Continuum of care for maternal health in Uganda: A national cross-sectional study

Abstract

Introduction A continuum of maternal care approach can reduce gaps and missed opportunities experienced by women and newborns. We determined the level of coverage and factors associated with the continuum of maternal care in Uganda. Methods We used weighted data from the Uganda Demographic and Health Survey (UDHS) 2016. We included 10,152 women aged 15 to 49 years, who had had a live birth within five years preceding the survey. Stratified two-stage cluster sampling design was used to select participants. Continuum of maternal care was considered when a woman had at least four antenatal care (ANC) visits, had delivered in a health facility and they had at least one postnatal check-up within six weeks. We conducted multivariable logistic regression analysis to determine factors associated with completion of the continuum of maternal care using SPSS version 25. Results The level of coverage of complete continuum of maternal care was 10.7% (1,091) (95% CI: 10.0–11.2). About 59.9% (6,080) (95% CI: 59.0–60.8) had four or more antenatal visits while 76.6% (7,780) (95% CI: 75.8–77.5) delivered in a health facility and 22.5% (2,280) (95% CI: 21.5–23.2) attended at least one postnatal care visit within six weeks. The following factors were associated with continuum of maternal care; initiating ANC in the first trimester (AOR 1.49, 95% CI: 1.23–1.79), having secondary level of education (AOR 1.60, 95% CI: 1.15–2.22) and tertiary level of education (AOR 2.08 95% CI: 1.38–3.13) compared to no formal education, being resident in Central Uganda (AOR 1.44, 95% CI:1.11–1.89), Northern Uganda (AOR 1.35, 95% CI: 1.06–1.71) and Western Uganda (AOR 0.61, 95% CI: 0.45–0.82) compared to Eastern Uganda, and exposure to newspapers and magazines. Conclusion The level of coverage of the complete continuum of maternal care was low and varied across regions. It was associated with easily modifiable factors such as early initiation of ANC, exposure to mass media and level of education. Interventions to improve utilisation of the continuum of maternal care should leverage mass media to promote services, especially among the least educated and the residents of Western Uganda.

Factors associated with utilization of quality antenatal care: a secondary data analysis of Rwandan Demographic Health Survey 2020

“…Additionally, frequent contact between the skilled provider and the pregnant woman helps in the development of good rapport between the two, enhances women’s familiarity with the health system, builds trust and confidence in the services received [ 47 ]. All these motivate women to freely share information with the ANC providers thereby facilitating the process of receiving more ANC components or reporting positively [ 2 , 47 , 48 ]. This demonstrates that Rwanda maternal health stakeholders need to prioritize explorative research to understand barriers of utilizing the recommended ANC contacts.…”

“…As recommended by the latest WHO guidelines, early ANC initiation was considered as initiation within the first trimester coded as one and initiation after first trimester coded as zero [ 27 ]. Adequate ANC frequency was considered as 4 and more contacts and coded as one and less than 4 contacts coded as zero [ 2 , 6 ]. However, sensitivity analysis was done using 8 or more contacts as a measure of adequate ANC frequency recommended by the latest WHO guidelines [ 27 ].…”

“…According to the 2019 World Health Organization's (WHO) report, over 810 maternal deaths are registered every day, with over 94% occurring in low- and middle-income countries (LMICs) [ 1 ]. Most of these deaths could be prevented or significantly reduced through interventions such as receiving quality antenatal care (ANC), skilled birth attendance (SBA) and post-natal care (PNC) [ 2 , 3 ]. The WHO’s latest ANC recommendations emphasize the importance of every pregnant woman receiving prompt, appropriate, and high-quality care throughout her pregnancy, childbirth, and postpartum period [ 4 , 5 ].…”

“…It also serves as an entry point to the utilization of maternal care services. Evidence shows that women that receive quality services during ANC develop confidence in the maternal care services, are more likely to deliver under the care of a skilled birth attendant, and also seek early postnatal care (PNC) [ 2 , 5 ]. The aim of ANC is to help women sustain normal pregnancies through early identification of preexisting conditions, identifying complications that arise during childbirth, and promotion of well-being [ 2 , 7 ].…”

“…Evidence shows that women that receive quality services during ANC develop confidence in the maternal care services, are more likely to deliver under the care of a skilled birth attendant, and also seek early postnatal care (PNC) [ 2 , 5 ]. The aim of ANC is to help women sustain normal pregnancies through early identification of preexisting conditions, identifying complications that arise during childbirth, and promotion of well-being [ 2 , 7 ]. Currently, the WHO guidelines recommend at least eight contacts, with the first one occurring within the first 12 weeks of gestation [ 8 ].…”