A model for continuum of care for reducing maternal and neonatal deaths in North Western Ethiopia

Abstract

Maternal and neonatal health continuum of care (MNH CoC) is one of the recommended strategies for reducing maternal and neonatal deaths. However, its utilisation remains low in sub-Saharan Africa, including Ethiopia. The purpose of the study was to investigate the determinants of maternal and neonatal service utilisation and develop a model for continuum of care for reducing maternal and neonatal mortality in North Western Ethiopia. A convergent mixed methods research design was used to conduct the study. For the quantitative phase, simple random sampling followed by systematic sampling was used to select a sample of 564 women who had given birth in the preceding nine months before data collection for the study. Data was collected through the use of a questionnaire. For the qualitative phase, a purposive sampling method was applied to select the study participants who were women, religious leaders, community leaders, Women‘s Development Army (WDA) leaders, health extension workers (HEWs), midwives, facility heads, experts, and directors, using in-depth interview tools. The quantitative data were analysed using SPSS version 27 and the qualitative data were analysed using Colaizzi‘s seven steps of analysis. The overall completion of maternal and neonatal CoC services in the antenatal, childbirth and postnatal stages was 53.7%. The study showed that factors such as occupation, partner support, knowledge of the expected number of antenatal visits, knowledge of neonatal danger signs, early booking of antenatal care, comprehensive counselling and physical examination during antenatal care (ANC), and mode of delivery were significantly associated with completion of MNC CoC services. Religious influence, perceptions, customs and husbands‘ influence were barriers that affected the completion of MNH CoC. Furthermore, poverty, an awareness gap, workload, unwanted pregnancy, late ANC booking and poor referral care including lack of timely services resulted in discontinuation of the CoC pathways. Lack of resources such as appropriate medication, laboratory investigations, medical equipment and transportation exacerbated poor utilisation of MNH CoC. The findings were used to develop a MNH CoC model for reducing maternal and neonatal deaths. The developed model challenges policy makers to set up programs that would facilitate action for improved and desired outcomes.