Completion of the maternal continuum of care and its association with antenatal care attendance during previous pregnancy among women in rural areas of the Gurage Zone, Southwest Ethiopia: a community-based cross-sectional study

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Study Justification:
– The maternal continuum of care is a cost-effective intervention to prevent pregnancy and childbirth-related maternal and neonatal mortality and morbidity.
– Understanding the prevalence of completion of the maternal continuum of care and its association with antenatal care (ANC) attendance is important for improving maternal healthcare services in rural areas of Gurage Zone, Southwest Ethiopia.
Highlights:
– The study found that the prevalence of completion of the maternal continuum of care was 15.5%.
– ANC attendance during a previous pregnancy, access to ambulance service as a means of transportation, and exposure to mass media were positively associated with completion of the maternal continuum of care.
Recommendations:
– Strengthen interventions to improve ANC attendance during previous pregnancies, as it was found to be positively associated with completion of the maternal continuum of care.
– Improve access to ambulance services as a means of transportation for pregnant women.
– Increase exposure to mass media to promote awareness and knowledge about maternal healthcare services.
Key Role Players:
– Ministry of Health: Responsible for implementing and coordinating interventions to improve maternal healthcare services.
– Local Health Authorities: Involved in planning and implementing interventions at the community level.
– Healthcare Providers: Responsible for delivering quality ANC services and providing information to pregnant women.
– Community Leaders and Volunteers: Engage in community mobilization and awareness campaigns.
Cost Items for Planning Recommendations:
– Training and Capacity Building: Budget for training healthcare providers on ANC services and communication skills.
– Infrastructure Development: Allocate funds for improving transportation infrastructure, including ambulance services.
– Communication and Media Campaigns: Budget for mass media campaigns to increase awareness about maternal healthcare services.
– Monitoring and Evaluation: Allocate resources for monitoring and evaluating the implementation and impact of interventions.
– Community Engagement: Set aside funds for community mobilization activities and incentives for volunteers.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a community-based cross-sectional study, which provides valuable information. However, the rating is not higher due to the limited sample size (497 women) and the lack of information on the methodology and data collection procedures. To improve the evidence, future studies could consider increasing the sample size and providing more details on the study design and data collection methods.

Objective The maternal continuum of care is a cost-effective intervention to prevent pregnancy and childbirth-related maternal and neonatal mortality and morbidity. This study aimed to investigate the prevalence of completion of the maternal continuum of care and its association with antenatal care (ANC) attendance during previous pregnancy among women in rural kebeles of Gurage Zone, Southwest Ethiopia. Design A community-based cross-sectional study. Setting The study took place in 12 rural kebeles of the Gurage Zone from 1 April 2022 to 12 May 2022. Participants: Randomly selected 497 women who gave birth in the previous 12 months in rural kebeles of the Gurage Zone. Outcome The outcome of this study was the prevalence of completion of the maternal continuum of care. Results: Overall, the prevalence of completion of the maternal continuum of care was 15.5% (95% CI: 12.55% to 18.9%). After adjusting for potential confounders, having ANC attendance during a previous pregnancy (adjusted OR (AOR): 2.01; 95% CI: 1.07 to 3.76) was positively associated with the completion of the maternal continuum of care. In addition, having access to ambulance service as a means of transportation (AOR: 6.01; 95% CI: 3.16 to 11.39) and exposure to mass media (AOR: 2.43; 95% CI: 1.27 to 4.68) were positively associated with completion of the maternal continuum of care. Conclusion The prevalence of completion of the maternity continuum of care was unacceptably low in this study. This result indicates that the women did not receive the maximum possible health benefit from existing maternal healthcare services. The completion of the maternal continuum of care was affected by ANC attendance in a previous pregnancy. Therefore, interventions that can strengthen ANC are crucial in the maternal continuum of the care pathway.

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Mobile Health Clinics: Implementing mobile health clinics that can travel to rural areas, providing antenatal care services and promoting the completion of the maternal continuum of care.

2. Telemedicine: Introducing telemedicine services to connect pregnant women in rural areas with healthcare professionals, allowing them to receive remote consultations and guidance throughout their pregnancy.

3. Community Health Workers: Training and deploying community health workers in rural areas to provide education, support, and follow-up care for pregnant women, ensuring they receive the necessary antenatal care and are guided through the maternal continuum of care.

4. Ambulance Services: Expanding access to ambulance services in rural areas, ensuring that pregnant women have a reliable means of transportation to reach healthcare facilities for antenatal care and delivery.

5. Mass Media Campaigns: Launching targeted mass media campaigns to raise awareness about the importance of antenatal care and the completion of the maternal continuum of care, reaching women in rural areas and encouraging them to seek appropriate healthcare services.

These innovations aim to address the barriers faced by women in rural areas of Gurage Zone, Southwest Ethiopia, and improve their access to maternal health services, ultimately reducing maternal and neonatal mortality and morbidity.
AI Innovations Description
Based on the study mentioned, here is a recommendation that can be developed into an innovation to improve access to maternal health:

1. Strengthening Antenatal Care (ANC) Services: Since ANC attendance during a previous pregnancy was found to be positively associated with the completion of the maternal continuum of care, it is important to focus on improving ANC services. This can be done through the following strategies:

a. Increasing Awareness: Implement targeted awareness campaigns to educate women in rural areas about the importance of ANC and the benefits of receiving regular check-ups during pregnancy.

b. Improving Accessibility: Enhance the availability and accessibility of ANC services in rural areas by establishing more health facilities or mobile clinics. This can help overcome geographical barriers and ensure that pregnant women have easy access to quality care.

c. Training Healthcare Providers: Provide comprehensive training to healthcare providers, particularly in rural areas, to ensure they have the necessary skills and knowledge to deliver high-quality ANC services. This includes proper antenatal examinations, counseling, and early detection of potential complications.

d. Community Engagement: Engage with local communities and traditional birth attendants to raise awareness about the importance of ANC and encourage women to seek care. This can be done through community meetings, workshops, and partnerships with community leaders.

e. Integration of Services: Integrate ANC services with other maternal and child health programs, such as immunization and family planning, to provide a comprehensive package of care. This can help streamline services and improve overall maternal health outcomes.

f. Use of Technology: Explore the use of telemedicine and mobile health applications to provide ANC services remotely, especially in areas with limited access to healthcare facilities. This can include virtual consultations, remote monitoring of vital signs, and educational resources for pregnant women.

By implementing these recommendations, it is possible to improve access to maternal health services, increase the completion of the maternal continuum of care, and ultimately reduce maternal and neonatal mortality and morbidity in rural areas.
AI Innovations Methodology
To improve access to maternal health in rural areas of the Gurage Zone, Southwest Ethiopia, the following recommendations can be considered:

1. Strengthening Antenatal Care (ANC) Services: Given that ANC attendance during a previous pregnancy was positively associated with the completion of the maternal continuum of care, it is important to focus on improving ANC services. This can include increasing the availability and accessibility of ANC clinics, ensuring trained healthcare providers are present, and promoting awareness about the importance of ANC among pregnant women.

2. Enhancing Transportation Infrastructure: The study found that having access to ambulance service as a means of transportation was positively associated with the completion of the maternal continuum of care. Therefore, improving transportation infrastructure, especially in rural areas, can help pregnant women reach healthcare facilities more easily and in a timely manner. This can involve building and maintaining roads, providing reliable transportation options, and addressing logistical challenges.

3. Increasing Health Education and Awareness: The study also highlighted that exposure to mass media was positively associated with the completion of the maternal continuum of care. Promoting health education and awareness campaigns through various media channels can help disseminate information about maternal health, including the importance of seeking appropriate care throughout the continuum. This can involve using radio, television, mobile phones, and community outreach programs to reach a wider audience.

To simulate the impact of these recommendations on improving access to maternal health, a methodology can be developed as follows:

1. Data Collection: Gather data on the current status of maternal health access in the target area, including information on ANC attendance, transportation infrastructure, and exposure to health education. This can be done through surveys, interviews, and existing data sources.

2. Define Indicators: Identify specific indicators that can measure the impact of the recommendations. For example, the percentage increase in ANC attendance, the improvement in transportation infrastructure, and the increase in health education coverage.

3. Baseline Assessment: Establish a baseline by quantifying the current situation for each indicator. This will serve as a reference point for comparison.

4. Modeling and Simulation: Use statistical modeling techniques to simulate the potential impact of the recommendations. This can involve creating scenarios that reflect the implementation of the recommendations and estimating the expected changes in the identified indicators.

5. Sensitivity Analysis: Conduct sensitivity analysis to assess the robustness of the results and understand the potential variations in the outcomes based on different assumptions or inputs.

6. Evaluation and Monitoring: Continuously monitor the progress and evaluate the effectiveness of the recommendations. This can involve collecting data at regular intervals to compare against the baseline and assess the actual impact on improving access to maternal health.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health in rural areas.

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