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Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries.
BMC Public Health. 2016 05 17; 16:414.BP

Abstract

BACKGROUND

Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). The continuum of care for MNCH that recognizes a tight inter-relationship between maternal, newborn and child health at different time periods and location is key towards reducing inequity in health. In this study, we explored the distributions in the utilization MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH.

METHODS

Using Demographic and Health Surveys data of 12 countries in SSA, structural equation modeling approach was employed to analyze the complex relationships in continuum of care for MNCH model. The Full Information Maximum Likelihood estimation procedure which account for the Missing at Random (MAR) and Missing Completely at Random (MCAR) assumptions was adopted in LISREL 8.80. The distribution of MNCH care utilization was presented before the estimated association in the continuum of care for MNCH model.

RESULTS

Some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilization in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from 'adequate antenatal care' to 'adequate delivery care' (0.32) and to 'adequate child's immunization' (0.36); from 'adequate delivery care' to 'adequate postnatal care' (0.78) and to 'adequate child's immunization' (0.15) were positively associated and statistically significant at p < 0.001. Only the path relationship from 'adequate postnatal care' to 'adequate child's immunization' (-0.02) was negatively associated and significant at p < 0.001.

CONCLUSIONS

In conclusion, utilization of each level of MNCH care is related to the next level of care, that is - antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child's immunization program. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child's immunization program could serve towards improving maternal and infant health outcomes and equity.

Authors+Show Affiliations

International Health Program, Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan.Institute of Community Health and Development, Great Lakes University of Kisumu, Kisumu, Kenya.Institute of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan. yjchou@ym.edu.tw.School of Health Care Administration, Taipei Medical University, Taipei, Taiwan.Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27188624

Citation

Owili, Patrick Opiyo, et al. "Associations in the Continuum of Care for Maternal, Newborn and Child Health: a Population-based Study of 12 sub-Saharan Africa Countries." BMC Public Health, vol. 16, 2016, p. 414.
Owili PO, Muga MA, Chou YJ, et al. Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. BMC Public Health. 2016;16:414.
Owili, P. O., Muga, M. A., Chou, Y. J., Hsu, Y. H., Huang, N., & Chien, L. Y. (2016). Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. BMC Public Health, 16, 414. https://doi.org/10.1186/s12889-016-3075-0
Owili PO, et al. Associations in the Continuum of Care for Maternal, Newborn and Child Health: a Population-based Study of 12 sub-Saharan Africa Countries. BMC Public Health. 2016 05 17;16:414. PubMed PMID: 27188624.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associations in the continuum of care for maternal, newborn and child health: a population-based study of 12 sub-Saharan Africa countries. AU - Owili,Patrick Opiyo, AU - Muga,Miriam Adoyo, AU - Chou,Yiing-Jenq, AU - Hsu,Yi-Hsin Elsa, AU - Huang,Nicole, AU - Chien,Li-Yin, Y1 - 2016/05/17/ PY - 2015/12/09/received PY - 2016/04/29/accepted PY - 2016/5/19/entrez PY - 2016/5/18/pubmed PY - 2017/8/24/medline KW - Continuum of care KW - Maternal, newborn and child health KW - Structural equation modeling KW - Sub-Saharan Africa SP - 414 EP - 414 JF - BMC public health JO - BMC Public Health VL - 16 N2 - BACKGROUND: Despite the progress in the Millennium Development Goals (MDGs) 4 and 5, inequity in the utilization of maternal, newborn and child health (MNCH) care services still remain high in sub-Saharan Africa (SSA). The continuum of care for MNCH that recognizes a tight inter-relationship between maternal, newborn and child health at different time periods and location is key towards reducing inequity in health. In this study, we explored the distributions in the utilization MNCH services in 12 SSA countries and further investigated the associations in the continuum of care for MNCH. METHODS: Using Demographic and Health Surveys data of 12 countries in SSA, structural equation modeling approach was employed to analyze the complex relationships in continuum of care for MNCH model. The Full Information Maximum Likelihood estimation procedure which account for the Missing at Random (MAR) and Missing Completely at Random (MCAR) assumptions was adopted in LISREL 8.80. The distribution of MNCH care utilization was presented before the estimated association in the continuum of care for MNCH model. RESULTS: Some countries have a consistently low (Mali, Nigeria, DR Congo and Rwanda) or high (Namibia, Senegal, Gambia and Liberia) utilization in at least two levels of MNCH care. The path relationships in the continuum of care for MNCH from 'adequate antenatal care' to 'adequate delivery care' (0.32) and to 'adequate child's immunization' (0.36); from 'adequate delivery care' to 'adequate postnatal care' (0.78) and to 'adequate child's immunization' (0.15) were positively associated and statistically significant at p < 0.001. Only the path relationship from 'adequate postnatal care' to 'adequate child's immunization' (-0.02) was negatively associated and significant at p < 0.001. CONCLUSIONS: In conclusion, utilization of each level of MNCH care is related to the next level of care, that is - antenatal care is associated with delivery care which is then associated with postnatal and subsequently with child's immunization program. At the national level, identification of communities which are greatly contributing to overall disparity in health and a well laid out follow-up mechanism from pregnancy through to child's immunization program could serve towards improving maternal and infant health outcomes and equity. SN - 1471-2458 UR - http://www.nlm.medscape.idmu.unboundmedicine.unboundmedicine.com/medline/citation/27188624/Associations_in_the_continuum_of_care_for_maternal_newborn_and_child_health:_a_population_based_study_of_12_sub_Saharan_Africa_countries_ L2 - https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3075-0 DB - PRIME DP - Unbound Medicine ER -