title: Continuum of Care in a Maternal, Newborn and Child Health Program in Ghana: Low Completion Rate and Multiple Obstacle Factors.
abstract: Slow progress has been made in achieving the Millennium Development Goals 4 and 5 in Ghana. Ensuring continuum of care (at least four antenatal visits; skilled birth attendance; postnatal care within 48 hours, at two weeks, and six weeks) for mother and newborn is crucial in helping Ghana achieve these goals and beyond. This study examined the levels and factors associated with continuum of care (CoC) completion among Ghanaian women aged 15-49.
  
  
  
  A retrospective cross-sectional survey was conducted among women who experienced live births between January 2011 and April 2013 in three regions of Ghana. In a two-stage random sampling method, 1,500 women with infants were selected and interviewed about maternal and newborn service usage in line with CoC. Multiple logistic regression models were used to assess factors associated with CoC completion.
  
  
  
  Only 8.0% had CoC completion; the greatest gap and contributor to the low CoC was detected between delivery and postnatal care within 48 hours postpartum. About 95% of women had a minimum of four antenatal visits and postnatal care at six weeks postpartum. A total of 75% had skilled assisted delivery and 25% received postnatal care within 48 hours. Factors associated with CoC completion at 95% CI were geographical location (OR = 0.35, CI 0.13-0.39), marital status (OR = 0.45; CI 0.22-0.95), education (OR = 2.71; CI 1.11-6.57), transportation (OR = 1.97; CI 1.07-3.62), and beliefs about childhood illnesses (OR = 0.34; CI0.21-0.61).
  
  
  
  The continuum of care completion rate is low in the study site. Efforts should focus on increasing postnatal care within 48 hours and overcoming the known obstacles to increasing the continuum of care completion rate.
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Francis
authors.initials: F
authors.lastname: Yeji
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Shibanuma
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Oduro
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Cornelius
authors.initials: C
authors.lastname: Debpuur
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Kimiyo
authors.initials: K
authors.lastname: Kikuchi
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Seth
authors.initials: S
authors.lastname: Owusu-Agei
authors.affiliation: Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana.
authors.forename: Margaret
authors.initials: M
authors.lastname: Gyapong
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Sumiyo
authors.initials: S
authors.lastname: Okawa
authors.affiliation: Research and Development Division, Ghana Health Service, Accra MB 190, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Ansah
authors.affiliation: Ghana Health Service Headquarters, Accra MB 190, Ghana.
authors.forename: Gloria Quansah
authors.initials: GQ
authors.lastname: Asare
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Keiko
authors.initials: K
authors.lastname: Nanishi
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: John
authors.initials: J
authors.lastname: Williams
authors.affiliation: Dodowa Health Research Centre, P.O. Box DD1, Dodowa, Greater Accra, Ghana.
authors.forename: Sheila
authors.initials: S
authors.lastname: Addei
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Tawiah
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Yasuoka
authors.affiliation: Kintampo Health Research Centre, P.O. Box 200, Kintampo, Brong-Ahafo, Ghana.
authors.forename: Yeetey
authors.initials: Y
authors.lastname: Enuameh
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Sakeah
authors.affiliation: Navrongo Health Research Centre, P.O. Box 114, Navrongo, Upper-East, Ghana.
authors.forename: Peter
authors.initials: P
authors.lastname: Wontuo
authors.affiliation: Department of Community and Global Health, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
authors.forename: Masamine
authors.initials: M
authors.lastname: Jimba
authors.affiliation: Research and Development Division, Ghana Health Service, Accra MB 190, Ghana.
authors.forename: Abraham
authors.initials: A
authors.lastname: Hodgson
mesh_terms: D000293:Adolescent; D000328:Adult; D000067576:Child Health / Q000592:standards*; D003266:Continuity of Patient Care / Q000592:standards*; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana; D006801:Humans; D007231:Infant, Newborn; D008427:Maternal Health Services / Q000592:standards*; D008875:Middle Aged; D011247:Pregnancy; D011295:Prenatal Care / Q000592:standards*; D012959:Socioeconomic Factors; D055815:Young Adult