Relationship between women's characteristics and continuum of care for maternal health in Kenya: Complex survey analysis using structural equation modeling.
The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15-49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02-1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75-2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30-1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01-1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era.
a International Health Program, Institute of Public Health, School of Medicine , National Yang-Ming University , Taipei , Taiwan.
Patrick Opiyo
PO
Owili
b Institute of Community Health and Development , Great Lakes University of Kisumu , Kisumu , Kenya.
Miriam Adoyo
MA
Muga
c Institute of Public Health, School of Medicine , National Yang-Ming University , Taipei , Taiwan.
Yiing-Jenq
YJ
Chou
d School of Health Care Administration , Taipei Medical University , Taipei , Taiwan.
Yi-Hsin Elsa
YE
Hsu
e Institute of Hospital and Health Care Administration , National Yang-Ming University , Taipei , Taiwan.
Nicole
N
Huang
f Institute of Clinical and Community Health Nursing , National Yang-Ming University , Taipei , Taiwan.
Li-Yin
LY
Chien
D000328:Adult; D003266:Continuity of Patient Care / Q000458:organization & administration*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007630:Kenya; D000068097:Maternal Health; D008427:Maternal Health Services / Q000458:organization & administration / Q000706:statistics & numerical data*; D011181:Postnatal Care / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D016387:Women's Health; D055815:Young Adult
Antenatal care; continuum of care; delivery care; maternal health care utilization; postnatal care; structural equation modeling