The relationship between antenatal provider type and maternal care in rural Ghana: a cross-sectional study

Skilled antenatal care services utilisation in sub-Saharan Africa: a pooled analysis of demographic and health surveys from 32 countries

Background

Each day, an estimated 800 women die from preventable pregnancy and childbirth related complications, where 99% of these avoidable deaths happen in low-and middle-income countries. Skilled attendance during antenatal care (ANC) plays a role in reducing maternal and child mortality. However, the factors that predict the utilisation of skilled ANC services in sub-Saharan Africa (SSA) remains sparsely investigated. Therefore, we examined women’s utilisation of skilled ANC services in SSA.

Methods

The research used pooled data from the most recent Demographic and Health Surveys conducted in 32 countries in SSA between January 1, 2010, and December 31, 2019. Binary logistic regression was used to examine the predictors of skilled ANC services utilisation. The results are presented as crude and adjusted odds ratios (aOR) with 95% confidence interval (CI).

Results

The prevalence of skilled ANC services utilisation in SSA was 76.0%, with the highest and lowest prevalence in Gambia (99.2%) and Burundi (8.4%), respectively. Lower odds of ANC from skilled providers was found among women aged 45–49 compared to those aged 20–24 (aOR = 0.86, CI = 0.79–0.94); widowed women compared to married women (aOR = 0.84, CI = 0.72–0.99); women who consider getting permission to visit the health facility as a big problem compared to those who consider that as not a big problem (aOR = 0.74, CI = 0.71–0.77); women who consider getting money needed for treatment as not a big problem compared to those who consider that as a big problem (aOR = 0.84, CI = 0.72–0.99); and women who consider distance to the health facility as a big problem compared to those who consider that as not a big problem (aOR = 0.75, CI = 0.72–0.77).

Conclusion

SSA has relatively high prevalence of skilled ANC services utilisation, however, there are substantial country-level disparities that need to be prioritised. Increasing maternal reproductive age being widowed and far distance to health facility were factors that predicted lower likelihood of skilled ANC services utilisation. There is, therefore, the need to intensify female formal education, invest in community-based healthcare facilities in rural areas and leverage on the media in advocating for skilled ANC services utilisation.

Determinants of choice of skilled antenatal care service providers in Ghana: analysis of demographic and health survey

BACKGROUND

The International Safe Motherhood initiative provides a focus for programmes and research to improve maternal health in low - income countries. Antenatal care is one of the key pillars of the initiative. This study sought to examine the association between background characteristics and choice of skilled providers of antenatal care services in Ghana.

METHODS

The study used data from the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to analyse the data.

RESULTS

Results show that the proportion of women who received antenatal care (ANC) services from skilled providers improved over the period. Also, women with secondary education (OR = 1.42, CI = 1.07-1.88), richest wealth status (OR = 5.10, CI = 2.28-11.85) were more likely to utilise antenatal care services from skilled providers. Whereas women from rural areas (OR = 0.55, CI = 0.41-0.74), with four births or more (OR = 0.55, CI = 0.36-0.85) and from the northern ethnic group were less likely to utilise antenatal care services from skilled providers.

CONCLUSION

Choice of skilled providers of antenatal care services were predicted by some predisposing factors including education, ethnicity, and ecological zone. Also enabling factors such as wealth status, residence and the need for care factor, parity predicted choice of skilled providers of antenatal care services. Women with secondary or higher education, those within richer and richest wealth status, those from forest zone are more likely to utilise the services of skilled providers during their antenatal care visits. Whereas women from rural areas, those with four births or more and those with the northern ethnic group were more likely to utilise ANC service from unskilled providers. The Ghana Health Service and Ministry of Health should encourage women in rural areas to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Providers of antenatal care services in Ghana: evidence from Ghana demographic and health surveys 1988-2014

Background

Antenatal care is one of the three most essential care - antenatal, delivery and post-natal, given to women during pregnancy and has the potential to contribute towards the achievement of the Sustainable Development Goal (SDG) target 3.1- reducing the global maternal mortality ratio to less than 70 per 100,000 and target 3.8 – achieve universal health coverage. The main objective is to examine the contribution of the various providers of antenatal care services in Ghana from 1988 to 2014.

Methods

The study uses data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Binary logistic regression models were applied to examine the association between background characteristics of respondents and providers of antenatal care services.

Results

The results show that majority of antenatal care services were provided by nurses over the period under review. The proportion of women who received antenatal care services from nurses improved over the period from 55% in 1988 to 89.5% in 2014. Moreover, there was a decline in antenatal care services provided by traditional birth attendants and women who did not receive antenatal care services from any service provider over the years under review. It was observed that women from rural areas were more likely to utilise antenatal care services provided by traditional birth attendants, whilst those from urban areas were more likely to utilise antenatal care from doctors and nurses.

Conclusion

To further improve access to and utilisation of antenatal care services provided by nurses and doctors it is recommended that the Ghana Health Service and the Ministry of Health should put in place systems aimed at improving on the quality of care given such as regular training workshops for health personnel and assessment of patient’s satisfaction with services provided. Also, they should encourage women in rural areas especially those from the savannah zone to utilise antenatal care services from skilled providers through social and behaviour change communication campaigns.

Public health facility resource availability and provider adherence to first antenatal guidelines in a low resource setting in Accra, Ghana

Background

Lack of resources has been identified as a reason for non-adherence to clinical guidelines. Our aim was to describe public health facility resource availability in relation to provider adherence to first antenatal visit guidelines.

Methods

A cross-sectional analysis of the baseline data of a prospective cohort study on adherence to first antenatal care visit guidelines was carried out in 11 facilities in the Greater Accra Region of Ghana. Provider adherence was studied in relation to health facility resource availability such as antenatal workload for clinical staffs, routine antenatal drugs, laboratory testing, protocols, ambulance and equipment.

Results

Eleven facilities comprising 6 hospitals (54.5 %), 4 polyclinics (36.4 %) and 1 health center were randomly sampled. Complete provider adherence to first antenatal guidelines for all the 946 participants was 48.1 % (95 % CI: 41.8–54.2 %), varying significantly amongst the types of facilities, with highest rate in the polyclinics. Average antenatal workload per month per clinical staff member was higher in polyclinics compared to the hospitals. All facility laboratories were able to conduct routine antenatal tests. Most routine antenatal drugs were available in all facilities except magnesium sulphate and sulphadoxine-pyrimethamine which were lacking in some. Antenatal service protocols and equipment were also available in all facilities.

Conclusion

Although antenatal workload varies across different facility types in the Greater Accra region, other health facility resources that support implementation of first antenatal care guidelines are equally available in all the facilities. These factors therefore do not adequately account for the low and varying proportions of complete adherence to guidelines across facility types. Providers should be continually engaged for a better understanding of the barriers to their adherence to these guidelines.

Focused maternity care in Ghana: results of a cluster analysis

BACKGROUND

Ghana missed out in attaining Millennium Development Goal 5 in 2015. The provision of adequate prenatal and postnatal care remains problematic, with poor evidence on women's views on met and unmet maternity care needs across all regions in Ghana. This paper examines maternal care utilization in Ghana by applying WHO indicators for focused maternal care utilization.

METHODS

Two-step cluster analysis segregated women into groups based on the components of the maternity care used. Using cluster membership variables as dependent variables, we applied multinomial and binary regression to examine associations of care use with individual, household and regional characteristics.

RESULTS

We identified three patterns of care use: adequate, less and least adquate care. The presence of a female and skilled provider is an indicator of adequate care. Women in Volta, Upper West, Northern and Western regions received less adequate care compared with other regions. Supply-related factors (drugs availability, distance/transport, health insurance ownership, rural residence) were associated with adequacy of care. The lack of female autonomy, widowed/divorced women, age and parity were associated with less adequate care. Care patterns were distinctively associated with the quality of health care support (skilled and female attendant) instead of with the number of visits made to the facility. Across regions and within rural settings, disparities exist, often compounded by supply-related factors.

CONCLUSIONS

Efforts to address skilled workforce shortages, greater accountability for quality and equity, improving women motivation for care seeking and active participation are important for maternity care in Ghana.

HIV status, knowledge of mother-to-child transmission of HIV and antenatal care use among Ethiopian women

Objective: To determine whether HIV status and knowledge of mother-to-child-transmission (MTCT) of HIV are associated with antenatal care (ANC) use.

Methods: Data were obtained from the 2011 Ethiopia Demographic and Health Survey among women aged 15–49 years who agreed to HIV testing and who reported giving birth in the preceding five years. The two exposures of interest were HIV status and knowledge of MTCT. Unadjusted and adjusted prevalence ratios for ANC use were estimated by fitting modified Poisson regression models.

Results: Among the 7392 women in the sample, ANC use was lowest among HIV-negative, low MTCT knowledge women (31.6% [95% confidence interval: 28.1–35.1]), and highest among HIV-positive, high knowledge women (81.9% [69.8–94.0%]). ANC use was significantly higher among HIV-positive, high knowledge (adjusted prevalence ratio [APR] = 1.60 [1.32–1.94]) and HIV-negative, high knowledge women (1.37 [1.24–1.51]) compared with HIV-negative, low knowledge women. There was no statistically significant difference in ANC use by HIV status among low knowledge women (1.26 [0.71–2.25]).

Conclusions: HIV-positive women generally had better MTCT knowledge. Among HIV-negative women, the prevalence of ANC use was greater among women with higher knowledge. Increasing MTCT knowledge may facilitate ANC use and in turn may eliminate MTCT.