Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial
Clement Narh,
Cornelius Debpuur,
Abraham Hodgson,
Abraham Rexford Oduro,
John Williams,
Sumiyo Okawa,
Keiko Nanishi,
Akira Shibanuma,
Masamine Jimba,
Evelyn Ansah,
Seth Owusu-Agyei,
Hannah Leslie,
Kimiyo Kikuchi,
Francis Yeji,
Charlotte Tawiah,
Sheila Addei,
Gloria Quansah Asare,
Junko Yasuoka,
Yoshiharu Yoneyama,
Ebenezer Appiah-Denkyira,
Vida Kukula,
Doris Sarpong,
Kwaku Poku-Asante,
Yeetey Enuameh,
Kwame Adjei,
Emmanuel Mahama,
Abraham Oduro,
Evelyn Sakeah,
Peter Wontuo,
Akiko Hagiwara,
Sakiko Shiratori,
Yusuke Kamiya
Affiliations
Clement Narh
Cornelius Debpuur
Abraham Hodgson
Research and Development Division, Ghana Health Service, Accra, Ghana
Abraham Rexford Oduro
Navrongo Health Research Centre, Navrongo, Ghana
John Williams
South Tees Hospitals NHS Foundation Trust
Sumiyo Okawa
Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
Keiko Nanishi
Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
Akira Shibanuma
Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
Masamine Jimba
Department of Community and Global Health, The University of Tokyo, Graduate School of Medicine, Faculty of Medicine, Bunkyo-ku, Tokyo, Japan
Evelyn Ansah
Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
Seth Owusu-Agyei
University of Health and Allied Sciences, Ho, Ghana
Hannah Leslie
Global Health and Population, University of California San Francisco, San Francisco, California, USA
Kimiyo Kikuchi
Department of Health Sciences, Kyushu University, Fukuoka, Japan
Francis Yeji
Planning, Policy, Monitoring, and Evaluation Division (PPMED), Ghana Health Service, HQ, Accra, Ghana
Charlotte Tawiah
Kintampo Health Research Centre, Kintampo, Ghana
Sheila Addei
Dodowa Health Research Centre, Dodowa, Ghana
Gloria Quansah Asare
Headquarters, Ghana Health Service, Accra, Greater Accra, Ghana
Junko Yasuoka
Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Fuchu, Japan
Yoshiharu Yoneyama
Ebenezer Appiah-Denkyira
Vida Kukula
Doris Sarpong
Kwaku Poku-Asante
Yeetey Enuameh
Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Kwame Adjei
Emmanuel Mahama
Abraham Oduro
Research and Development Division, Ghana Health Service, Accra, Ghana
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.
