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 Nzerekore (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 Nzerekore (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 Labe (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.