Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial

Sumiyo Okawa; Margaret Gyapong; Hannah Leslie; Akira Shibanuma; Kimiyo Kikuchi; Francis Yeji; Charlotte Tawiah; Sheila Addei; Keiko Nanishi; Abraham Rexford Oduro; Seth Owusu-Agyei; Evelyn Ansah; Gloria Quansah Asare; Junko Yasuoka; Abraham Hodgson; Masamine Jimba; Ghana EMBRACE Implementation Research Project Team

doi:10.1136/bmjopen-2018-025347

Effect of continuum-of-care intervention package on improving contacts and quality of maternal and newborn healthcare in Ghana: a cluster randomised controlled trial

BMJ Open. 2019 Sep 11;9(9):e025347. doi: 10.1136/bmjopen-2018-025347.

Authors

Sumiyo Okawa^{1

2}, Margaret Gyapong^{3

4}, Hannah Leslie⁵, Akira Shibanuma¹, Kimiyo Kikuchi^{1

6}, Francis Yeji⁷, Charlotte Tawiah⁸, Sheila Addei³, Keiko Nanishi^{1

9}, Abraham Rexford Oduro⁷, Seth Owusu-Agyei⁸, Evelyn Ansah^{4

10}, Gloria Quansah Asare¹¹, Junko Yasuoka^{1

12}, Abraham Hodgson¹⁰, Masamine Jimba¹³; Ghana EMBRACE Implementation Research Project Team

Collaborators

Ghana EMBRACE Implementation Research Project Team:
Yoshiharu Yoneyama, Ebenezer Appiah-Denkyira, Masamine Jimba, Abraham Hodgson, Gloria Quansah Asare, Evelyn Ansah, Junko Yasuoka, Keiko Nanishi, Akira Shibanuma, Kimiyo Kikuchi, Sumiyo Okawa, Margaret Gyapong, Sheila Addei, Vida Kukula, Doris Sarpong, Clement Narh, Seth Owusu-Agyei, Kwaku Poku-Asante, Charlotte Tawiah, Yeetey Enuameh, Kwame Adjei, Emmanuel Mahama, Abraham Oduro, John Williams, Cornelius Debpuur, Francis Yeji, Evelyn Sakeah, Peter Wontuo, Akiko Hagiwara, Sakiko Shiratori, Yusuke Kamiya

Affiliations

¹ Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
² Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan.
³ Dodowa Health Research Centre, Dodowa, Ghana.
⁴ Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana.
⁵ Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
⁶ Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan.
⁷ Navrongo Health Research Centre, Navrongo, Ghana.
⁸ Kintampo Health Research Centre, Kintampo, Ghana.
⁹ Office of International Academic Affairs, Graduate School of Medicine and Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
¹⁰ Research and Development Division, Ghana Health Service, Accra, Ghana.
¹¹ Headquarters, Ghana Health Service, Accra, Greater Accra, Ghana.
¹² Research and Education Center for Prevention of Global Infectious Diseases of Animals, Tokyo University of Agriculture and Technology, Tokyo, Japan.
¹³ Department of Community and Global Health, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan mjimba@m.u-tokyo.ac.jp.

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. .

Keywords: community child health; maternal medicine; quality in health care.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Continuity of Patient Care / organization & administration*
Female
Ghana
House Calls / statistics & numerical data*
Humans
Infant, Newborn
Outcome Assessment, Health Care
Postnatal Care / statistics & numerical data
Pregnancy
Prenatal Care / methods*
Rural Health Services / organization & administration*
Rural Population / statistics & numerical data*

Associated data

ISRCTN/ISRCTN90618993