ArticleBMJ open2022
What prevents pregnant women from adhering to the continuum of maternal care? Evidence on interrelated mechanisms from a cohort study in Kenya.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 1 of them a synthesis that pooled it.
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Who cites it
14 citing papers in PubMed, 1 synthesis or guideline pooled it.
- The continuum of care for maternal health in Africa: A systematic review and meta-analysis.PloS one · 2024Pooled it
- The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial.Health policy and planning · 2024Trial
- Maternal, newborn, and child health continuum of care: completion and associated factors in Xiengkhuang and Huaphanh, Lao PDR.Tropical medicine and health · 2026Article
- Long-Acting Injectable Cabotegravir/Rilpivirine as a Second-Line ART Regimen for Pregnant and Breastfeeding Women in Kenya: Modeling the Potential Impact on Vertical Transmission.Open forum infectious diseases · 2026Article
- "We sometimes stress our own wives": perspectives on maternal mental health and emotional support among mothers, fathers, nurses, and community health workers in Western Kenya.BMC pregnancy and childbirth · 2026Article
- Modeling the Potential Impact of Mentor Mother Programs on Vertical Transmission of HIV in Kenya.Open forum infectious diseases · 2025Article
- Modeling the potential impact of viral load monitoring on vertical transmission of HIV in Kenya.AIDS (London, England) · 2025Article
- Key barriers to the provision and utilization of maternal health services in low-and lower-middle-income countries; a scoping review.BMC women's health · 2024Article
- Spatial accessibility to health facilities among pregnant women with and without exposure to intimate partner violence in Uganda.BMC pregnancy and childbirth · 2023Article
- Prevalence and risk factors for delayed antenatal care visits in Rwanda: an analysis of secondary data from Rwanda demographic health survey 2019-2020.The Pan African medical journal · 2023Article
- Maintaining Continuity of Care for Expectant Mothers in Kenya During the COVID-19 Pandemic: A Study of MomCare.Global health, science and practice · 2022Article
- Digital health systems strengthening in Africa for rapid response to COVID-19.Frontiers in health services · 2022Article
- Implementing value-based healthcare using a digital health exchange platform to improve pregnancy and childbirth outcomes in urban and rural Kenya.Frontiers in public health · 2022Article
- Examining the Effect of Maternity Cash Incentives Under Nepal's Aama Program on the Continuum of Maternity Care: A Difference-in-Differences Analysis of NDHS 2011 to 2022.Inquiry : a journal of medical care organization, provision and financingArticle
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Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo examine the determinants of the continuum of maternal care from an integrated perspective, focusing on how key components of an adequate journey are interrelated.
designA facility-based prospective cohort study.
setting25 health facilities across three counties of Kenya: Nairobi, Kisumu and Kakamega.
participantsA total of 5 879 low-income pregnant women aged 13-49 years. OUTCOME MEASURES: Ordinary least squares, Poisson and logistic regression models were employed, to predict three key determinants of the continuum of maternal care: (i) the week of enrolment at the clinic for antenatal care (ANC), (ii) the total number of ANC visits and (iii) utilisation of skilled birth attendance (SBA). The interrelationship between the three outcome variables was assessed with structural equation modeling.
resultsEach week of delayed enrolment in ANC reduced the number of ANC visits by 3% (incidence rate ratio=0.967, 95% CI 0.965 to 0.969). A higher number of ANC visits increased the relative probability of using SBA (odds ratio=1.28, 95% CI 1.22 to 1.34). The direct association between late enrolment and SBA was positive (odds ratio=1.033, 95% CI 1.02 to 1.04). Predisposing factors (age, household head's education), enabling factors (wealth, shorter distance, rural area) and need factors (risk level of pregnancy, multigravida) were positively associated with adherence to ANC.
conclusionThe results point towards a domino-effect and underscore the importance of enhancing the full continuum of maternal care. A larger number of ANC visits increases SBA, while early initiation of the care journey increases the number of ANC visits, thereby indirectly supporting SBA as well. These beneficial pathways counteract the direct link between enrolment and SBA, which is partly driven by pregnant teenagers who both enrol late and are at heightened risk of complications, stressing the need for specific attention to this vulnerable population.
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