Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial. Issue 9 (11th September 2019)

• Record Type: Journal Article
• Authors: Okawa, Sumiyo; Gyapong, Margaret; Leslie, Hannah; Shibanuma, Akira; Kikuchi, Kimiyo; Yeji, Francis; Tawiah, Charlotte; Addei, Sheila; Nanishi, Keiko; Oduro, Abraham Rexford; Owusu-Agyei, Seth; Ansah, Evelyn; Asare, Gloria Quansah; Yasuoka, Junko; Hodgson, Abraham; Jimba, Masamine
• Other Names: author non-byline.; Yoneyama Yoshiharu author non-byline.; Appiah-Denkyira Ebenezer author non-byline.; Jimba Masamine author non-byline.; Hodgson Abraham author non-byline.; Asare Gloria Quansah author non-byline.; Ansah Evelyn author non-byline.; Yasuoka Junko author non-byline.; Nanishi Keiko author non-byline.; Shibanuma Akira author non-byline.; Kikuchi Kimiyo author non-byline.; Okawa Sumiyo author non-byline.; Gyapong Margaret author non-byline.; Addei Sheila author non-byline.; Kukula Vida author non-byline.; Sarpong Doris author non-byline.; Narh Clement author non-byline.; Owusu-Agyei Seth author non-byline.; Poku-Asante Kwaku author non-byline.; Tawiah Charlotte author non-byline.; Enuameh Yeetey author non-byline.; Adjei Kwame author non-byline.; Mahama Emmanuel author non-byline.; Oduro Abraham author non-byline.; Williams John author non-byline.; Debpuur Cornelius author non-byline.; Yeji Francis author non-byline.; Sakeah Evelyn author non-byline.; Wontuo Peter author non-byline.; Hagiwara Akiko author non-byline.; Shiratori Sakiko author non-byline.; Kamiya Yusuke author non-byline.;
• Is Part Of: BMJ open. Volume 9:Issue 9(2019)
• Publication Date: 2019-09-11
• Subjects: quality in health care -- maternal medicine -- community child health; Medicine -- Research -- Periodicals; 610.72
• DOI: 10.1136/bmjopen-2018-025347
• Languages: English
• ISSNs: 2044-6055

Abstract

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 .