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

Date Published: April 23, 2019

Publisher: Public Library of Science

Author(s): Saki Sakuma, Junko Yasuoka, Khampheng Phongluxa, Masamine Jimba, Juhwan Oh.


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.

Partial Text

Maternal, newborn, and child health (MNCH) remains one of the main global health issues. Approximately 303,000 women still succumbed to complications of pregnancy and childbirth in 2015, and about 99% of such deaths occurred in low- and middle-income countries [1]. In addition, in 2015, 5.9 million deaths occurred for children under the age of five and 2.7 million deaths during the neonatal period [2]. The high number of these mortalities in some areas of the world reflects inequities in access to health services [3].

To the authors’ knowledge, this is the first study to focus on the coverage level of MNCH services and investigate predictors of MNCH utilization in the form of modified CCI in Lao PDR. The study demonstrated important findings. We introduced the modified CCI to better explain the coverage level of preventive MNCH services utilization along with the continuum of care. First, only 6.8% of mothers received all ten MNCH services, highlighting the low MNCH coverage and underscoring room for improvement. Second, the study identified barriers and promoting factors involved in continuum of care. The findings indicate that receiving the first ANC within the first trimester and having discussion about the services with husband or other family members were new promoting factors for continuum of care. In addition, factors such as women’s education was positively associated, and being a farmer as occupation and distance from the health facility were negatively associated with the modified CCI score.

In conclusion, we demonstrated a low percentage of continuity in continuum of care in rural Lao PDR, as evidenced by only 6.8% of mothers receiving all MNCH services. New promoting factors for the continuum of care were demonstrated in this study expressed by modified CCI, including receiving the first antenatal care within the first trimester and family and male involvement in MNCH. This is an important finding since they are modifiable factors which can be promoted in short term.