal, infant, neonatal and perinatal mortality. The interventions that linked antenatal care, skilled birth attendance, and postnatal care had significantly reduced neonatal mortality [RR=0.84; 95% CI: 0.75 - 0.94]; perinatal mortality [RR=0.81; 95% CI: 0.74 - 0.90] and maternal mortality [RR = 0.52; 0.38 – 0.71]. Moreover, linked the three stages of the space dimension (community–family care, outpatient–outreach care, and clinical care) had a significant reduction in neonatal mortality (RR= 0.88; 95% CI: 0.79 - 0.97) and perinatal mortality (RR = 0.78; 95%CI: 0.66 - 0.92) but there was no significant reduction in maternal mortality (RR=0.94; 95%CI: 0.49 - 1.83).

Conclusion: As a conclusion, completion of a continuum of care was low and different determinant factors were identified that hinders the completion rate. Continuity of maternal health service was a key strategy for the reduction of maternal, infant, neonatal and perinatal mortality in developing countries.  Thus, eliminating those hindering factors and expansion of continuum of care in a maternal health program is strongly recommended for developing countries.