Determinants of Continuity of Care amongst Pregnant Women in Two Municipal Hospitals in Greater Accra Region

ABSTRACT

Introduction: In the past two decades, maternal mortality ratio in Ghana has been on the decline but rather at a slow pace. Patronage of skilled birth assistance is still met with skepticism and this brings about gaps in maternity care. Pregnant women still seek care from the informal health sector while evidence suggests that some pregnant women changed their regular antenatal care provider during ANC and delivery. However, factors that influence continuity of care and the reasons for some pregnant women switching care provider during ANC and delivery have not been explored in Ghana. This research sought to find the determinants of Continuity of Care (CoC) amongst pregnant women and reasons pregnant women switch providers during ANC 

Method: A systematic sampling method was used for this quantitative study. Questionnaires were administered to mothers attending postnatal clinics at La General Hospital and Lekma Hospitals in the La Dade Kotopon and Ledzokuku-Krowor Municipalities respectively. Usual Provider Continuity of Care (UPC) Index was calculated for each woman and Chi square, student t-test and logistic regression were used to determine associations of the various factors and continuity of care using STATA 15.

Results:  There were 325 participants with age ranging between 15 to 49 years. A third had SHS education (33.9%), self-employed (53.5%) and with household income less than 1000 GH Cedi a month. Average UPC was 0.943 with 15.6% of the women switched providers during ANC while 84.3% maintained only one provider throughout the pregnancy.

Performance of cultural rites after delivery (aOR=3.03, 95%CI=1.2-7.64), history of abortion (aOR=1.95, 95%CI=1.01-3.77) and absence of family members during ANC (aOR=2.62, 95%CI=1.28-5.34) were significantly associated with CoC after controlling for various factors in a multivariate analysis.

Conclusions: Though majority of participants had perfect CoC those who decided to switch care from their regular ANC provider, did so mostly due to self-made decisions.