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BMC Public Health
Published in: BMC Public Health 1/2024

Open Access 01-12-2024 | Vaccination | Research

Continuum of care for maternal and child health and child undernutrition in Angola

Authors: Akiko Saito, Masahide Kondo

Published in: BMC Public Health | Issue 1/2024

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Abstract

Background

Continuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status.

Methods

We used nationally representative data from the Angola 2015–2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels.

Results

The prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight.

Conclusions

The completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.
Literature
1.
Fernald LC, Grantham-McGregor SM. Stress response in school-age children who have been growth retarded since early childhood. Am J Clin Nutr. 1998;68(3):691–8.PubMedCrossRef
2.
Pelletier DL, Frongillo EA Jr, Schroeder DG, Habicht J-P. The effects of malnutrition on child mortality in developing countries. Bull World Health Organ. 1995;73(4):443.PubMedPubMedCentral
3.
Martorell R. The nature of child malnutrition and its long-term implications. FoodNutr Bull. 1999;20(3):288–92.
4.
Gardner JMM, Grantham-McGregor SM, Himes J, Chang S. Behaviour and development of stunted and nonstunted Jamaican children. J Child Psychol Psychiatry Allied Disciplines. 1999;40(5):819–27.CrossRef
5.
Black RE, Allen LH, Bhutta ZA, Caulfield LE, De Onis M, Ezzati M, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet. 2008;371(9608):243–60.PubMedCrossRef
6.
Victora CG, Adair L, Fall C, Hallal PC, Martorell R, Richter L, et al. Maternal and child undernutrition: consequences for adult health and human capital. Lancet. 2008;371(9609):340–57.PubMedPubMedCentralCrossRef
7.
Kossmann J, Nestel P, Herrera M, Amin A, Fawzi W. Undernutrition in relation to childhood infections: a prospective study in the Sudan. Eur J Clin Nutr. 2000;54(6):463–72.PubMedCrossRef
8.
Olofin I, McDonald CM, Ezzati M, Flaxman S, Black RE, Fawzi WW, et al. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies. PLoS ONE. 2013;8(5):e64636.ADSPubMedPubMedCentralCrossRef
9.
10.
Lasky RE, Klein RE, Yarbrough C, Engle PL, Lechtig A, Martorell R. The relationship between physical growth and infant behavioral development in rural Guatemala. Child development. 1981:219– 26.
11.
Webb K, Horton N, Katz D. Parental IQ and cognitive development of malnourished Indonesian children. Eur J Clin Nutr. 2005;59(4):618–20.PubMedCrossRef
12.
Adair LS, Fall CH, Osmond C, Stein AD, Martorell R, Ramirez-Zea M, et al. Associations of linear growth and relative weight gain during early life with adult health and human capital in countries of low and middle income: findings from five birth cohort studies. Lancet. 2013;382(9891):525–34.PubMedPubMedCentralCrossRef
13.
Crookston BT, Schott W, Cueto S, Dearden KA, Engle P, Georgiadis A, et al. Postinfancy growth, schooling, and cognitive achievement: young lives. Am J Clin Nutr. 2013;98(6):1555–63.PubMedPubMedCentralCrossRef
14.
Sandjaja S, Budiman B, Harahap H, Ernawati F, Soekatri M, Widodo Y, et al. Food consumption and nutritional and biochemical status of 0·5-12-year-old Indonesian children: the SEANUTS study. Br J Nutr. 2013;110(Suppl 3):11–20.CrossRef
15.
Casale D, Desmond C, Richter L. The association between stunting and psychosocial development among preschool children: a study using the South African birth to twenty cohort data. Child Care Health Dev. 2014;40(6):900–10.PubMedCrossRef
16.
Jamison DT. Child malnutrition and school performance in China. J Dev Econ. 1986;20(2):299–309.CrossRef
17.
Moock PR, Leslie J. Childhood malnutrition and schooling in the Terai region of Nepal. J Dev Econ. 1986;20(1):33–52.CrossRef
18.
Beasley N, Hall A, Tomkins A, Donnelly C, Ntimbwa P, Kivuga J, et al. The health of enrolled and non enrolled children of school age in Tanga, Tanzania. Acta Trop. 2000;76(3):223–9.PubMedCrossRef
19.
Hoddinott J, Maluccio JA, Behrman JR, Flores R, Martorell R. Effect of a nutrition intervention during early childhood on economic productivity in Guatemalan adults. Lancet. 2008;371(9610):411–6.PubMedCrossRef
20.
Ruel MT, Alderman H. Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition? Lancet. 2013;382(9891):536–51.PubMedCrossRef
21.
Keats EC, Das JK, Salam RA, Lassi ZS, Imdad A, Black RE, et al. Effective interventions to address maternal and child malnutrition: an update of the evidence. Lancet Child Adolesc Health. 2021;5(5):367–84.PubMedCrossRef
22.
Instituto Nacional de Estatística (INE). Ministério Da Saúde (MINSA), Ministério do Planeamento E do Desenvolvimento Territorial (MINPLAN) and ICF. Inquérito De Indicadores Múltiplos E De Saúde em Angola 2015–2016. Angola e Rockville, Maryland, EUA: Luanda; 2017.
23.
Rosario EVN, Gomes MC, Brito M, Costa D. Determinants of maternal health care and birth outcome in the Dande Health and demographic Surveillance System area, Angola. PLoS ONE. 2019;14(8):e0221280.PubMedPubMedCentralCrossRef
24.
25.
Simkhada B, Teijlingen ER, Porter M, Simkhada P. Factors affecting the utilization of antenatal care in developing countries: systematic review of the literature. J Adv Nurs. 2008;61(3):244–60.PubMedCrossRef
26.
Banke-Thomas OE, Banke-Thomas AO, Ameh CA. Factors influencing utilisation of maternal health services by adolescent mothers in low-and middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2017;17(1):65.PubMedPubMedCentralCrossRef
27.
Nyongesa C, Xu X, Hall JJ, Macharia WM, Yego F, Hall B. Factors influencing choice of skilled birth attendance at ANC: evidence from the Kenya demographic health survey. BMC Pregnancy Childbirth. 2018;18(1):88.PubMedPubMedCentralCrossRef
28.
Ahinkorah BO, Seidu AA, Agbaglo E, Adu C, Budu E, Hagan JE Jr., et al. Determinants of antenatal care and skilled birth attendance services utilization among childbearing women in Guinea: evidence from the 2018 Guinea demographic and Health Survey data. BMC Pregnancy Childbirth. 2021;21(1):2.PubMedPubMedCentralCrossRef
29.
Dimitrova A, Carrasco-Escobar G, Richardson R, Benmarhnia T. Essential childhood immunization in 43 low- and middle-income countries: analysis of spatial trends and socioeconomic inequalities in vaccine coverage. PLoS Med. 2023;20(1):e1004166.PubMedPubMedCentralCrossRef
30.
Shibre G, Zegeye B, Idriss-Wheeler D, Yaya S. Factors affecting the utilization of antenatal care services among women in Guinea: a population-based study. Fam Pract. 2021;38(2):63–9.PubMedCrossRef
31.
Yunitasari E, Wahyuning Putri DU, Alit Armini NK, Sudarsiwi NP, Ramoo V. Analysis of factors that affect the utilization of antenatal care in developing countries: a systematic review. J Pak Med Assoc. 2023;73(Suppl 2):S162–S9.CrossRef
32.
Tsala Dimbuene Z, Amo-Adjei J, Amugsi D, Mumah J, Izugbara CO, Beguy D. Women’s education and Utilization of Maternal Health Services in Africa: a multi-country and socioeconomic status analysis. J Biosoc Sci. 2018;50(6):725–48.PubMedCrossRef
33.
Andriani H, Rahmawati ND, Fauzia S, Kosasih RI. Population-based study on the maternal-newborn-child Health Continuum of Care: evidence from Lower-Middle-Income Countries in Southeast Asia. Asia Pac J Public Health. 2022;34(5):547–56.PubMedCrossRef
34.
35.
Kuhnt J, Vollmer S. Antenatal care services and its implications for vital and health outcomes of children: evidence from 193 surveys in 69 low-income and middle-income countries. BMJ Open. 2017;7(11):e017122.PubMedPubMedCentralCrossRef
36.
World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: methods and development. Geneva; 2006.
37.
38.
Croft, Trevor N, Aileen MJ, Marshall CK, Allen, et al. Guide to DHS statistics. Maryland, USA: ICF.: Rockville; 2018.
39.
Osaki K, Hattori T, Kosen S. The role of home-based records in the establishment of a continuum of care for mothers, newborns, and children in Indonesia. Glob Health Action. 2013;6:1–12.PubMedCrossRef
40.
Yeji F, Shibanuma A, Oduro A, Debpuur C, Kikuchi K, Owusu-Agei S, et al. Continuum of Care in a maternal, Newborn and Child Health Program in Ghana: low completion rate and multiple obstacle factors. PLoS ONE. 2015;10(12):e0142849.PubMedPubMedCentralCrossRef
41.
Iqbal S, Maqsood S, Zakar R, Zakar MZ, Fischer F. Continuum of care in maternal, newborn and child health in Pakistan: analysis of trends and determinants from 2006 to 2012. BMC Health Serv Res. 2017;17(1):1–15.CrossRef
42.
Sakuma S, Yasuoka J, Phongluxa K, Jimba M. Determinants of continuum of care for maternal, newborn, and child health services in rural Khammouane, Lao PDR. PLoS ONE. 2019;14(4):e0215635.PubMedPubMedCentralCrossRef
43.
Kikuchi K, Gyapong M, Shibanuma A, Asah E, Okawa S, Addei S, et al. EMBRACE intervention to improve the continuum of care in maternal and newborn health in Ghana: the RE-AIM framework-based evaluation. J Glob Health. 2021;11:04017.PubMedPubMedCentralCrossRef
44.
Kothavale A, Meher T. Level of completion along continuum of care for maternal, newborn and child health services and factors associated with it among women in India: a population-based cross-sectional study. BMC Pregnancy Childbirth. 2021;21(1):731.PubMedPubMedCentralCrossRef
45.
Rammohan A, Mavisakalyan A, Vu L, Goli S. Exposure to conflicts and the continuum of maternal healthcare: analyses of pooled cross-sectional data for 452,192 women across 49 countries and 82 surveys. PLoS Med. 2021;18(9):e1003690.PubMedPubMedCentralCrossRef
46.
Shibanuma A, Ansah EK, Kikuchi K, Yeji F, Okawa S, Tawiah C, et al. Evaluation of a package of continuum of care interventions for improved maternal, newborn, and child health outcomes and service coverage in Ghana: a cluster-randomized trial. PLoS Med. 2021;18(6):e1003663.PubMedPubMedCentralCrossRef
47.
James K, Mishra US, Pallikadavath S. Sequential impact of components of maternal and child health care services on the continuum of care in India. J Biosoc Sci. 2022;54(3):450–72.
48.
Seidu AA, Ahinkorah BO, Aboagye RG, Okyere J, Budu E, Yaya S. Continuum of care for maternal, newborn, and child health in 17 sub-saharan African countries. BMC Health Serv Res. 2022;22(1):1394.PubMedPubMedCentralCrossRef
49.
World Health Organization. (2002). WHO antenatal care randomized trial: manual for the implementation of the new model. World Health Organization.
50.
Enos JY, Amoako RD, Doku IK, Utilization. Predictors and gaps in the Continuum of Care for Maternal and Newborn Health in Ghana. Int J MCH AIDS. 2021;10(1):98–108.PubMedPubMedCentralCrossRef
51.
Humbwavali JB, Giugliani C, Duncan BB, Harzheim E, Lavor AC, Lavor MC, et al. Health and health care of mothers and children in a suburban area of Luanda, Angola. J Community Health. 2014;39(3):617–26.PubMedCrossRef
52.
53.
Boah M, Mahama AB, Ayamga EA. They receive antenatal care in health facilities, yet do not deliver there: predictors of health facility delivery by women in rural Ghana. BMC Pregnancy Childbirth. 2018;18(1):1–10.CrossRef
54.
55.
World health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva; 2016.
56.
Oliveira MF, Martinez EZ, Rocha JS. Factors associated with vaccination coverage in children < 5 years in Angola. Rev Saude Publica. 2014;48(6):906–15.PubMedPubMedCentralCrossRef
57.
Brown DW, Tabu C, Sergon K, Shendale S, Mugoya I, Machekanyanga Z, et al. Home-based record (HBR) ownership and use of HBR recording fields in selected Kenyan communities: results from the Kenya missed opportunities for Vaccination Assessment. PLoS ONE. 2018;13(8):e0201538.PubMedPubMedCentralCrossRef
Metadata
Title
Continuum of care for maternal and child health and child undernutrition in Angola
Authors
Akiko Saito
Masahide Kondo
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-024-18144-2

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