Okawa, Sumiyo; Gyapong, Margaret; Leslie, Hannah; Shibanuma, Akira; Kikuchi, Kimiyo; Yeji, Francis; Tawiah, Charlotte; Addei, Sheila; Nanishi, Keiko; Oduro, Abraham Rexford; +7 more... Owusu-Agyei, Seth; Ansah, Evelyn; Asare, Gloria Quansah; Yasuoka, Junko; Hodgson, Abraham; Jimba, Masamine; Ghana EMBRACE Implementation Research Project Team; (2019) Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial. BMJ open, 9 (9). e025347-. ISSN 2044-6055 DOI: https://doi.org/10.1136/bmjopen-2018-025347
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Abstract
OBJECTIVE: To evaluate the effect of a continuum-of-care intervention package on adequate contacts of women and newborn with healthcare providers and their reception of high-quality care. DESIGN: Cluster randomised controlled trial. SETTING: 32 subdistricts in 3 rural sites in Ghana. PARTICIPANTS: The baseline survey involved 1480 women who delivered before the trial, and the follow-up survey involved 1490 women who received maternal and newborn care during the trial. INTERVENTIONS: The intervention package included training healthcare providers, using an educational and recording tool named 'continuum-of-care card', providing the first postnatal care (PNC) by retaining women and newborns at healthcare facility or home visit by healthcare providers. OUTCOME MEASURES: Adequate contacts were defined as at least four contacts during pregnancy, delivery with assistance of skilled healthcare providers at a healthcare facility and three timely contacts within 6 weeks postpartum. High-quality care was defined as receiving 6 care items for antenatal care (ANC), 3 for peripartum care (PPC) and 14 for PNC. RESULTS: The difference-in-difference method was used to assess the effects of the intervention on the study outcome. The percentage of adequate contacts with high-quality care in the intervention group in the follow-up survey and the adjusted difference-in-difference estimators were 12.6% and 2.2 (p=0.61) at ANC, 31.5% and 1.9 (p=0.73) at PPC and 33.7% and 12.3 (p=0.13) at PNC in the intention-to-treat design, whereas 13.0% and 2.8 (p=0.54) at ANC, 34.2% and 2.7 (p=0.66) at PPC and 38.1% and 18.1 (p=0.02) at PNC in the per-protocol design that assigned the study sample by possession of the continuum-of-care card. CONCLUSIONS: The interventions improved contacts with healthcare providers and quality of care during PNC. However, having adequate contact did not guarantee high-quality care. Maternal and newborn care in Ghana needs to improve its continuity and quality. TRIAL REGISTRATION NUMBER: ISRCTN90618993. .
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Dept of Disease Control |
PubMed ID | 31511278 |
Elements ID | 137776 |