A causal model of the continuum of care for maternal, newborn, and child health in Myanmar: a structural equation modeling approach

Abstract

Background: Incredible drop in global maternal mortality ratio (MMR) and neonatal mortality rate (NMR) is still far from sustainable development goals (SDGs) targets. Applying the continuum of care (CoC) concept reduces mother and newborn deaths. We determined the influencing factors of the continuity of maternal, newborn, and child health care (MNCH) services from pregnancy to child immunization with structural equation modeling (SEM) to continuously improve health outcomes and MNCH service utilization.Methods: We included 1,669 pair samples of mothers and their children under 24 months from (2015-2016) Myanmar demographic health survey (MDHS) data. We used STATA software (version 14) for all analyses. We evaluated the relationships between four latent independent constructs-characteristics of the individual, household, socio-economic, and child and four latent dependent constructs of CoC components- utilization of antenatal care (ANC), delivery, postnatal care (PNC), and vaccination programs using SEM approach.Results: Adequate utilization of ANC, delivery, PNC, and child immunization along the MNCH pathway were 19.7%, 44.8%, 21.8%, and 30.6%, respectively. SEM analysis shows that socio-economic status influences all CoC care components. Moreover, the receiving ANC favors the utilization of subsequent components of delivery, PNC, and vaccination. However, receiving delivery care favors only PNC utilization but not childhood vaccination. In addition, PNC utilization does not affect childhood vaccination.Conclusions: The quality and coverage of ANC is the most crucial factor in establishing the care continuum of MNCH services in Myanmar. The overall socio-economic development of the nation will alleviate the inequity in health access.