Occupational Types and Antenatal Care Attendance Among Women in Ghana

Factors influencing maternal healthcare utilization in Papua New Guinea: Andersen's behaviour model

BACKGROUND

Papua New Guinea (PNG) has recorded the highest maternal mortality ratio in the Western Pacific Region and faces major challenges in achieving SDG 3. Antenatal care (ANC), skilled birth attendant (SBA) and postnatal care (PNC) services are critical components of maternal healthcare services (MHS) for reducing maternal mortality and promoting maternal health in PNG. The study sought to assess the prevalence and determinants of ANC, SBA and PNC services amongst women in PNG.

METHODS

The study was conducted using the 2016-2018 Papua New Guinea Demographic and Health Survey. A total of 5248 reproductive-age women were considered as the analytical sample. The outcome variables were utilisation of ANC, SBA and PNC services. Chi-square test, multivariable logistic regression and dominance analysis were conducted. Statistical significance was set at p < 0.05.

RESULTS

The prevalence rates of ANC, SBA and PNC services were 52.3%, 58.7% and 26.6%, respectively. Women's employment, education, media exposure, distance to health facility, household wealth, region, residence and parity were determinants of MHS utilisation. ANC, SBA and PNC services utilisation were all primarily influenced by enabling factors, followed by predisposing and need factors.

CONCLUSIONS

This study demonstrated that enabling factors such as media exposure, distance to health facility, household wealth, region and residence have the greatest impact on MHS utilisation, followed by predisposing (working, education) and need factors (parity). Therefore, enabling factors should be prioritised when developing maternal health programmes and policies. For example, transport and health infrastructure should be strengthened and women's education and vocational training should be increased, especially in Highlands region, Momase region and rural areas, to increase the utilisation of MHS.

Type of occupation and early antenatal care visit among women in sub-Saharan Africa

Background

Type of occupation has been linked to early antenatal care visits whereby women in different occupation categories tend to have different timing for antenatal care visits. Different occupations require varying levels of commitment, remuneration and energy requirements. This study, therefore, sought to investigate the association between the type of occupation and early antenatal care visits in sub-Saharan Africa.

Methods

This is a secondary analysis of Demographic and Health Survey data from 29 countries in sub-Saharan Africa conducted between 2010 and 2018. The study included 131,912 working women. We employed binary logistic regression models to assess the association between type of occupation and timely initiation of antenatal care visits.

Results

The overall prevalence of early initiation of antenatal care visits was 39.9%. Early antenatal care visit was high in Liberia (70.1%) but low in DR Congo (18.6%). We noted that compared to managerial workers, women in all other work categories had lower odds of early antenatal care visit and this was prominent among agricultural workers [aOR = 0.74, CI = 0.69, 0.79]. Women from Liberia [aOR = 3.14, CI = 2.84, 3.48] and Senegal [aOR = 2.55, CI = 2.31, 2.81] had higher tendency of early antenatal care visits compared with those from Angola.

Conclusion

The findings bring to bear some essential elements worth considering to enhance early antenatal care visits within sub-Saharan Africa irrespective of the type of occupation. Women in the agricultural industry need much attention in order to bridge the early antenatal care visit gap between them and workers of other sectors. A critical review of the maternal health service delivery in DR Congo is needed considering the low rate of early antenatal care visits.

A multinomial regression analysis of factors associated with antenatal care attendance among women in Papua New Guinea

Objectives

This study sought to assess the prevalence and factors associated with antenatal care (ANC) uptake among women in Papua New Guinea.

Study design

This is a secondary data analysis of a nationally representative population based cross-sectional survey of households in Papua New Guinea conducted from 2016 to 2018.

Methods

Descriptive statistics in the form of frequencies and percentages and multinomial logistic regression analysis were done to assess the factors associated with ANC uptake and statistical significance was set at p<0.05.

Results

The prevalence of 4 or more ANC visits was 51.4%. The multinomial logistic regression analysis showed that women aged 35–39 [ARRR = 1.630, 95% CI = 1.016,2.615], those in the richest wealth quintile [2.361, 95% CI = 1.595,3.496], women who had secondary/higher level of education [ARRR = 3.644, 95% CI = 2.614,5.079], and those whose partners had secondary/higher education [ARRR = 1.706, 95% CI = 1.310,2.223] were more likely to attain 4 or more ANC visits. The likelihood of 4 or more ANC visits increased among women in Momase region [ARRR = 3.574, 95% CI = 2.683,4.762], those with parity 1 [ARRR = 2.065, 95% CI = 1.513,2.816], women who did not have a big problem with permission to go to the hospital for care [ARRR = 1.331, 95% CI = 1.110,1.597] and distance to health facility [ARRR = 1.970, 95% CI = 1.578,2.458]. However, women who were not working [ARRR = 0.756, 95% CI = 0.630,0.906], those in rural areas [ARRR = 0.712, 95% CI = 0.517,0.980] and those who do not take healthcare decisions alone [ARRR = 0.824, 95% CI = 0.683,0.994] were less likely to attain 4 or more ANC visits.

Conclusion

It was found that 51.4% of women have attained 4 or more ANC visits. Age, wealth status, employment, maternal and partner’s education, region and place of residence, parity, exposure to mass media, problem with distance and getting money needed for treatment and decision making on healthcare are associated with 4 or more ANC uptake among women in Papua New Guinea. To promote optimal number of ANC visits, there is the need for a multi-sectorial collaboration. For example, the various ministries such as the Ministry of Labour/Employment, Education, Development, Women affairs and Finance could collaborate with the Ministry of Health to achieve universal ANC coverage.

Factors associated with early antenatal care attendance among women in Papua New Guinea: a population-based cross-sectional study

BACKGROUND

Early initiation of antenatal care (ANC) is a key component of antenatal care, as suggested by the World Health Organisation (WHO). It helps in early identification and mitigation of adverse pregnancy-related complications. Despite this, a greater proportion of women worldwide still do not adhere to this recommendation. This study, therefore, sought to assess the prevalence and factors associated with early initiation of ANC among women in Papua New Guinea (PNG).

METHODS

A population-based cross-sectional study was conducted among 4,274 women using data from the 2016-2018 PNG Demographic and Health Survey (PDHS). The outcome variable was early initiation of ANC. Bivariate (chi-square) and multivariable logistic regression analyses were done and statistical significance was set at p < 0.05.

RESULTS

The prevalence of early ANC initiation was 23.0 % (CI = 20.8-24.6). The binary logistic regression analysis showed that working women had higher odds of early ANC attendance compared with those who were not working [AOR = 1.37, 95 %CI = 1.17 = 1.60]. The results also showed that women from Islands region had lower odds [AOR = 0.50, 95 %CI = 0.40-0.62] of early ANC attendance compared with those from Southern region. Finally, women with parity 3 had lower odds of early ANC attendance compared to those with parity 1[AOR = 0.64,95 % CI = 0.49-0.84].

CONCLUSIONS

This study found a relatively low prevalence of early ANC uptake among women in PNG. The factors associated with early ANC attendance were region of residence, parity, and working status of mothers. To increase early ANC uptake, these factors should be considered when designing new policies or reviewing policies and strategies on ANC uptake to help increase ANC attendance, which can help in the reduction of maternal mortality.

Understanding unmet health-care need among older Ghanaians: a gendered analysis

Health insurance schemes are important for bridging gaps in health-care needs between the rich and poor, especially in contexts where poverty is higher among seniors (persons aged 65 years and above). In this study we examined (a) gender-based predictors of unmet health-care need among seniors and (b) whether access was influenced by wealth status (measured by income quintiles). Gender-specific negative log–log regression models were fitted to data from the Study on Global Ageing and Health to examine associations between unmet health-care need and health insurance status controlling for theoretically relevant covariates. Insurance status was an important determinant of men and women's unmet health-care need but the relationship was moderated by income quintile for women and not men. While occupation was important for men, religion, marital status and income quintile were significantly associated with women's unmet health-care need. Based on the observed gender differences, we recommend the implementation of programmes aimed at improving the economic situation of older people, particularly women.

The effects of individual and community-level factors on maternal health outcomes in Ghana

Background

Utilization of maternal health care services is key to reducing the number of perinatal deaths and post-natal complications in sub-Saharan Africa. With a few exceptions, many studies that examine the use of maternal health services in sub-Saharan Africa have focused largely on individual-level explanations and have ignored the importance of contextual and community-level explanations. In Ghana, progress has been made in reducing maternal mortality ratio from 740/100,000 in the late 1990s to 319/100,000 in 2015 but these rates are still high. Our study focuses on impact of individual and community level-factors on maternal outcomes with the hope that it will inform public policy in Ghana. This approach highlights latent or unacknowledged aspects of fragility within health systems designed to improve maternal health and opportunities for improving uptake of services.

Methods and findings

Using the 2014 Ghana Demographic and Health Survey, we examined the effects of individual and community-level factors on antenatal care, facility-based delivery, and post-natal care. Multilevel logistic regression models were used to examine the effects of individual and community-level factors on the outcome variables. Our analysis revealed that overall utilization of antenatal, facility-based delivery and post-natal care was substantial across the board; however, both individual and community-level factors were significant predictors of these maternal health outcomes. Wealthier and better educated women were more likely to use antenatal services and facility-based delivery; in contrast poor and uneducated women were more likely to use antenatal and postnatal care but not facility-based delivery. Additionally, use of National Health Insurance Scheme was statistically associated with the utilization of maternal health services.

Conclusions

The findings point to areas where services can be better tailored to meet community-specific needs. Policy makers must consider factors such as educational levels and economic security at both individual and community-levels that shape women’s preferences and uptake of maternal health care in Ghana.

Associations of government health expenditures, the supply of health care professionals, and country literacy with prenatal care use in ten West African countries

Social and health care context may influence prenatal care use. We studied associations of government health expenditures, supply of health care professionals, and country literacy rates with prenatal care use in ten West African countries, controlling for individual factors. We used data from Demographic and Health Surveys (n = 58,512) and random effect logistic regression models to estimate the likelihood of having any prenatal care and adequate prenatal care. Each percentage increase in the literacy rate was associated with 4% higher odds of having adequate prenatal care (p = .029). Higher literacy rates among women may help to promote adequate prenatal care.

EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA

Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines.

Examining the Risk Factors Associated With Hypertension Among the Elderly in Ghana

OBJECTIVE

This study sought to examine the risk factors associated with hypertension among the elderly in Ghana. We focused on the association between chronic diseases, socioeconomic factors, and being hypertensive.

METHOD

Data for the study were drawn from Wave 1 of the 2007/2008 Ghana Study on Global Ageing and Adult Health (SAGE). A binary logit model was used to estimate the effect of other noncommunicable diseases, psychosocial factors, lifestyle factors, and sociocultural and biosocial factors on the elderly being hypertensive.

RESULTS

Elderly Ghanaians who had been diagnosed with arthritis, angina, diabetes, and asthma were significantly more likely to be hypertensive. Additionally, those depressed were found to be 1.22 times more likely to be hypertensive.

DISCUSSION

Prevention and control of hypertension are complex and demand multistakeholder collaboration including governments, educational institutions, media, food and beverage industry, and a conscious focus on personal lifestyle factors.