Abstract
BackgroundThe coverage for reproductive care continuum is a growing concern for communities in low- income economies. Adolescents (15–19 years) are often at higher odds of maternal morbidity and mortality due to other underlying factors including biological immaturity, social, and economic differences. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20–49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive care-seeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design.MethodsIn each country, communities in two districts/sub-districts received timed community health worker (CHW) household health promotion and social accountability interventions with community scorecards. Two matched districts/sub-districts were selected for comparison and received routine healthcare services.ResultsResults from the final evaluation showed that there were no significant differences in the care continuum for adolescents and adults except for Kenya (26.1% vs 18.8%, p<0.05). SBA was significantly higher for adolescents compared to adult women for Guatemala (64% vs 55.5%, p<0.05). Adolescents in the intervention sites showed significantly higher ANC utilization for Kenya (95.3% vs 84.8%, p<0.01) and Zambia (87% vs 72.7%, p<0.05), ANC4 for Cambodia (83.7% vs 43.2%, p<0.001) and Kenya (65.9% vs 48.1%, p<0.05), SBA for Cambodia (100% vs 88.9%, p<0.05), early PNC for Cambodia (91.8% vs 72.8%, p<0.01) and Zambia (56.5% vs 16.9%, p<0.001) compared to the comparison sites. However, the findings from Guatemala illustrated significantly lower care continuum for intervention sites (aOR:0.34, 95% CI 0.28–0.42, p<0.001). The study provides some evidence on the potential of multilevel community-oriented interventions to improve adolescent healthcare seeking in rural contexts. The predictors of care continuum varied across countries, indicating the importance of contextual factors in designing interventions.
Highlights
Pregnancy-complications and childbirth are the leading causes of death among adolescent girls, especially in low-and-middle-income economies where 95% of the world’s 16 million adolescent births occur every year [1, 2]
skilled birth attendance (SBA) was significantly higher for adolescents compared to adult women for Guatemala (64% vs 55.5%, p
To effectively address maternal and neonatal mortality, skilled birth attendance (SBA) and access to facilities that provide quality obstetric and newborn care is essential, yet 70% of births among women belonging to the lowest wealth quintiles in Sub-Saharan Africa, South East Asia, and South Asia occur at home [9]
Summary
Pregnancy-complications and childbirth are the leading causes of death among adolescent girls, especially in low-and-middle-income economies where 95% of the world’s 16 million adolescent births occur every year [1, 2]. A myriad of socioeconomic and environmental factors influences reproductive care-seeking practices in rural areas [6, 10,11,12,13] These range from geographical and financial access barriers, maternal education and employment, marital status, parity, wealth status, transportation, decision dynamics, and cultural practices. The aim of the study was to examine a) differences in care-seeking and continuum of care (4 antenatal care (ANC4+), skilled birth attendance (SBA) and postnatal care (PNC) within 24h) between adult (20–49 Years) and adolescents and b) the effect of multilevel community-oriented interventions on adolescent and adult reproductive careseeking in Cambodia, Guatemala, Kenya, and Zambia using a quasi-experimental study design. 1st 2nd 3rd 4th 5th Self-decisions about household purchase Self-decisions with or without partners on healthcare Access to mobile phone
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