ABSTRACT
Background: Maternal and child health improved considerably due to the Sustainable Development Goals of the United Nations. However, the rate of preventable death worldwide remains high. Nevertheless, implementation was insufficient in low- and middle-income countries, including Indonesia. The study aims to assess the relationships between continuum of care (CoC) in maternal, neonatal and child health (MNCH) services and levels of care in Indonesia, examine the distribution of utilisation and investigate the associations between CoC in MNCH. Design and methods: Data were derived from the recent 2017 Indonesia Demographic and Health Survey. Fieldwork took place from July 24 to September 30, 2017. The sample included ever-married women aged 15-49 years who had given birth in the last 5 years prior to the survey. The total sample size is 15,288. Results: Only 52.6% (n = 8038) continued to receive the three levels of MNCH services. Multivariate analysis revealed that variables, such as socioeconomic status, parity and distance from health facilities were statistically significantly associated with the continuum from antenatal to postnatal care (PNC). The use of each level of MNCH care is correlated with the next level of care. Antenatal care is associated with delivery care which is subsequently associated with postnatal care. Conclusions: Identifying populations that contribute significantly to overall health inequalities and a well-established follow-up system from pregnancy to PNC may enhance maternal and child health and equity outcomes.
ABSTRACT
OBJECTIVE: WHO recommends that every pregnant woman and newborn receive quality care throughout the pregnancy, delivery and postnatal periods. However, Maternal Mortality Ratio in Indonesia for 2015 reached 305 per 100 000 live births, which exceeds the target of Sustainable Development Goals (<70 per 100 000 live births). Receiving at least four times antenatal care (ANC4+) and skilled birth attendant (SBA) during childbirth is crucial for preventing maternal and neonatal deaths. The study aims to assess the determinants of ANC4 +and SBA independently, evaluate the distribution of utilisation of ANC4 + and SBA services, and further investigate the associations of two levels of continuity of services utilisation in Indonesia DESIGN: Data from the Indonesia Demographic and Health Survey, a cross-sectional and large-scale national survey conducted in 2017 were used. SETTING: This study was set in Indonesia. PARTICIPANTS: The study involved ever-married women of reproductive age (15-49 years) and had given birth in the last 5 years prior to the survey (n=15 288). The dependent variables are the use of ANC4 + and SBA. Individual, family and community factors, such as age, age at first birth, level of education, employment status, parity, autonomy in healthcare decision-making, level of education, employment status of spouses, household income, mass media consumption residence and distance from health facilities were also measured. RESULTS: Results showed that 11 632 (76.1%) women received ANC4 + and SBA during childbirth. Multivariate analysis revealed that age, age at first birth, and parity have a statistically significant association with continuity of services utilisation. The odds of using continuity of services were higher among women older than 34 years (adjusted OR (aOR) 1.54; 95% CI 1.31 to 1.80) compared with women aged 15-24 years. Women with a favourable distance from health facilities were more likely to receive continuity of services utilisation (aOR 1.39; 95% CI 1.24 to 1.57). CONCLUSIONS: The continuity of services utilisation is associated with age, reproductive status, family influence and accessibility-related factors. Findings demonstrated the importance of enhancing early reproductive health education for men and women. The health system reinforcement, community empowerment and multisectoral engagement enhance accessibility to health facilities, reduce financial and geographical barriers, and produce strong quality care.
