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

Abstract

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. 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. 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). 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.