Determinants of continuum of care for maternal, newborn, and child health services in rural Khammouane, Lao PDR

Abstract

Introduction The concept of continuum of care has gained attention as measures to improve maternal, newborn, and child health. However, little is known about the factors associated with the coverage level of continuum of care in Lao PDR. Therefore, this study was conducted 1) to investigate the coverage level of continuum of care and 2) to identify barriers and promoting factors that are associated with mothers’ continuation in receiving services in rural Lao PDR. Methods A community-based, cross sectional study was conducted in a rural district in Khammouane Province, Lao PDR, using a structured questionnaire. The outcome to the express continuum of care was assessed by the modified composite coverage index (CCI) that reflects ten maternal and child health services. Results In total, 263 mothers were included in the final analyses. Only 6.8% of mothers continued to receive all MNCH services. Five factors were shown to have statistically significant associations with modified CCI score: higher educational attainment (B = 0.070, p<0.001), being a farmer (B = -0.078, p = 0.003), receiving the first antenatal care within the first trimester (B = 0.109, p<0.001), longer distance from district hospital (B = -0.012, p<0.001), and discussion with husband or family members (B = 0.057, p = 0.022). Conclusions In this study, we introduced the modified CCI to better explain the utilization of preventive maternal and child health services along with the continuum of care. By utilizing the modified CCI, we identified five factors as determinants of continuum of care. Furthermore, new and modifiable promoting factors were identified for continuum of care: receiving the first antenatal care within the first trimester and family and male involvement. Such demand side actions should be encouraged to improve the continuity of MNCH service use.

Regional disparities in antenatal care utilization in Indonesia

“…The analysis shows that women who have husbands/partners are more likely to use ANC. This is in line with the findings of several studies that have shown the role of a husband/partner in providing support for a woman's healthy lifestyle [32][33][34][35]. Some other studies actually encourage a husband to help improve a woman's health status by actively encouraging a healthier lifestyle [36,37].…”

Neonatal care and community-level treatment seeking for possible severe bacterial infection (PSBI) in Amhara, Ethiopia

“…Logistical barriers such as distance to facilities and time were rarely mentioned as obstacles in assuring biomedical treatment. However, many studies conducted in LMICs recognize geographic accessibility as a significant impediment to achieving care, particularly in rural settings [32][33][34]. This contrast may have been because study participants were recruited from the catchment area of local health centers and thus, participants may not have been likely to reside in hyper-rural areas far from health facilities.…”

Influence of China’s 2009 healthcare reform on the utilisation of continuum of care for maternal health services: Evidence from two cross-sectional household surveys in Shaanxi Province

“…Recent studies have evaluated socio-economic inequalities and found socioeconomic determinants of prenatal and postnatal visits [17][18][19], explored influence of health policy on improving the utilisation of hospital delivery [20], prenatal or postnatal visits [21], fewer studies explore the utilisation of CMHS. To date, there has been some research exploring the determinants, effects, value, measurement of CMHS in LMICs outside of China: in Lao PDR [22], Nepal [23], Tanzania [10], South Africa [11], Cambodia [24].…”