Maternal, newborn, and child health continuum of care: completion and associated factors in Xiengkhuang and Huaphanh, Lao PDR

BACKGROUND: Completing the full continuum of maternal, newborn, and child health (MNCH) care remains challenging in remote Lao PDR, which has among the highest maternal and neonatal mortality rates in Southeast Asia. Evidence on continuum of care (CoC) completion and its determinants is limited for Xiengkhuang and Huaphanh, two underserved provinces. METHODS: A community-based cross-sectional household survey was conducted in February 2023 using stratified three-stage cluster sampling across eight districts. Women aged 15-49 with a live birth in the preceding 24 months were enrolled (n = 380). The maternal and newborn health CoC (MNH CoC) required ≥ 4 antenatal care (ANC) visits, skilled birth attendance, postnatal care for mother and newborn, and postpartum family planning (n = 367). An extended MNCH CoC incorporating six childhood vaccines was assessed among women with a child aged 12-23 months (n = 152). Province-stratified multivariable logistic regression models with cluster-robust standard errors were fitted for MNH CoC; a pooled model was used for the extended continuum. RESULTS: Overall, 36.2% completed the MNH CoC and 22.4% completed the extended MNCH CoC. Completion was higher in Xiengkhuang than Huaphanh (MNH CoC: 49.7% vs. 22.2%; extended: 28.9% vs. 14.5%). In Xiengkhuang, Tai Folk or other religious affiliation (vs. Buddhist) was associated with lower MNH CoC completion (adjusted odds ratio [AOR] 0.10, 95% confidence interval [CI] 0.01-0.66). In Huaphanh, ethnic-minority status (AOR 0.17, 95% CI 0.03-0.96) and living 6-10 km (AOR 0.16, 95% CI 0.03-0.94) or > 10 km (AOR 0.13, 95% CI 0.02-0.83) from the nearest health facility were independently associated with lower completion. For the extended MNCH CoC, ANC initiation at ≥ 3 months was associated with lower completion (AOR 0.27, 95% CI 0.10-0.70). CONCLUSIONS: MNCH CoC completion was low and differed markedly by province, reflecting local socioeconomic and geographic disparities. Determinants varied by context, underscoring the need for province-tailored strategies. Across the extended continuum, late ANC initiation was a key barrier, highlighting first-trimester engagement as a programmatic priority. Addressing structural and socio-cultural barriers and strengthening linkage from delivery to postnatal and child health services are critical to improving continuity.