Women's progression through the maternal continuum of care in Guinea: Evidence from the 2018 Guinean Demographic and Health Survey

Objective: To examine women's progression through the antenatal, birth, and post-partum maternal care in Guinea in 2018.

Methods: Using the Guinea Demographic and Health Survey of 2018, we analysed data on most recent live births in the 24 months preceding the survey among women aged 15-49 and the determinants (health system, quality of care, reproductive and sociodemographic factors) of women's progression through three steps of the continuum of care, using multivariable logistic regression.

Results: In the sample of 3,018 women, 87% reported at least one ANC visit (ANC1) with a health professional and 36% reported ANC4+, at least one of which was with a health professional. In the study, 26% of women reported ANC4+ plus birth in a health facility, and 20% reported ANC4+, birth in a health facility, plus post-partum check-up. Predictors of woman's progression from ANC1 to ANC4+ visits included living in the administrative regions of Kindia (AOR: 1.96, 95% CI: 1.23-3.14) and Nzérékoré (AOR: 0.50, 95% CI: 0.32-0.79) vs. Kankan, being aged 15 to 17 (AOR: 0.55, 95% CI: 0.35-0.86) vs. aged 25 to 34, having primary or more education (AOR: 1.37, 95% CI: 1.09-1.72), and being from a middle (AOR: 1.52, 95% CI: 1.18-1.96) or wealthier (AOR: 2.38, 95% CI: 1.67-3.39) household vs. a poor household. Living in the administrative regions of Nzérékoré (AOR: 6.27, 95% CI: 1.57-25.05) vs. Kankan, in a middle (AOR: 1.64, 95% CI: 1.05-2.57) or wealthier (AOR: 3.23, 95% CI: 1.98-5.29) household vs. a poor household, nulliparity (AOR: 1.75, 95% CI: 1.03-2.97) vs. 2-4 previous births, the distance to health facility perceived as not being a problem (AOR: 1.75, 95% CI: 1.23-2.50), and higher ANC content score (AOR: 1.29, 95% CI: 1.10-1.52) remained independently associated with progression from ANC4+ to birth in a health facility. Predictors of progression from birth in the health facility to post-partum check-up included residing in the administrative regions of Labé (AOR: 0.22, 95% CI: 0.09-0.51) or Faranah (AOR: 0.43, 95% CI: 0.19-0.96) vs. Kankan, higher ANC content score (AOR: 1.76, 95% CI: 1.36-2.28), skin-to-skin contact after birth (AOR: 3.00, 95% CI: 1.70-5.31), and being attended at birth by a health professional (AOR: 17.52, 95% CI: 4.68-65.54).

Conclusions: Removing financial barriers and improving quality of care appear to be important to increase the percentage of women receiving the full maternal continuum of care.