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.


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